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Chapter 1: What is the main topic discussed in this episode?
The Clare Byrne Show on Newstalk. With Aviva Insurance.
Well, the upcoming summer holidays mean many children will be heading off to summer camps. They'll be starting GAA camps and soccer tournaments, athletics, summer programs and all the rest of it. And chartered physiotherapist Larry O'Mahony is with me now to talk about why injuries spike during the school holidays and what we can do about it.
Well, maybe the clue is in everything that I just said there, Larry, that they're doing so much more, aren't they, in terms of physical activity in the summer? Yeah, thanks for having me, Clare. Absolutely. So for a lot of children, they're going from maybe having a winter season where they do very little.
Chapter 2: Why do injuries spike during the school holidays?
And then now suddenly back in February, March, they might be back to two trainings and maybe a match. And then when the summer holidays come, what you see is an increase in structured activity. And that's your camps. They could be at that for a couple of hours a day. And maybe they're doing now a summer league. For some kids, they might be in academy training or development squads.
And they're also hanging out with their friends. OK, and so they're doing the cycling and the trampolining and the swimming. And one thing we don't take into account enough is actually they have then less recovery time. So you see like later bedtimes, maybe more screen time and then also less routine and maybe more travel.
So you're asking a lot more of the body and the body doesn't have as much time to recover. And I think sometimes we can get confused looking at teenagers because sometimes they look very grown up, but actually a teenage, an adolescent body is so different to an adult body. Okay, and they're growing as well, sometimes at a pace, you know, depending on what stage they're at.
And that can bring its own problems too, can't it? Yeah, that brings problems for everybody. Parents going to the shop to try and constantly keep their kids in shoes and clothes because boys can experience at certain points like between seven to 12 centimetres of growth in less than a year. And so for girls, it can be eight to nine centimetres within a year, which is enormous.
And that's when you'll see parents talking about their daughters on the pitch and their sons as well, all of a sudden looking clumsy. And they'll say, oh my gosh, yeah, like last year they were moving so well. And this year now, they're a bit clumsy or they're a bit awkward or they're all hands and legs. And so the bones will grow first and then the tendons and the muscles have to catch up.
And then your brain... has to try and figure out what comes next, because your brain's used to living in the same body for maybe 10 years or, well, for girls, you know, puberty will hit kind of from eight. For boys, generally, it's kind of 10. But your brain is used to like looking after your body, being in control. And now it's a completely different body.
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Chapter 3: What activities increase physical strain on children during summer?
So your brain has to catch up as to how well it's giving the commands for running and jumping and landing. And then you can have problems like Severus disease, which is, again, the ligaments haven't caught up with the bones. Isn't that right?
Yes.
Yeah, so Severus disease, imagine, affects about 16% of adolescents, which is huge. And it is, first of all, it's not a disease. It's a growth related condition. So it really only occurs when adolescents are growing. And what happens is the heel bone can grow very quickly. And we'll all have experienced that when all of a sudden the shoes are really small. And you're like, how did this happen?
So the heel bone can grow really quickly. And then the calf muscles and the tendon attaching onto the bone are struggling to catch up. So where they attach onto the bone, the adolescent or athlete can experience irritation and pain. So the good news is that you don't have to stop playing sport, but it's all about load management, okay?
And it's looking at how much training is your child or adolescent doing? And so then can you manage that a little bit? And then also looking at stretching and flexibility, footwear is another thing to look at, making sure the football boots are correct. Do you need a lift in the heel?
Yeah, sometimes adding in a heel lift is really useful because it takes the tension off the tendon while the tendon then can lengthen a little bit. So lots of things you can do. So is that the main one that you would be worried about when you look at the summer and all of these additional activities or what are the other concerns you have or what do you see coming to you?
Yeah, we see a lot of Osgood-Schlatter's as well. And that's like 10 to 20 percent of adolescents. And that's pain at the front of the knee. And that's a growth related condition as well. And a lot of these conditions are related to load. So once again, coming from that maybe season of doing very little and then they're thrilled.
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Chapter 4: How does reduced recovery time affect young athletes?
Hopefully the weather is better. They're off school and then we're up to maybe 10 hours of training. And so then you have your... Severs are also known as apophyseal calcinitis. Or we also have... The Osgood-Schlatter's, which you talked about, the pain in the front of the knee. Is the treatment the same for that? Is that stretching and watching how much you're doing, but not complete rest?
Absolutely now there'll be like rare times where you might need complete rest but often what we're looking at how can we keep somebody in sport because it's really important for their social connection in the summer and for their mood and so yeah so stretching strength work and reducing training if we need to.
Then we'll also see I suppose for girls is they're at a much higher risk of ACL injuries. Yeah talk to me about that because that's getting more and more attention of late isn't it that women are more likely to experience an ACL injury women and girls do we know why? Well, there's actually lots of different reasons.
So first of all, when we think of puberty and the changes the body experiences, so the pelvis will widen. And so therefore, this can then have an effect on their neuromuscular control. So let's say they're jumping and they're landing. So like the strength then around their hip and their knee and their ankle.
Biomechanically, sometimes the knee can fall in a little bit more for girls because the pelvis is wider. Hormonal changes can also have an impact. And then, you know, are they're training properly?
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Chapter 5: What growth-related issues affect adolescents' physical performance?
Are they getting sufficient training to kind of combat the fact that some of these factors are at play? OK, because you don't want to have that injury in the first place. So it's trying to avoid the occurrence, isn't it? Yeah, absolutely.
And this got real, I suppose, notice because it was at the World Cup last year or the last female World Cup, there was 30 players unable to play because of ACL injuries. And so females are three to seven times more likely to get these injuries. But the good news is that there's really good programs out there that coaches can implement before they do a training session.
And they're available online and they have been shown to reduce risk of ACL injury by 40 to 60%. And so the GAA have a programme, that's the GAA 15+. So FIFA have, FIFA 11+, I think it's the GAA 15. And then rugby have Elevate. So they're really good programmes that our athletes should be doing to reduce their risk. And well worth it if it's going to reduce the incidence of it by 40 to 60%.
You did say there that it's really important to keep them playing and that's what you want to do while you're treating this. But when do you get to the point where you can't push through or you shouldn't push through? Yeah.
When you can see that your child is limping, okay, you know, if pain isn't settling within 24 hours, if your child is limping, if they're talking about night pain, if you start to see that their mood changes a little bit, you know, I think sometimes younger people, they're not as good at expressing if they're in pain.
And I think if you're seeing mood changes, limping, if there are tissue changes as well, of course, like if you are noticing swelling, redness, heat, that sort of irritation. And then if they're saying to you, I can't go training. You know, these are all kind of really big combined kind of reasons to say maybe we need to stop and have a look at this.
So when that happens, when you have those factors, what is the next step? So I would always say go and see a chartered physiotherapist. OK, but in the short term, what you can do is like look at reducing load. So it's load management. And then straight away looking at as a parent, you know, has your child gone from that three hours to maybe 10 hours of training?
And can you just take a step back yourself? What we would say when it comes to load is. In the past, there was this like 10% rule, which is very outdated. So modern policies would suggest actually maybe going from three hours to four to five hours and then the next week, maybe five to six hours. So maybe you're taking a month to get up to 10 hours of exercise a week.
So as a parent looking at, can you reduce maybe their training load initially? Does that help their symptoms? But definitely, you know, keeping them doing some stretching, keeping them doing some strength training. And you can do that yourself at home. Now, if you're not settling, then, you know, children recover and adolescents recover really quickly.
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