Pediatric Annals

Guest Editorial Free

Youth Athletes and Sports Medicine: Part 1

Chris Koutures, MD, FAAP; Valarie Wong, MD, FAAP, CAQSM

Ask many pediatric providers to serve as part of a sports medicine team, and quite likely you will get a lack of perceived comfort with lamentations over insufficient specific training1 and experience.

However, ask those same providers to profess aptitude with injury prevention, discussing growth and development, and using risk-benefit analysis, and you will encounter a far more confident response.

The discipline of pediatric sports medicine deals not just with musculoskeletal care, but rather encompasses a host of medical and orthopedic concerns to optimize safe and lifelong participation in sports and activities. Pediatric health care providers' well-known general medical and anticipatory guidance skills absolutely make them a natural and trusted part of the sports medicine team.

The goal of this special two-part sports medicine issue of Pediatric Annals is to use illustrative sports medicine presentations to make the pediatric provider realize just how much they already know about important growth, development, and injury prevention components in sports medicine. The articles presented will also bridge particular gaps in musculoskeletal or activity-specific issues with evidence-based clinical recommendations that can readily be shared with young patients and their families.

The significance of injury prevention is highlighted in the outstanding article on shoulder injuries in young throwers authored by Dr. John A. Schlechter. He provides a thorough review of the pertinent anatomy and physical examination techniques used in the diagnosis of this type of overuse injury. However, the discussion on reducing risk, including rest periods and limitations on excessive amount and intensity of pitching, is of particular value to the office-based clinician. The ability to have regular encounters with young patients and their families allows enhanced opportunities for “teachable moments” to impart this information and to reduce likelihood of a future injury-related visit.

In their eloquent overview of the advanced skill of en pointe ballet dancing, Drs. Jeffrey C. Lai and David W. Kruse underscore the notion that an individualized review of physical and emotional development is the form of readiness assessment for beginning to dance en pointe. Readers will not only enjoy learning about the unique history and terms used in ballet that will enable them to better relate to their young dancers, but will also have greater confidence in looking at the “big picture” in providing expert recommendations about higher level dance participation.

Young athletes commonly present to the pediatric provider to obtain a medical and musculoskeletal preparticipation evaluation (PPE) which, in part, attempts to identify those who are possibly at higher risk for serious health consequences during exercise. Drs. Kelly Chain and Andrew Gregory provide a thoughtful review of evidence both in favor of and against routine incorporation of an electrocardiogram (EKG) as part of the PPE to reduce the risk of sudden cardiac death. They provide the pediatric provider with ample discussion points on currently known capabilities and limitations of the EKG to share with families in an effort to make informed decisions, while also making solid suggestions for future study and inquiry.

This issue is an extension of the textbook Pediatric Sports Medicine: Essentials for Office Evaluation,2 also published by SLACK Incorporated (the publisher of Pediatric Annals).

We are thankful for the work of our authors who all bring real-world experience to their articles by describing specialist-level evaluation and management concepts in a way that can be readily translated to all pediatric clinic and visit settings. We trust that these articles will increase the reader's comfort in advocating for active young patients and their families.


  1. Demorest RE, Bernhardt DT, Best TE, Landry GL. Pediatric residency education: is sports medicine getting its fair share?Pediatrics. 2005;115:28–35.
  2. Koutures CG, Wong VYM (editors). Pediatric Sports Medicine: Essentials for Office Evaluation. Thorofare, NJ: SLACK Incorporated; 2013.

About the Guest Editors

Chris Koutures, MD, FAAP, is American Board of Pediatrics Certified in both General Pediatrics and Sports Medicine, and practices general pediatrics, sports medicine, and performing arts medicine in Anaheim Hills, CA.

He is the co-editor and co-author on several articles in the textbook Pediatric Sports Medicine: Essentials for Office Evaluation that was published by SLACK Incorporated in 2013. He also fulfilled a lifetime dream with his selection as a volunteer Olympic Team Physician for the USA Volleyball and Table Tennis teams at the 2008 Summer Games in Beijing, China. He has worked as a USA Volleyball National Team Physician since 2006 and is also the team physician for Cal State Fullerton.

He completed a 6-year term as an elected member of the American Academy of Pediatrics Executive Committee on Sports Medicine and Fitness, and currently edits the biannual newsletter for that group. He has authored many medical publications, and speaks regularly on sports medicine topics around the country. His interests include concussion management, overuse injuries, performing arts medicine, and injury prevention strategies/programs.

He regularly delivers sports medicine lectures and mentors residents at UC Irvine/Children's Hospital of Orange County. He is also the co-founder of the Orange County Concussion Consortium which brings together concussion providers from many disciplines for networking, referral, community and continuing education.

Address correspondence to Chris Koutures, MD, FAAP, via email:


Valarie Wong, MD, FAAP, CAQSM, is currently an Associate Physician with Kaiser Permanente in Fontana, CA.

Dr. Wong has established American Board of Pediatrics certification in both General Pediatrics and Sports Medicine. She was formerly an Assistant Professor for 12 years at Loma Linda University Healthcare Group in Southern California. Her practice consists of both sports medicine and general pediatric patients. She had participated in several concussion research studies while at Loma Linda University, including looking at magnetic resonance spectroscopy as an imaging tool for athletes who have prolonged concussion symptoms. She has been a member of the American Medical Society for Sports Medicine (AMSSM) Educational Committee, reviewing case abstracts for presentation at the annual meeting of AMSSM.

She is co-editor of and also co-author of several chapters in Pediatric Sports Medicine: Essentials for Office Evaluation, a book also published by SLACK Incorporated, which is filled with practical pearls for the busy pediatric practitioner and residents in training.

Dr. Wong completed her sports medicine fellowship at Jersey Shore Medical Center and Rutgers University. She received her medical degree from Baylor College of Medicine and finished her pediatric residency at the University of California, Los Angeles. She has been active on the lecture circuit, giving talks to medical students, residents, nursing, and physical therapy students. Dr. Wong has been the team physician for the Inland 66er's, a minor league baseball team in San Bernardino for 8 years. Dr. Wong also provides medical coverage for local community sports events.

Address correspondence to Valarie Wong, MD, FAAP, CAQSM, via email:


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