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don't thank you very much indeed nice introduction thank you to the
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organising committee for putting together this fantastic he's actually for them
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and uh a model for inviting me to be a say thank you to you all
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so perhaps that may require challenging task which is to discuss the consequences
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of a movie you sports injuries in uh children and young people
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so i thought it was appropriate just to revisit definitions so we knew exactly what it was we're talking about
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so in the definition of consequence that will use this morning is the results or fire
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this typically one that's um welcome or unpleasant so that's gonna be
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what i should use uh for our definition of consequence
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what i'd like to do is just put this in perspective um
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uh to start with talk a little bit about that genealogy
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answer a question that i think we'll maybe also do quite well about young bodies
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then talk about consequence and we can't get away from the politics uh
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and some of the difficulties of and they will tackle later today
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so i wanted to start with this hopeful positions status this was a
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consensus statement from the american medical started to school to madison
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and indeed nero vigilantes here use one of your first on the study and
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it looks but i've used injuries and been out in youth sport
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and just summarise some of the findings so they reckoned that
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roughly overviews acute injuries are yeah roughly fifty fifty
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i think our previous speaker demonstrated those sorts of figures in it depends which grew you
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look at which supports which age group are very roughly it's a fifty fifty split
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but if you look in different sports you do come up with different results i movie use injuries
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a somewhat more prevalent in running then if you study uh populations of ski or humble players
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but actually is widely recognised we probably underestimate these numbers because of the
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key definitions that we use politically the dash definition of timeless injury
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but as we've heard all ready yesterday and today was starting to reckon customs
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recognises patterns of uh of presuppose an factors such as prime injuries
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we had from ought to um speakers this morning but cool fine q. talked about
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um the the grapes but as as a problem low muscle mass hyper mobility
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uh training volume and for female athletes amen area so there's
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certain things that we on the standard predisposed to risk
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i'm gonna hear more about the risk of schools rationalisation and supple redness later
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but perhaps for me when looking at this particular topic what i couldn't find
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in these consensus statement was much about consequence so what happens after
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over use injuries and perhaps after sports has ceased uh in these young people
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so these next few slides um off a fun actually
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a far or land a white that night last night uh
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she runs a children's obesity clinic uh in geneva
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and i really wanted to place this talk in context because despite labour
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saying that in the u. k. following london twenty twelve
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on legacy monies we have seen some increase
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in activity levels in young people i think globally we have a major problem
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and the major problem really is on your left rather than the
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fee you relatively few elite athletes i'm on the right
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so we're facing a global problem of inactivity in young people
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and this is an info graphic that we've recently produced to this is twenty
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fifteen to follow the twenty eleven physical activity guidelines for young people
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in the u. k. and this is a way of us trying to
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translate those guidelines in a somewhat more palatable way and we
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need to do this we need to make things um more available
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translate evidence better uh to uh to to young people
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and it's important because young people are dropping out of sporting if
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we look at sports as opposed to just incidental activity
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and this is just one study i could've picked many but this is australian data and they
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calculated roughly eighty percent dropout from spoiled um so yeah
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and so if you run the figure seven eight percent dropout starting at the age of ten the thousand young
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people and then you correct carry that through the age of eighteen you pretty much lost half of them
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so that's a real concern and it's it's of great concern certainly in our country um in young women
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and this has consequences is us data no across like doesn't look terribly dramatic
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actually it is this is a piece to levels in young people in
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the us starting in a nineteen seventy long going through twenty ten
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i'm always saying is fairly significant increases in childhood obesity
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others i put it to you that when we consider the issue globally
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um and you're by two normally on a friday morning i'm
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in my pediatrics adolescent clinic in my national service
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hospital in not saying i'm actually the issues on interactivity not over
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activity in labour had a very lovely slide where she demonstrated
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the the maximum every benefit probably lies somewhere in the middle is narrative
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home you stay says in the middle that we need acted
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so i think we have a job to get young people to be more active we also certainly have a job look
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after those who are very busy active cage and having to
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use problems so that was just to set the c.
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so here's a very simple question all children simply smaller dials
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um and the also that is no no with very well educated sitting in this room
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but i have to tell you um you know when i sit in my clinic
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um parents often who uh living out there
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inadequate and inadequacy vicariously through that children
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are often pushing and pushing and pushing them and they have the mentality of an adult and they're applying it
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to a child and to charles body and we need to understand the children are very very different anatomically
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and we know this because there's a lot of good epidemiological data that will
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tell us that if you look at a injury patterns you can describe
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around fifteen percent specifically to physical scully to immaturity
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and it has significant consequences feisty oh fractures very fractious through growth
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plates my account for about a fifth of those fractures
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but actually for a one to two percent there's great the
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rest and that's a serious consequence of that injury
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we also get focused on certain anatomical areas so whether it be the shoulder and
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a young tennis player the wrist indigenous the elbow uh in a basketball player
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and certainly fit in terms of consequence these have specific problem so the
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radioactive says and the rest is married with particularly interested in
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i think what's really interesting is this crossover one doesn't
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move use problem then present as an acute injury
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we have classifications on big we made as a scribe to an h. each presentation
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but actually what was going on in that young person that young people persons body with repetitive training
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i don't know if it's predisposed to a subsequent acute injury and our brief revisit that little bit later
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and we saw for with all of our studies with a lack of standard classification
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we generally know that all the launching children have agreed to injury risk
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so in our clinic we um would it to our new patients
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and this is to use of data is this is twenty thirteen twenty fourteen
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and we just asked them where where do you think you yeah you problem came from your your presenting complaint
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and actually know how clinic which is a national health service clinic actually the vast
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majority not specifically related to schools activity there that classified as insidious onset
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but we know new so from our continue professional development without trainees you come through clinic
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we know whether problems lynette problems lie predominantly in low them out and back
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we also know anatomically we need to understand the young
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skeleton well whether it be a prophecy l. injuries
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five seal injuries or stick under i suggest accounts that we had about earlier this morning
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so the prophecies are growth centres um and they can be
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injured either through a repetitive stress and traction injuries
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well sometimes as in the wrong tape to the anterior inferior products
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by numbers x. ray on your drawing to an acute injury
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the most interesting to me is does that patience is the same x. ray
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does that perhaps a lead to impinge meant uh i'm in late i service uses perhaps another crawls
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all of a former fitting punishment which robin past being common punishment in this case would
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be concerned page which is a different type of from a stabbing pain shouldn't
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thinking about the future what these injuries due in the years ahead
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just to briefly talk about the also country sees the ones we really worry about
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so the articulate all secondary sees i think is interesting in madsen generally
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when somebody puts than name to a condition or syndrome or there's a long time like
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cost your control is just just a cans based on latin or greek definitions
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often it's telling us that we don't really understand the nature of that condition i think this is the
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case for loss of the the conditions we see in in all young uh oh young athletes
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but they are interesting and they have consequences so here's an example
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of one of those particular conditions this is fry books disease
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uh so this is a collapse of to be the second or for that matter tossed her head
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uh and this is a um an x. ray of one such young child with this problem
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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
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with for for today and she doesn't recall having injuries uh as a youngster but she has
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a collapse methods also had um i suspect she will most certainly had fried ducks disease
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uh as a young person so these conditions have significant consequence and we need to
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treat them well and recognise them as best we can in young people
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sean labour the point about the c. d. because we've heard
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a very elegant talk about this condition early this morning
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but just suffice to say we see different patterns of this in different
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athletes seven females we see ankles more commonly out than perhaps nice
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in nothing and we have a high performance gymnastics centre was that we haven't young tennis players presenting with
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similar lesions in the elbows because i spend a lot of time wandering around on the opulence
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and frank alluded to the rock group so this is a group in the
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us the doing a really great thing which is trying to create
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eight how what of young people with us to control just s. a. cans
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along with you know how to try and provide us with some data
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so we can better understand the long term consequences of this condition so i read the itchy
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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
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we learned about different ways of of trying to address this problem
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but i put it to you that you're having an a. c. l. injury so
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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
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that's just coming out of showing changes but only changes just three months post a. c. l. ha
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so whilst doing surgery may fix the leg and may provide
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a stable ne and i'm not in any way diminishing
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the importance of nice stability that's been elegantly demonstrated to us uh idea
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what we do know is that these young people have a
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much higher incidence of subsequent osteoarthritis of the nice
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and so if we know who the the two greatest
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risk factors osteoarthritis are being overweight and injury
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what can we do about it well it's important that we intervene and we
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provide both primary and secondary prevention strategies and this is some early data
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from i'm karen memories group reported by jacking which again this is the calgary group
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and they've got an interesting study where they've taken a hundred uh youngsters with knee
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injuries and dave match them with a similar number of age sensible much controls
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and not entirely germane to to us 'cause actually the age range here is fifteen to twenty six
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but the problem really dated which is reported a couple of years
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back showed that those with knee injuries have four function
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great and the symptoms have a greater risk of being overweight uh and
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the base three ten years post injury when compared to control groups
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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
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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
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and if you then look boulder so this is a um a matter analysis systematic review
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from phil commands group in leeds and they
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looked at sports participation and osteoporosis
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and what they concluded was that the evidence base um is of low quality
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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
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this doesn't really include the age group we're interested to tool
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and the follow our time was either very short or quite long service daughter is not transferable
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to the age group that we're concerned with so we have a job to
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do which is to create some really good long vertical care what's
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and i would urge us all to get together because for the studies we need huge numbers
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so if we're able to collaborate together then i think we have a chance of providers and data not for me but for
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the people that follow me and my my work and and and some of our work to provide ounces in the future
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so to go back as i said i would do to review
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since you this is a very well known paradigm where we
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understand the intensive genesis of injury we have intrinsic factors you can't do a great deal about
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such your age and sex an extrinsic factors are all the things that we do
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the training error is one of the greatest that he sees but we
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also interested in equipment that's a office environment and so on
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when you put those together what you end up with is a predisposed
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ass halfway to maybe then become susceptible to injury or illness
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and then the key thing is is are inciting if that does something happen that then triggers that injury
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so here suffice seal injury this is a typical uh five seal injury ah well humour up if it's it's
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so we see this in young tennis players uh and and we
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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
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and we recognise a pattern of more significant phi seal injuries
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with with fracture and this is the salter harris classification
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but i put it to you here's a young gymnasts they got it wrong
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coming off of old and stuff for the very nasty that injury
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was it was was the phi six week and pry ah to that one
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of all that went wrong what had this bean a problem that was brewing so i take it back to the model
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predisposed susceptible actually we need to think hard about
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whether or not we're training in such a
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way that we're converting predisposed referees to susceptible athletes so we'll see what's going to happen
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as it happens i can tell you the outcome for this actually was good actually did very well
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and this is important and again it just cries out for more down to because this is from um
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because i'm not for the but really drawn if your u. c. l. a. and david canes group
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actually we know who the consequence of phi seal injuries
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can be severe but there's a huge age range
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a big problems like this huge range of um well all
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subsequent miss chief um as as athletes get get older
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so the age range uh get can be from zero to the
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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
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doing in society so he is just one example so in peewee baseball
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in north america um the baseball speed down has been
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introduced how young kids and coaches estimate um friends
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um and you can say exactly the same um in this what the tennis that on involve with
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i don't think i notice single tennis player wimbledon he
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hasn't lost into a rotation of that dominant all
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which tells us they have a but any problem is typically bunny relevance off to
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she related to years of throwing a tennis racket i great angular velocity
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and perhaps we have this speed on it they say is a very damaging thing
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because it's encouraging youngsters prancing tartan coaches to do something that we know it's going to be injurious
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i had a fascinating consultation and just earlier this week with the young cricket so
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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
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and as a creek liza fast policy runs in both um a
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maybe thirty twenty to thirty meter run up and bowls the
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ball that um that probably seventy eighty miles an hour
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um and we know that the repairs five extension rotation
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using e. u. is injurious for the low back
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but in the conversation with a file that i said how many of us has your
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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
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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

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Conference Program

Welcome
Frederic Koehn, President Young Athletes Forum Foundation
21 Sept. 2017 · 1:18 p.m.
3,172 views
Opening address
Boris GOJANOVIC
21 Sept. 2017 · 1:22 p.m.
136 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.
570 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.
431 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.
355 views
111 views
Resistance training during long-term athlete development
Urs GRANACHER
21 Sept. 2017 · 2:52 p.m.
386 views
The development of aerobic power in young athletes
Grégoire MILLET
21 Sept. 2017 · 3:15 p.m.
1,494 views
Fueling the young athlete
Asker JEUKENDRUP
21 Sept. 2017 · 3:36 p.m.
196 views
Training young athletes: challenges and opportunities
Marco CARDINALE
21 Sept. 2017 · 4:01 p.m.
187 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.
203 views
Knee ligament injuries in immature athletes
Franck CHOTEL
22 Sept. 2017 · 7:48 a.m.
102 views
Osteochondral lesions
Franck ACCADBLED
22 Sept. 2017 · 8:11 a.m.
248 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.
105 views
161 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.