Player is loading...
Long term sequelae of youth overuse injuries
Mark BATT
Friday, Sept. 22, 2017 · 10:19 a.m. · 21m 22s
Embed
Transcriptions
Note: this content has been automatically generated.
00:00:00
don't thank you very much indeed nice introduction thank you to the
00:00:04
organising committee for putting together this fantastic he's actually for them
00:00:09
and uh a model for inviting me to be a say thank you to you all
00:00:14
so perhaps that may require challenging task which is to discuss the consequences
00:00:20
of a movie you sports injuries in uh children and young people
00:00:26
so i thought it was appropriate just to revisit definitions so we knew exactly what it was we're talking about
00:00:33
so in the definition of consequence that will use this morning is the results or fire
00:00:38
this typically one that's um welcome or unpleasant so that's gonna be
00:00:43
what i should use uh for our definition of consequence
00:00:47
what i'd like to do is just put this in perspective um
00:00:52
uh to start with talk a little bit about that genealogy
00:00:56
answer a question that i think we'll maybe also do quite well about young bodies
00:01:01
then talk about consequence and we can't get away from the politics uh
00:01:06
and some of the difficulties of and they will tackle later today
00:01:11
so i wanted to start with this hopeful positions status this was a
00:01:15
consensus statement from the american medical started to school to madison
00:01:20
and indeed nero vigilantes here use one of your first on the study and
00:01:24
it looks but i've used injuries and been out in youth sport
00:01:30
and just summarise some of the findings so they reckoned that
00:01:35
roughly overviews acute injuries are yeah roughly fifty fifty
00:01:40
i think our previous speaker demonstrated those sorts of figures in it depends which grew you
00:01:45
look at which supports which age group are very roughly it's a fifty fifty split
00:01:49
but if you look in different sports you do come up with different results i movie use injuries
00:01:54
a somewhat more prevalent in running then if you study uh populations of ski or humble players
00:02:01
but actually is widely recognised we probably underestimate these numbers because of the
00:02:08
key definitions that we use politically the dash definition of timeless injury
00:02:13
but as we've heard all ready yesterday and today was starting to reckon customs
00:02:19
recognises patterns of uh of presuppose an factors such as prime injuries
00:02:24
we had from ought to um speakers this morning but cool fine q. talked about
00:02:31
um the the grapes but as as a problem low muscle mass hyper mobility
00:02:37
uh training volume and for female athletes amen area so there's
00:02:41
certain things that we on the standard predisposed to risk
00:02:45
i'm gonna hear more about the risk of schools rationalisation and supple redness later
00:02:51
but perhaps for me when looking at this particular topic what i couldn't find
00:02:56
in these consensus statement was much about consequence so what happens after
00:03:01
over use injuries and perhaps after sports has ceased uh in these young people
00:03:10
so these next few slides um off a fun actually
00:03:14
a far or land a white that night last night uh
00:03:18
she runs a children's obesity clinic uh in geneva
00:03:22
and i really wanted to place this talk in context because despite labour
00:03:28
saying that in the u. k. following london twenty twelve
00:03:31
on legacy monies we have seen some increase
00:03:34
in activity levels in young people i think globally we have a major problem
00:03:40
and the major problem really is on your left rather than the
00:03:44
fee you relatively few elite athletes i'm on the right
00:03:50
so we're facing a global problem of inactivity in young people
00:03:55
and this is an info graphic that we've recently produced to this is twenty
00:04:00
fifteen to follow the twenty eleven physical activity guidelines for young people
00:04:05
in the u. k. and this is a way of us trying to
00:04:07
translate those guidelines in a somewhat more palatable way and we
00:04:11
need to do this we need to make things um more available
00:04:16
translate evidence better uh to uh to to young people
00:04:22
and it's important because young people are dropping out of sporting if
00:04:26
we look at sports as opposed to just incidental activity
00:04:29
and this is just one study i could've picked many but this is australian data and they
00:04:35
calculated roughly eighty percent dropout from spoiled um so yeah
00:04:41
and so if you run the figure seven eight percent dropout starting at the age of ten the thousand young
00:04:46
people and then you correct carry that through the age of eighteen you pretty much lost half of them
00:04:51
so that's a real concern and it's it's of great concern certainly in our country um in young women
00:04:59
and this has consequences is us data no across like doesn't look terribly dramatic
00:05:06
actually it is this is a piece to levels in young people in
00:05:09
the us starting in a nineteen seventy long going through twenty ten
00:05:14
i'm always saying is fairly significant increases in childhood obesity
00:05:19
others i put it to you that when we consider the issue globally
00:05:24
um and you're by two normally on a friday morning i'm
00:05:27
in my pediatrics adolescent clinic in my national service
00:05:31
hospital in not saying i'm actually the issues on interactivity not over
00:05:36
activity in labour had a very lovely slide where she demonstrated
00:05:41
the the maximum every benefit probably lies somewhere in the middle is narrative
00:05:45
home you stay says in the middle that we need acted
00:05:49
so i think we have a job to get young people to be more active we also certainly have a job look
00:05:55
after those who are very busy active cage and having to
00:05:58
use problems so that was just to set the c.
00:06:04
so here's a very simple question all children simply smaller dials
00:06:08
um and the also that is no no with very well educated sitting in this room
00:06:13
but i have to tell you um you know when i sit in my clinic
00:06:18
um parents often who uh living out there
00:06:21
inadequate and inadequacy vicariously through that children
00:06:25
are often pushing and pushing and pushing them and they have the mentality of an adult and they're applying it
00:06:30
to a child and to charles body and we need to understand the children are very very different anatomically
00:06:39
and we know this because there's a lot of good epidemiological data that will
00:06:43
tell us that if you look at a injury patterns you can describe
00:06:48
around fifteen percent specifically to physical scully to immaturity
00:06:53
and it has significant consequences feisty oh fractures very fractious through growth
00:06:58
plates my account for about a fifth of those fractures
00:07:02
but actually for a one to two percent there's great the
00:07:06
rest and that's a serious consequence of that injury
00:07:10
we also get focused on certain anatomical areas so whether it be the shoulder and
00:07:16
a young tennis player the wrist indigenous the elbow uh in a basketball player
00:07:22
and certainly fit in terms of consequence these have specific problem so the
00:07:26
radioactive says and the rest is married with particularly interested in
00:07:32
i think what's really interesting is this crossover one doesn't
00:07:35
move use problem then present as an acute injury
00:07:40
we have classifications on big we made as a scribe to an h. each presentation
00:07:46
but actually what was going on in that young person that young people persons body with repetitive training
00:07:52
i don't know if it's predisposed to a subsequent acute injury and our brief revisit that little bit later
00:07:59
and we saw for with all of our studies with a lack of standard classification
00:08:05
we generally know that all the launching children have agreed to injury risk
00:08:12
so in our clinic we um would it to our new patients
00:08:16
and this is to use of data is this is twenty thirteen twenty fourteen
00:08:21
and we just asked them where where do you think you yeah you problem came from your your presenting complaint
00:08:27
and actually know how clinic which is a national health service clinic actually the vast
00:08:32
majority not specifically related to schools activity there that classified as insidious onset
00:08:38
but we know new so from our continue professional development without trainees you come through clinic
00:08:44
we know whether problems lynette problems lie predominantly in low them out and back
00:08:52
we also know anatomically we need to understand the young
00:08:56
skeleton well whether it be a prophecy l. injuries
00:08:59
five seal injuries or stick under i suggest accounts that we had about earlier this morning
00:09:06
so the prophecies are growth centres um and they can be
00:09:11
injured either through a repetitive stress and traction injuries
00:09:16
well sometimes as in the wrong tape to the anterior inferior products
00:09:20
by numbers x. ray on your drawing to an acute injury
00:09:25
the most interesting to me is does that patience is the same x. ray
00:09:29
does that perhaps a lead to impinge meant uh i'm in late i service uses perhaps another crawls
00:09:36
all of a former fitting punishment which robin past being common punishment in this case would
00:09:42
be concerned page which is a different type of from a stabbing pain shouldn't
00:09:46
thinking about the future what these injuries due in the years ahead
00:09:54
just to briefly talk about the also country sees the ones we really worry about
00:09:59
so the articulate all secondary sees i think is interesting in madsen generally
00:10:04
when somebody puts than name to a condition or syndrome or there's a long time like
00:10:10
cost your control is just just a cans based on latin or greek definitions
00:10:15
often it's telling us that we don't really understand the nature of that condition i think this is the
00:10:19
case for loss of the the conditions we see in in all young uh oh young athletes
00:10:26
but they are interesting and they have consequences so here's an example
00:10:30
of one of those particular conditions this is fry books disease
00:10:34
uh so this is a collapse of to be the second or for that matter tossed her head
00:10:39
uh and this is a um an x. ray of one such young child with this problem
00:10:46
but this is some guy so just a couple of weeks ago this the thirty two year old lady who presented to me she's a renault
00:10:52
with for for today and she doesn't recall having injuries uh as a youngster but she has
00:10:59
a collapse methods also had um i suspect she will most certainly had fried ducks disease
00:11:04
uh as a young person so these conditions have significant consequence and we need to
00:11:09
treat them well and recognise them as best we can in young people
00:11:14
sean labour the point about the c. d. because we've heard
00:11:18
a very elegant talk about this condition early this morning
00:11:22
but just suffice to say we see different patterns of this in different
00:11:26
athletes seven females we see ankles more commonly out than perhaps nice
00:11:32
in nothing and we have a high performance gymnastics centre was that we haven't young tennis players presenting with
00:11:37
similar lesions in the elbows because i spend a lot of time wandering around on the opulence
00:11:45
and frank alluded to the rock group so this is a group in the
00:11:49
us the doing a really great thing which is trying to create
00:11:53
eight how what of young people with us to control just s. a. cans
00:11:58
along with you know how to try and provide us with some data
00:12:01
so we can better understand the long term consequences of this condition so i read the itchy
00:12:07
to look at any data that's coming from that group because they're doing a great thing
00:12:13
and similarly we heard about and two crucial ligament rupture and we took
00:12:17
we learned about different ways of of trying to address this problem
00:12:21
but i put it to you that you're having an a. c. l. injury so
00:12:25
it doesn't change with deanna it but it does change you are like transcription
00:12:29
so things are happening very quickly placed a a seal
00:12:32
repair and some lovely elegant data from sweden
00:12:36
that's just coming out of showing changes but only changes just three months post a. c. l. ha
00:12:43
so whilst doing surgery may fix the leg and may provide
00:12:47
a stable ne and i'm not in any way diminishing
00:12:50
the importance of nice stability that's been elegantly demonstrated to us uh idea
00:12:55
what we do know is that these young people have a
00:12:58
much higher incidence of subsequent osteoarthritis of the nice
00:13:05
and so if we know who the the two greatest
00:13:08
risk factors osteoarthritis are being overweight and injury
00:13:14
what can we do about it well it's important that we intervene and we
00:13:21
provide both primary and secondary prevention strategies and this is some early data
00:13:26
from i'm karen memories group reported by jacking which again this is the calgary group
00:13:32
and they've got an interesting study where they've taken a hundred uh youngsters with knee
00:13:37
injuries and dave match them with a similar number of age sensible much controls
00:13:43
and not entirely germane to to us 'cause actually the age range here is fifteen to twenty six
00:13:50
but the problem really dated which is reported a couple of years
00:13:53
back showed that those with knee injuries have four function
00:13:57
great and the symptoms have a greater risk of being overweight uh and
00:14:02
the base three ten years post injury when compared to control groups
00:14:07
so this this is a long but you don't care what it's gonna be fascinating to see the data
00:14:12
that comes from this how what as i as the years progress but early on we know you
00:14:18
having knee injuries and any at a young age is not a good
00:14:21
thing that we need to get better at primary and secondary prevention
00:14:29
and if you then look boulder so this is a um a matter analysis systematic review
00:14:35
from phil commands group in leeds and they
00:14:38
looked at sports participation and osteoporosis
00:14:43
and what they concluded was that the evidence base um is of low quality
00:14:48
um so it's very difficult to be clear about whether or not there is a true a correlation
00:14:56
but importantly th raise studied here was seventy to seventy years so
00:15:00
this doesn't really include the age group we're interested to tool
00:15:04
and the follow our time was either very short or quite long service daughter is not transferable
00:15:10
to the age group that we're concerned with so we have a job to
00:15:13
do which is to create some really good long vertical care what's
00:15:18
and i would urge us all to get together because for the studies we need huge numbers
00:15:24
so if we're able to collaborate together then i think we have a chance of providers and data not for me but for
00:15:29
the people that follow me and my my work and and and some of our work to provide ounces in the future
00:15:37
so to go back as i said i would do to review
00:15:40
since you this is a very well known paradigm where we
00:15:44
understand the intensive genesis of injury we have intrinsic factors you can't do a great deal about
00:15:49
such your age and sex an extrinsic factors are all the things that we do
00:15:55
the training error is one of the greatest that he sees but we
00:15:58
also interested in equipment that's a office environment and so on
00:16:03
when you put those together what you end up with is a predisposed
00:16:07
ass halfway to maybe then become susceptible to injury or illness
00:16:13
and then the key thing is is are inciting if that does something happen that then triggers that injury
00:16:20
so here suffice seal injury this is a typical uh five seal injury ah well humour up if it's it's
00:16:27
so we see this in young tennis players uh and and we
00:16:31
sit in in baseball players new schools by repetitive stress
00:16:36
uh we see similar problems further down the arm in in young gymnasts
00:16:41
and we recognise a pattern of more significant phi seal injuries
00:16:46
with with fracture and this is the salter harris classification
00:16:50
but i put it to you here's a young gymnasts they got it wrong
00:16:54
coming off of old and stuff for the very nasty that injury
00:16:59
was it was was the phi six week and pry ah to that one
00:17:05
of all that went wrong what had this bean a problem that was brewing so i take it back to the model
00:17:11
predisposed susceptible actually we need to think hard about
00:17:16
whether or not we're training in such a
00:17:18
way that we're converting predisposed referees to susceptible athletes so we'll see what's going to happen
00:17:25
as it happens i can tell you the outcome for this actually was good actually did very well
00:17:31
and this is important and again it just cries out for more down to because this is from um
00:17:38
because i'm not for the but really drawn if your u. c. l. a. and david canes group
00:17:44
actually we know who the consequence of phi seal injuries
00:17:47
can be severe but there's a huge age range
00:17:51
a big problems like this huge range of um well all
00:17:55
subsequent miss chief um as as athletes get get older
00:17:59
so the age range uh get can be from zero to the
00:18:03
thirty seven sent in terms of future a future problems
00:18:10
so i just want to say a few things about you know what are we
00:18:14
doing in society so he is just one example so in peewee baseball
00:18:21
in north america um the baseball speed down has been
00:18:25
introduced how young kids and coaches estimate um friends
00:18:31
um and you can say exactly the same um in this what the tennis that on involve with
00:18:37
i don't think i notice single tennis player wimbledon he
00:18:40
hasn't lost into a rotation of that dominant all
00:18:44
which tells us they have a but any problem is typically bunny relevance off to
00:18:49
she related to years of throwing a tennis racket i great angular velocity
00:18:55
and perhaps we have this speed on it they say is a very damaging thing
00:19:00
because it's encouraging youngsters prancing tartan coaches to do something that we know it's going to be injurious
00:19:07
i had a fascinating consultation and just earlier this week with the young cricket so
00:19:13
and so this youngster was um was fifteen years of age and you know the spongy lay
00:19:17
license that goes back to the leaders talk about low back pain in young athletes
00:19:22
and as a creek liza fast policy runs in both um a
00:19:28
maybe thirty twenty to thirty meter run up and bowls the
00:19:32
ball that um that probably seventy eighty miles an hour
00:19:38
um and we know that the repairs five extension rotation
00:19:41
using e. u. is injurious for the low back
00:19:46
but in the conversation with a file that i said how many of us has your
00:19:50
child balls how many oh over to people last season nice yeah well not many
00:19:54
as well as the calculation and i see you do a calculation is there was about a hundred and fifty
00:20:00
well actually we them went through to news over four hundred fifty and we know that in young cricket is
00:20:05
if your body movement of four hundred is a very high chance you'll get us on like this thesis
00:20:12
so that we can monitor in the backs away and trying prevent these injuries from happening
00:20:21
um yesterday i was able just to drop in on lasagna speak to my friend and colleague richard budget
00:20:26
uh for the i. o. c. and um as has already been demonstrated um
00:20:30
at this conference they produced a very helpful statement on mute athletic development
00:20:36
with fantastic goals i think we would all absolutely sigh now to
00:20:41
but actually the worry thing or something for me it was actually the topic of all conversation
00:20:45
in starbucks uh just yesterday morning was this i didn't see anything about consequence being written
00:20:52
and i believe we do have a responsibility to understand what happens placed sport
00:20:58
and also i i think we have responsibility has doctor's visit their this phase i teaches
00:21:05
teachers in school to think about what happens post activity
Conference Program
Opening address
Boris GOJANOVIC
Sept. 21, 2017 · 1:22 p.m.
244 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
Sept. 21, 2017 · 1:31 p.m.
977 views
Designing pathways to success – part kaleidoscope, part microscope
Jason GULBIN, Designing pathways to success – part kaleidoscope, part microscope
Sept. 21, 2017 · 1:53 p.m.
930 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
Sept. 21, 2017 · 2:16 p.m.
749 views
BIOLOGICAL DEVELOPMENT AND PATHWAYS TO SUCCESS - Q&A
Panel
Sept. 21, 2017 · 2:41 p.m.
202 views
Resistance training during long-term athlete development
Urs GRANACHER
Sept. 21, 2017 · 2:52 p.m.
781 views
The development of aerobic power in young athletes
Grégoire MILLET
Sept. 21, 2017 · 3:15 p.m.
2631 views
Fueling the young athlete
Asker JEUKENDRUP
Sept. 21, 2017 · 3:36 p.m.
449 views
Training young athletes: challenges and opportunities
Marco CARDINALE
Sept. 21, 2017 · 4:01 p.m.
384 views
TRAINING THE YOUNG ATHLETE - Q&A
Panel
Sept. 21, 2017 · 4:33 p.m.
150 views
Coaching from junior to the top of the world (Lara Gut)
Patrick Flaction, Elitment
Sept. 21, 2017 · 5:20 p.m.
580 views
Keep your athletes close and their parents closer: Working effectively with parents
Olivier SCHMID
Sept. 21, 2017 · 5:52 p.m.
199 views
Combine sport and studies, are the schools doing enough ?
Florian ETTER
Sept. 21, 2017 · 6:11 p.m.
219 views
COACHING, PARENTING AND DEVELOPMENT - Q&A
Panel
Sept. 21, 2017 · 6:28 p.m.
DÉBAT PUBLIC (IN FRENCH) : Children and competitive sport, for the best or the worst ?
Panel
Sept. 21, 2017 · 8:07 p.m.
238 views
Knee ligament injuries in immature athletes
Franck CHOTEL
Sept. 22, 2017 · 7:48 a.m.
351 views
Osteochondral lesions
Franck ACCADBLED
Sept. 22, 2017 · 8:11 a.m.
988 views
The influence of athletic activities during growth on hip development
Rintje AGRICOLA
Sept. 22, 2017 · 8:35 a.m.
164 views
INJURIES WITH THE ORTHOPEDISTS - Q&A
Panel
Sept. 22, 2017 · 8:54 a.m.
Back pain in young athletes
Liba SHEERAN
Sept. 22, 2017 · 9:34 a.m.
215 views
Injuries and illnesses amongst young elite athletes – so healthy it hurts?
Christine HOLM MOSEID
Sept. 22, 2017 · 9:57 a.m.
199 views
Long term sequelae of youth overuse injuries
Mark BATT
Sept. 22, 2017 · 10:19 a.m.
OVERUSE INJURIES - Q&A
Panel
Sept. 22, 2017 · 10:40 a.m.
Concussions in young athletes : myths and reality
Christopher NEWMAN
Sept. 22, 2017 · 10:52 a.m.
Screening for heart disease in sports – nonsense or necessary?
Matthias WILHELM
Sept. 22, 2017 · 11:16 a.m.
123 views
Energy deficiency in young athletes – prevalence, consequences and screening
Anna MELIN
Sept. 22, 2017 · 11:39 a.m.
723 views
Competitive Sport & Health: hidden issues
Gordon MATHESON
Sept. 22, 2017 · 12:04 p.m.
117 views
THE COMPLEX MEDICAL PROBLEMS - Q&A
Sept. 22, 2017 · 12:33 p.m.
Injury prevention in youth : What is learned in the cradle is carried in the tomb ?
Evert VERHAGEN
Sept. 22, 2017 · 1:46 p.m.
176 views
Injury prevention programs : The 11+ Kids Project
Mario BIZZINI
Sept. 22, 2017 · 2:12 p.m.
185 views
Sports specialized training: what are the true effects and is it really all bad ?
Neeru JAYANTHI
Sept. 22, 2017 · 2:29 p.m.
141 views
What is “load” and how does it impact athletes’s risk of injury ?
Torbjorn SOLIGARD
Sept. 22, 2017 · 2:49 p.m.
344 views
Instituting a unique public health approach to ACL injury risk management
Joseph Janoski
Sept. 22, 2017 · 3:47 p.m.
Instituting a unique public health approach to ACL injury risk management - Q&A
Joseph Janoski
Sept. 22, 2017 · 3:54 p.m.
Parents’ Knowledge of Sport Psychology and Nutrition
Dr Camilla J. Knight
Sept. 22, 2017 · 3:57 p.m.
152 views
Injuries and injury risk factors in youth alpine ski racing: A two-season prospective study
Lisa, Müller
Sept. 22, 2017 · 4:09 p.m.
FREE COMMUNICATION AND BEST ABSTRACT PRESENTATION - Q&A
Panel
Sept. 22, 2017 · 4:21 p.m.
610 views
Closing Address
Frederic Koehn, President Young Athletes Forum Foundation
Sept. 22, 2017 · 6:04 p.m.
140 views