In the Spotlight: Kelly Davis, M.D.

A board-certified physician in pediatrics and sports medicine has recently joined the CHOC Children’s Orthopaedic Institute. Dr. Kelly Davis specializes in sports injuries, injury prevention, concussion management and advanced musculoskeletal ultrasound medicine for children, adolescents and young adults. Among the most common diagnoses she sees include overuse injuries and knee pain in athletes of all ages who play a variety of sports.

Her passion for helping young athletes comes from her own experience growing up playing sports. She played tennis, soccer, basketball, and also swam and water skied. She continues to play competitive tennis today and thanks her mom, a huge tennis enthusiast, for getting her into the sport.

“My mom played in college and has been my coach my whole life. I think what I love about tennis so much is that no matter your age or skill level, there is always someone you can play with and it is a great way to meet new people,” she says.

Dr. Davis completed her undergraduate studies at the University of California, San Diego, followed by medical school at Temple University School of Medicine, in Philadelphia. After graduation, she completed a pediatric residency at CHOC, and stayed an additional year to serve as chief resident. She completed a fellowship in pediatric primary care sports medicine at Vanderbilt University in Tennessee.

During her time at Vanderbilt University, she served as a team physician for a high school and for several collegiate teams including football, baseball, cross country, track and field, tennis and soccer. Additionally, she was a team physician for the Nashville Sounds, a minor league baseball team.

Today, she continues to have the same commitment and enthusiasm for her patients.

“These kids have a certain drive. They’re really motivated and fun to work with,” she explains. “I also know what it’s like to sustain an injury, put in the rehab work and come back to the sport you love.”

Her patient care philosophy is straightforward: She treats each patient and their family as she would want one of her own family members to be treated. As a recent, first-time mom, she has gained an added appreciation for her patients’ parents and their questions or concerns, she says.

“I’m available as a resource for our community providers as well,” Dr. Davis adds. “If they have any concerns or questions, they can reach out to me or a member of my team anytime.”

In her spare time, Dr. Davis loves spending time with her husband and their baby boy. She also enjoys playing soccer and tennis, hiking, camping and exploring the outdoors.

To contact Dr. Davis, please call 714-633-2111.

Learn more about the CHOC Children’s Orthopaedic Institute.

Return to Learn Concussion Guidelines Every Medical Provider Should Know

While most medical providers are familiar with Return to Play laws – a step-wise progression addressing when student athletes with concussions should return to sports/physical activity – there is no similar legal process for “Return to Learn” guidelines addressing when students with concussions should return to school.

Further, a study in the December 2016 Pediatrics found that only a few states have Return to Learn concussion laws, and these varied in delineation of responsibility. Some of the laws were restricted to student athletes, excluding students who sustained non-sport related concussions.

Dr. Chris Koutures, pediatrician and sports medicine specialist at CHOC Children’s.

When returning a student to the classroom after a concussion, we try to balance stimulation levels and worsening of symptoms, explains Dr. Chris Koutures, a board certified pediatrician and sports medicine specialist at CHOC Children’s.  While too much cognitive exertion can lead to headaches, problems concentrating, fatigue and trouble with emotional control, over restriction from classroom and academic activities can result in social isolation and anxiety about falling behind or lower grades that can also slow the recovery process.

“Returning to the classroom after a concussion optimally takes a team approach including the student, family, medical and education teams,” Dr. Koutures says. “Flexibility and creativity in paying attention to individual student needs and concerns can make this process more rewarding for all parties.”

Dr. Koutures advises the patient’s care team to follow CHOC’s recommended six stages for returning a student to school after a concussion, including the following added guidelines:

Step-wise Return to Learn Progression

Step 1: No formal academic activity

  • Recent studies suggest that full or prolonged limitations in cognitive activity may actually delay recovery
  • In first few days after concussion, allow 15-20 minute intervals of single-task activities that do not provoke symptoms and are not excessively taxing
    • Listen to light music
    • Draw or color
    • Journal writing
    • Audiobooks
    • Passive television or movies (at home), larger screen preferred, lower volume
    • Some texting, smartphone use; want to balance maintaining key social contacts with not having symptom-flare
    • Conversations with 1-2 other people
  • Separate the 15-20 minute bursts of activity by 30-40 minutes minimum of non-cognitive activity
  • If symptoms flare before 15-20 minute limit, stop activity and try again later
  • If patient can handle 2-3 periods of 15-20 minute activity over the course of day, can consider advancing toward partial return to school

Step 2: Light academic activity

  • Attend 1-2 periods or 1-2 hours of school
  • Select consecutive classes; have child help make decision
  • No physical education or other activity classes
    • Caution with more noisy classes such as woodshop, music/band, chorus
  • Tend to avoid first class in morning to allow more sleep and arrival at school without busy parking lot and hallways
  • Main goal: be in class; no responsibility for note-taking, participating in class /responding to teacher, in-class work, homework or testing
    • Audible learning (most kids handle this better than visual learning after a concussion)
    • Should have pre-printed notes for reference or have others take notes and share
  • Sit away from louder students, windows, projectors, or other light/noise stimulation
  • Sit close to teacher
  • Allow to wear earplugs and sunglasses as needed
  • May allow brief 1-2 minute periods of putting head on desk for rest
  • May leave class early to avoid the noise and commotion of hallways during passing periods

Step 3: Increased academic activity

  • Expand day to 3-4 periods or hours per day
  • Incorporate break periods (nutrition break, lunch)
    • Have quiet place to rest
  • Recommend against assemblies or rallies due to noise stimulation
  • Continue to avoid physical education or activity classes
  • Main goal is to be in class and handle longer day; still not responsible for note-taking, participating in class/responding to teacher, in-class work or homework

Step 4: Full-time attendance

  • Full-day attendance without activity or other higher-stimulation classes
  • May expect some increased fatigue at end of school day
    • If student wants to nap after school, limit to no more than one hour
  • May start to take own notes, though helpful to have pre-printed teacher’s notes or other student notes
  • Incorporate “to do” lists with short-block (10-15 minute) work periods followed by short (5 minute) breaks
  • Break period and breaks in class (especially if block schedule) may still be needed
  • If possible, move most challenging courses to time of day when student feels the best

Step 5: Return to Majority of Academic Activities

  • Once handling full day attendance, can resume taking notes in class, verbal responses to teacher, and in-class work
  • May begin homework starting with limits to 30-60 minutes a night and priority on essential concepts that are needed for eventual testing or continuity of learning
    • Waive any projects, papers, essays or other assignments that are not required for future learning needs
    • Try to limit burden of make-up work; focus should be on those assignments that are necessary for future learning
      • Sequential classes (math, foreign languages, science) tend to be the most challenging for make-up work
    • No tests or quizzes at this stage
    • Audible learning – listen/speak responses vs. writing, dictating work, audiobooks may be more favorable at this point

Step 6: Return to Full Academic Activity

  • Full-day attendance without symptoms, fulfilling all in-class duties and completing usual homework assignments
  • Can resume tests and quizzes
    • Strongly consider waiving missed tests or quizzes
    • Combine missed tests or quizzes to allow more quick completion of make-up work
    • Allow student to take missed tests/quizzes to gain exposure/mastery of material without being graded, or only receive grade if results are in usual level of achievement
    • Assign grades at end of grading period based on level of work prior to concussion
  • May need more time for test completion
  • May need individual room placement for testing
  • May limit testing/make-up testing to one test per day
  • May allow open book, use of notes, word banks or home-based testing
  • Consider alternate forms of testing such as spoken test, or multiple choice vs. longer essay responses that might be more taxing for the student
  • Students may still benefit from more audio learning
  • Can resume physical education (with physician release) and activity courses.

To contact Dr. Chris Koutures, please call 714-974-2220.

Learn more about CHOC’s concussion program.

Olympic Medalist Turned Physical Therapist

When athletes of any caliber come to physical therapy appointments, they often struggle with emotional hurdles as big as their physical challenges. Working with an expert who understands their struggles can make it easier to cope, especially when that expert is a former Olympian.

Robin Beauregard, a physical therapist at CHOC Children’s and two-time Olympic medalist in women’s water polo, understands the physical challenges that can sometimes stand in the way of achieving athletic goals.

“Having a career in athletics helps me establish a rapport with my patients, particularly my history with sustaining and overcoming injuries,” she says. “Sincere empathy creates a stronger bond than sympathy.”

Shortly before the team was named for the Sydney Olympics in 2000, the first time women’s water polo was to be recognized as an Olympic sport, Beauregard dislocated her knee and didn’t know if a recovery was possible. Distraught but determined, she committed fully to her physical therapy plan, as well as a rigorous conditioning program, and made the team. They’d win a silver medal that year, and a bronze four years later. She was later inducted into the USA Water Polo Hall of Fame.

Beauregard’s experience with physical therapy in the midst of her Olympic career ultimately played a big role in her professional career.

“I was not the perfect patient, but it prepared me for being a physical therapist because it gave me an idea of asking only what is reasonable of my teen and young adult patients,” she says. “I really do understand their worry of not being able to get back to the top level in their sport, but also weighing the risks of not wanting to cause further or permanent injury.”

Growing up in Southern California, Beauregard loved to be outdoors and was always active. Having an older brother who was also athletic made her competitive, too. She started swimming competitively for a local club team on her fourth birthday simply because her brother swam, and she wanted to be as a good as he was. Water polo came into play just four years later, and by age 8 she joined a competitive club team.

But when she got to high school, there was no girls’ varsity team. Instead of giving up on her passion, she simply joined the boys’ team instead. Playing with the boys didn’t faze her, or them, since they’d been competing together for almost a decade by that point. When opponents made comments about playing with a girl, she channeled it into her game and used it as fuel to play even harder.

After high school, she attended UCLA to play water polo, and originally planned on becoming an orthopedic surgeon. She later changed her path to physical therapy, which would ultimately give her a different kind of interaction with patients and athletes.

In the Spotlight: Jonathan Minor, M.D.

The newest addition to the CHOC Children’s Orthopaedic Institute team, Dr. Jonathan Minor brings a unique expertise in ultrasound-guided injections and procedures, as well as diagnostic ultrasound evaluations. As a non-surgical sports medicine physician, he has a special interest in sports and dance injuries, concussion management and advanced musculoskeletal ultrasound medicine.

CHOC Children's Orthopaedic Institute

Dr. Minor’s commitment to helping young athletes stems from his own experience growing up playing sports. As an adult, he has completed multiple marathons and Ironman triathlons, including three Long Course World Championship races with Team USA.

In addition to recognizing and treating acute injuries, Dr. Minor is dedicated to preventing overuse injuries. His research has been diverse: identifying running gait mechanics related to injuries, reporting of concussions, and evidence-based approaches to joint injections. He presented original work at the 2015 American Academy of Pediatrics National Conference showing concussion reporting among high school football players remains problematic, and is trying to shed light on risk factors that may influence reporting.

Dr. Minor’s passion for sports medicine and orthopaedics was inspired by his father, an accomplished orthopaedic surgeon.

“I was moved by my dad being able to take an injury, and just like a carpenter, put it back together,” Dr. Minor said. “As a non-surgeon, I consider myself more like an architect, laying out a floor plan, and bringing together a team of providers to safely return our athletes back to the sports arena. I recognize that often there are multiple ways to solve the same problem.”

Dr. Minor attended medical school at Texas A&M University System
Health Sciences Center, College of Medicine. He completed his residency training at McLane Children’s Hospital Scott & White, followed by a non-surgical sports medicine fellowship and an additional musculoskeletal ultrasound fellowship at Boston Children’s Hospital.

During his training in Boston, he served as team physician for several collegiate and high school teams, including Northeastern University men’s and women’s basketball and soccer teams.  He also worked closely with the Boston Ballet.

Dr. Jonathan Minor

A chance to work with the expert team at CHOC eventually led him back to his native California. He was drawn to the opportunity to help grow the program. The CHOC Orthopaedic Institute plans to expand the footprint of the sports medicine program, with the addition of physical therapists, new regional physical therapy locations, and integrating injury prevention with clinical practice. The department has also added Dr. Jessica McMichael, an orthopaedic surgeon, who will help to develop an osteogenesis imperfecta program at CHOC.

Dr. Minor has quickly become an integral part of the team, treating everything from ankle and knee ligament sprains, to overuse injuries and concussions. Through the use of ultrasound-guided injections, he provides bedside visualization of body tissues, which can confirm the location of pain and assist with surgical decision-making. Classically, injections are performed blindly, with risk of poor accuracy, or with fluoroscopy, with exposure to radiation and often, increased discomfort. The ultrasound-guided injections offer a quicker recovery and can sometimes be used to avoid surgery altogether.

“While cortisone injections are not performed brazenly among pediatric patients, they can be used judiciously here at CHOC to provide cutting-edge care,” Dr. Minor explains.

He offers physicians the following guidelines on when to refer:

  • An acute injury or ankle sprain, with negative x-rays and pain after 1-2 weeks.
  • Persistence of pain despite rest, ice, compression/bracing, stretching and physical therapy.
  • Persistent joint swelling.
  • Painful popping and clicking.

Dr. Minor sees patients at CHOC Children’s Clinic; CHOC Children’s Health Center, Corona; and Adult & Pediatric Orthopaedic Specialists in Mission Viejo. To contact him, please call 949-600-8800, ext. 205.