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and with the mute button
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um thank you very much thanks for the kind introduction suzanne um yes what i would like to talk
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about to you to day a a is a low back pain in the end union fleet um
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it is something that uh i work um with very closely with young young i'm developing at least i'm
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inversion british apply takes and uh this is certainly one of a big big issues for us
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so what i'm gonna do today's talk to you about the problem first of all what we doing
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uh what is the evidence for what we do the impact of what we do and what we should really be
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doing and for the questions that they seem always to be small one more questions really more research we do
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so in terms of the problem in adults uh a huge problem low back pain it
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um um effects about sixty to eighty percent people in some point of their lives
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indicates in comparison it's small it's ten to twenty percent but uh let's
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not before by this this is very highly variable number and uh
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the preference is much higher in in especially me
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and athletes participating in sports involving repeated flexion
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tension and rotation so if you can see the start slow down for borrowing and gymnastics are the most um
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high risk sports which shouldn't be if gymnastics always i'm getting a um
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up to eighty six percent off um prevalence of back pain
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the other issues that forty seven percent uh is reported to be born related
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um and eleven percent disk related now these disc uh um discredited problems ah again
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head nations to and a mature bone when you've got a problem yeah
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desk any eighteen through and and uh not yet to develop a ball
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and uh and place failures a series pathologies also something that we need to consider
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and i think one thing that we probably all c. but it is very
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much on the reckon ion and reported on recognised in literature is
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and nonspecific low back pain in in net uh adolescence children
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and deputy clean yeah yeah natalie it's it seems
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to be something that i seem to be dealing with a lot um at this point in time
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so the other problem that we have is that we have a rising levels of exercise participation
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and regardless of what the media and everything have leads us to believe
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there is that you know kids are active and are increasingly active
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in the u. k. the london twenty twelve legacy meant that the government apart huge amount
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of money into a supporting physical education and support for five to fifteen year olds
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and also um uh created morse old school games programs which
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basically these two high participation levels in competitive sport
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uh uh subsequently there has been a rising participation not necessarily in and out as a part
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as part of the london twenty to have like a c. but said mean children
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um now in ten to fifteen eighty four percent oh five to ten
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year olds uh participate in some sort of level of support
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um which is fifteen percent rise since twenty ten and ninety seven percent or
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for uh eleven to fifteen and fifteen year olds on now doing sports
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and that's a ten ten percent hot uh rice instantly ten so
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that's a fallacy in these numbers are fairly significant significant
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also the other thing is all that line and other injuries clock said this is certainly something
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that we are observing uh there are some uh there is some research that unfortunately is
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um the remit of this uh of this presentation just because the time is so limited but uh
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i just wanted to show you some data that be recognising from my own a person that is developing athletes
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uh that the money said over the period of twenty twelve to twelve to fourteen
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for relationship of low back pain and other injuries remaining usually for us would
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be hamstring injury since printers and what we left finding is that
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those who report low back pain i'm limiting training uh either one day
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or up to a week i'm more likely to sustain hamstring injury
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so well in some radio back then any athlete is common
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in especially in high school it's it is significant
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in terms of the majority of the ball and it is a potentially
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increasing so what are we doing about it what is the evidence
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so the evidence is based on clinical praxis its own consensus an expert opinion and
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uh it it but it mounts up to the statesman so low back pain
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more than three weeks is consider serious until proven otherwise x-ray c. t.s m.
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r. i. seventeen repeatedly conducted red flags are always screen for serious pathology
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the treatment is mostly recommended to be conservative although surgery in some
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cases is appropriate and uh and uh it can be effective
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uh in terms of the conservative treatment due consideration of sport we've got of up to six months um
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bracing for four to six weeks and gradually tend to activity guided by a pain response
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we tend to play a criteria compared to other injuries for example income streams we're kind of left inadequate at the base
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you need to be pain free whatever that means pain free in up in in sports a new
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logically intact if you need to have some full strength and range of motion whatever that means
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um if you look at the evidence behind the statements uh this has been published um
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uh just uh just recently and that basically these um uh uh recommendations that have just read out
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have got a a low level of evidence never see evidence which is basically based on consensus
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it's a huge impact is expected being in case erase it it
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doesn't have the robust research behind it including this coming
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um it's a level be evidence of slightly high is for
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extension related exercises and stabilisation for disk related pain
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so what is the impact of what of what we do
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a lot of what we do is we summarise it in terms of cessation of support bracing
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in response guardedly happen scanning has got can have a massive impact on an athlete festival
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association of activity tissue actual three d. d. c.
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d.'s use the conditioning boredom isolation guilt
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often frustration that meant they can exercise they start to develop habits you know uh exercising
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in secret eating disorders these are things that we see uh with with these kids
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um if you stop somebody exercising a bracing again it can lead to disuse
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fear and anxiety of people trying to exercise without it being over reliance
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i'm developing these guarding a habitual um uh behaviours that
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unfortunately don't help uh in terms of the pain because they actually
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seem to increase the compressor forces on the desk uh scanning
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it's it over to a focus on pathology then everybody then becomes obsessed with the pathology inhaling of
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the pathology and we know that in bonus points in particular we may not see complete union
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uh so that can have a powerful impact and pain response guided rehab
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well it leads to bringing the focus again on pain rather than function
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it isn't helpful for us to use this in terms of rehabilitation and it leads
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to frustration of the athlete trying to exercise pain free and unable to
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uh and go uh make was high uh high i let mister payne and hyper vigilance
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so where does this leave us out with huge amount of uncertainty unfortunately uh uh
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darts um about the uh the process itself and how the progress it
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for the whole team for the coach athlete as well as the parent and that can have a
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profound implication of how on how successful we are attending the best to to a possible
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so what should we do
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well not in complete darkness although it we do need more and more research
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um one thing we have is training theory we know
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that if the psycho a cycle time periods overloading
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recovery begets how male static response and biological adaptation
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that leads to enhance capacity to handle well
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and potentially about uh expect simply too high a fitness and hopefully performance so
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this is when things go wrong you get increase capacity in tissues
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if it goes badly um then you get excessive loading and you get you get inadequate recovery
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you can get biological my adaptation which then leads to reduced capacity of the tissues in the body time to load in
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you can then get illness and injury so the athletes starts to starts to move around the sort of red area
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so how does this apart we honestly the low but by no load
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seems to be very important part of the of this equation
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uh we know that normal loading like covering a school bark
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a sitting room watching too much t. v. o.
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we would like to but unfortunately does not actually call was a
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risk uh too low back pain too young young people
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once we start looking at loading of exercise it set me there is that these
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buttons tend to image so in this very large epidemiological study by soft oh
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we started to see buttons where uh that groups of um young uh groups of young people
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in adolescence uh exercising less than six hours a week that would get twenty percent prevalence
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uh between six and twelve hours they get thirty percent under those over twelve hours of exercise
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in get forty percent prevalence of older right so you can start to see these buttons
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the impact of the load is important so if you look at these two video
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same athlete age sixteen absolutely huge do you all the two meters age seventeen
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um the trite training load has been on relatively unchanged over this yeah
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that's on top of um uh what he's been doing he's obviously grown now he's put
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on large amount of weight the forces and uh uh the the most uh
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well that's still relatively mature spine lead a lead to a uh um a low back
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pain and as well as me pain so this guy despite of that very very
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as a valid somebody the same amount of loading in terms of training has developed to
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injuries that where most likely related the impact of the load rather than anything else
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so what's happening with the capacity well we know that low button is more prevalent in periods of rapid growth
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uh so then maybe um there may be a link a link
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pain in in terms of the majority of the tissue
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and uh and the the the load being being placed on on these athletes these three studies that have called here
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uh seem to show the pattern that it doesn't really matter how active these uh kids are
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uh they will develop more back pain and they have been tapes of progress from the age of um
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uh eleven to fifteen for example um and that seems to be at the age of the maximum growth
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so the capacity of not fully mature tissue may be compromised and predisposed to insure
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you know to injury risk so where does that leave us capacity unloaded wage
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one hand we've put in much of on we've got potentially a kinetic chain that is
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a slit still uh the tissues place within a kinetic chain that is still
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i'm growing and the forces place the pop on that issue are great to
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you've got hormone changes physiological changes that i'm a young athletes adolescents
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to go through and also had um to develop coping strategies
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that read them to i'm not being able to handle load as well the capacities lowell
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on the other hand you've got obviously the training load you also have
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exams you have a sitting latch sustained a static loading of the spine combined with the training
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you also have that pressure have psychological o. d. feel like
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from um at the uh coach enough lead relationship parents
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and let's not forget about the media and see what uh we how we plus you
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how we perceive rather a low back pain in media with uh with that
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you know the the the the cases that uh get a lot of attention and how can that exactly an athlete but they
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this is the perfect storm is probably the best example you can
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get both imbalance between logan capacity is lobe opinion athlete
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so where does that leave us what do we know how can be optimised load
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um if we look at this graph here you can see that too much or too little is not
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right for that issue adaptation there is the speech stop stop a spotted a sort of a um
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area where most optimal loading is being uh is being uh uh
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uh uh could uses that issue adaptation that we often really
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we still don't know how um how much is too much and east uh a consensus statements by i. o. c.
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provided that it provided us with a huge amount of information as to what constitutes overload physiological mechanic was
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about a psychological and it gives up some uh some direction in terms of how to monitor load
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a little bit they can provide us with the frame white but not necessarily huge
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amount of information as to how we can implement optimisation overload in enough lead
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but it is definitely a start time is really good to see that people are starting to look at this
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so how do we implement this knowledge to be unhappy low back pain we think about load and try to put
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it into context context we need to recognise that load for each awfully need to monitor and up to mice
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be a base a lot as well so in terms of recognising and monitoring
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load the training and competition load is the obvious one and that that's
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something that you know a a i. b. need we do need to closely
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monitor in terms of uh uh in terms of the the amount
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life style um you know 'cause of to do other supporting p. they uh also often sit for
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long periods of time and they don't exercise all this produces extra mechanical as well a psychological
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a psychological a load 'em relationships be quite events and
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to predisposed feeds to injury uh including back pain
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so it is certainly something that we need to recognise an assessment in terms of log monitoring
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we can actually can them money to the actual role also g. p. s. monitoring
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uh it counts um a performance analysis at all sorts of
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these things now and examples that have been shown here
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but we can also money to the response to load and i think that
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is i'm probably more optimal way it's less costly um and more
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individualised for each athlete so how does that particular athlete response to load
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because that will change depending on uh a japanese capacity really
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up to my zero to exercise um about school has published this very
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seminal paid uh and he threw advice out of the window
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um which is uh has been go standard for soft tissue injury
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uh_huh injury management and replaces the rest of the optimal loading
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um and uh um the optimal loading in terms of what that is
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it has to be tissue specific so for example ball response much
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more to cyclic loading like we had in the presentations before
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uh that you jumping running that every spoil that a bonus is stimulated by that
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and then we um tends to respond response to might need to for example and muscle to variability in different
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um uh activities it needs to be to range that is specific
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to the sport very magnitude greater intensity individualised and fun
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no wait mentions best uh that uh as a as a whole as a concept
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bracing for low back pain only know that applying extensible to enjoy it um
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area without strengthening of the local tissue and improving the kinetic chain function is incompatible with
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save training parties we can't really uh uh reconcile this this this issue however
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racing does have a role just like all those things do they do seem to um uh uh um they do seem
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to help me in terms of the passive and active function of it over muscle for example ligament or tendon
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and temporary device can be used as an assistant device to
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facilitate effective straight coming putting that that's in in
00:16:27
the right position and having that fed the impact that will that will go to berkeley as well
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so backing up to muzzle to movement efficiency it's a
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it's a contentious question do we change the way
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how people move well in in in training and i'm sure that they are coaches in here
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who would probably say yes movement efficiencies absolutely crucial for splitting performance
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um people little back when they start to uh athletes uh both
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of them it's central low back pain completely different impairments
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how do we reconcile this how do we teach these people to
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move a more optimum all ultimately to improve the lot reasons
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for this are multiple they could be led by believes by the fact how they should be moving and not slouching
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um they could be uh also the uh due to pull
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capacity people to shoestring um a poll stability issues
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uh or vice versa it could be just guarding and way how
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how those patients are moving so how do we reconcile this
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this is my working right but i've invested you i'm trying to break the cycle uh we
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tell people to exercise about that causes more pain how do we deal with this
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the um we need to understand it's often that's related to see yeah it's really to avoid ends inactivity in
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guarding and all to tissue loading capacity so all of these things are uh you know at play
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we tried to break it by um designing this uh um sense of technological the
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fees even talking which gives a pessimist individualised feedback to people doing exercise
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it is framed around the behaviour change model feel like that allows capability
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it motivates any provides pro opportunity for for training in different environments
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these are the starting to collect lots and lots of data on back when patients uh performing various movements
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and uh we started to see those buttons the matching and what we need to do
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is collecting of data to then have a training sample for uh that we
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can apply to machine learning algorithms that build then allow us to classify a various
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impairments and apply uh uh optimal amount um and spent a specific feedback
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so what does exercise does for young athlete in a bit low back pain it
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gives it gives them an opportunity for evidential landing exercise is not harmful
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it doesn't cause more pain there other things in play that could potentially lead
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to that it gives a message my spine is strong rather than we
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it it gives control over outcomes five do it like this it doesn't had it's
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about experimentation experimentation it's about a landing by example and repeating right movements
00:19:10
focus on function and performance not pain reduces pain politeness and high privilege vigilance
00:19:15
which is related to a a crummy city in low back pain
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and reduces certainty uncertainty for the athlete and for the team so rather than looking
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at a very subjective think it gives you objective measure how to progress
00:19:27
so this is what we saw before the impact of what we do in terms of uncertainty we start to look at instead
00:19:33
of cessation of training be optimised loading uh and uh instead
00:19:37
of pain response we look at load response guided management
00:19:42
um in terms of the optimism load you consider overload mechanical psychological
00:19:47
physiological and trying to a much it's to the training load
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the message to the athlete and the team is tissue needs a
00:19:53
stimulus to heal it cannot be vested um including bone
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in terms of bracing um assisted an optimal loading um uh uh is is the way to
00:20:04
go really is the you know if a if an athlete if it helps them to
00:20:08
uh uh the more on food and then it is a it is a a a good thing to use if temporarily but it
00:20:13
needs to be put into completely different context it's not about protection
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it's about assisting load and the message is exactly that
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um in terms of scanning i'm bottom stress is often silent these are the messages that we need to tell them
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they also spun to rice lies ceases devices um problems
00:20:32
the interface that out and recognised and a symptomatic
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um well bone looks like is not products of an outcome these are things that we these are
00:20:42
conversations that we need to have and get enough to eat and low response kind of management
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much response to load and modified accordingly is the way uh
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to uh improve the outcomes and to improve the confidence
00:20:57
that gives people knowledge gives them control over the problem and it gives them it it
00:21:02
powers the whole of the team the coach athlete as well as the parent
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and that will have any implications for success of returning athlete to sport
00:21:10
so for the questions there are lots of questions unfortunately we've got lots
00:21:14
of research that has been presented here in back pain in
00:21:17
terms of of a bust evidence for this is not very high
00:21:20
dose response relationship for example is not very well known
00:21:24
hi psychological and social stresses interact with the physiological and mechanical
00:21:28
factors fall back pain again we don't know about the
00:21:31
bills and the response and how we should handle it it's all about clinical judgement at this point in time
00:21:37
that's that's useful scanning and young athletes we don't have that at all when and frequency how
00:21:42
often should be would be discounting the radiation risk is huge in these young kids
00:21:48
how to best money to spine bone a maturation and have been applied load
00:21:52
according that i think is a very important question to to um so
00:21:56
the table messages well that painting and athletes a serious and it's a growing problem
00:22:01
establishing a diagnosis union athlete especially in high risk sport is absolutely paramount
00:22:06
balancing loading a capacity is the key follow but prevention and management
00:22:11
mechanical physiological and psychological load mice must be all considered
00:22:16
police not price look at optimal loading try to concept caught trying to put
00:22:20
a this into context for the young athlete and for the coach
00:22:25
it's about maximising tissue adaptation by optimising not minimising load
00:22:29
three that they should not this can i think many of us already do that you know the clinical picture and response to loading
00:22:35
is much more important than a a uh you know the fact just seen on the on the on that a scam
00:22:41
and the whole team needs to be on message we need to involve the whole team coaches absolutely important in this

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Conference program

Welcome
Frederic Koehn, President Young Athletes Forum Foundation
21 Sept. 2017 · 1:18 p.m.
3,138 views
Opening address
Boris GOJANOVIC
21 Sept. 2017 · 1:22 p.m.
131 views
Biological Maturation and the Path to Success: Before and After the Fact
Manuel COELHO-E-SILVA, Biological Maturation and the Path to Success: Before and After the Fact
21 Sept. 2017 · 1:31 p.m.
559 views
Designing pathways to success – part kaleidoscope, part microscope
Jason GULBIN, Designing pathways to success – part kaleidoscope, part microscope
21 Sept. 2017 · 1:53 p.m.
386 views
Talent ID and Development: Why doing the “right thing” is not always the “best thing
Ross TUCKER , Talent ID and Development: Why doing the “right thing” is not always the “best thing
21 Sept. 2017 · 2:16 p.m.
341 views
108 views
Resistance training during long-term athlete development
Urs GRANACHER
21 Sept. 2017 · 2:52 p.m.
366 views
The development of aerobic power in young athletes
Grégoire MILLET
21 Sept. 2017 · 3:15 p.m.
1,475 views
Fueling the young athlete
Asker JEUKENDRUP
21 Sept. 2017 · 3:36 p.m.
195 views
Training young athletes: challenges and opportunities
Marco CARDINALE
21 Sept. 2017 · 4:01 p.m.
183 views
TRAINING THE YOUNG ATHLETE - Q&A
Panel
21 Sept. 2017 · 4:33 p.m.
Coaching from junior to the top of the world (Lara Gut)
Patrick Flaction, Elitment
21 Sept. 2017 · 5:20 p.m.
195 views
Knee ligament injuries in immature athletes
Franck CHOTEL
22 Sept. 2017 · 7:48 a.m.
Osteochondral lesions
Franck ACCADBLED
22 Sept. 2017 · 8:11 a.m.
225 views
INJURIES WITH THE ORTHOPEDISTS - Q&A
Panel
22 Sept. 2017 · 8:54 a.m.
Back pain in young athletes
Liba SHEERAN
22 Sept. 2017 · 9:34 a.m.
Long term sequelae of youth overuse injuries
Mark BATT
22 Sept. 2017 · 10:19 a.m.
OVERUSE INJURIES - Q&A
Panel
22 Sept. 2017 · 10:40 a.m.
Concussions in young athletes : myths and reality
Christopher NEWMAN
22 Sept. 2017 · 10:52 a.m.
Screening for heart disease in sports – nonsense or necessary?
Matthias WILHELM
22 Sept. 2017 · 11:16 a.m.
Competitive Sport & Health: hidden issues
Gordon MATHESON
22 Sept. 2017 · 12:04 p.m.
Injury prevention programs : The 11+ Kids Project
Mario BIZZINI
22 Sept. 2017 · 2:12 p.m.
104 views
159 views
Parents’ Knowledge of Sport Psychology and Nutrition
Dr Camilla J. Knight
22 Sept. 2017 · 3:57 p.m.
Closing Address
Frederic Koehn, President Young Athletes Forum Foundation
22 Sept. 2017 · 6:04 p.m.