Could sport be putting your child at risk of injury in later life?

Could sport be putting your child at risk of injury in later life?

UPMC Sports Surgery Clinic Children in Sport
If you have kids of a certain age, chances are your week nights and weekends are consumed by a constant whirl of Go Games, blitzes, training sessions and tournaments. While inactive children are at risk of childhood obesity, others spend every spare hour battling it out on a muddy pitch somewhere.
The physical benefits of exercise are obvious, as well as the life skills that can be learned from playing team sports, yet many parents wonder if their young children are at risk of injury down the line due to the sheer extent of the sporting activities they do.
I’ve heard sideline conversations where parents talk of the 10-20 hours of organised sports their young ones did the week before. But is that amount of high-impact activity too much for growing bodies, putting children at risk of recurrent injuries in their 20s and 30s?

One man who is well placed to answer this question is Professor of Orthopaedics and Sports Medicine at Trinity College Dublin, Cathal Moran. In addition to his Trinity role, Cathal, who did his sports medicine training in New York working with athletes from teams including the Giants and the Mets, is also a consultant surgeon at one of the country’s leading centres for sports-related injuries, UPMC Sports Surgery Clinic.

UPMC Sports Surgery Clinic and Trinity College are currently working closely together to drive research and learning that can support the care of injured athletes of all ages.
Professor Moran, who has had work published internationally on knee and shoulder injury, explains the problem: “One of the issues is that when injury happens in younger life, you may be at risk of developing further problems with that joint over your lifetime.” Appropriate injury management, as well as injury prevention where possible, are key factors in improving outcomes.
One of the most common things Professor Moran sees are knee injuries, which appear to be on the rise across all age groups, from age four right up to age 40.
His area of expertise includes the ACL (anterior cruciate ligament) – SSC consultants perform about 1,500 reconstruction surgeries every year. The youngest he’s operated on so far in 2016 is a 12-year-old who had recurrent instability.
“International research suggests that there is over 20pc re-injury rate on the same or opposite knee following an ACL injury in one’s teens,” he says.
If you dislocate your shoulder, a common rugby injury, at a young age, this is the strongest predicting factor for this happening again.
What’s also of concern though, according to Professor Moran, is the fact that of those who get injured, a significant number may struggle to achieve their previous level of performance or may decide to give up their sport entirely as a result, which no parent wants to see either.
A paper just published in the American Journal of Orthopaedic Sports Medicine examines the benefits or otherwise of early sports specialisation among young children. They classify this as roughly 12-year-olds, who participate in one main sport for eight or more months of the year.
What they found was that these kids were subject to overuse injury, burnout and increased drop-out rates from sport. It also showed that there are no benefits to be derived from specialising in a sport early on.
Greg Myer, director of research and the Human Performance Lab at Cincinnati Children’s Hospital, is a similar advocate to Professor Moran; both shared a stage recently at an international SSC-TCD ACL injury conference which took place in Trinity.
(2nd Annual Meeting in Orthopaedics & Sports Medicine focusing on the ACL took place in Trinity College Dublin on October 21st. L-R Cathal Moran, Consultant Orthopaedic Surgeon specialising in knee & shoulder surgery, SSC; Enda King, Head of performance Rehabilitation SSC;  Luke Anthony, Injury Prevention Specialist at Norwich City FC; Greg Myer, Director of Research & The Human Performance Laboratory, Cincinnati Childrens Hospital; Nick Winkelman, Head of Athletic Performance IRFU; Grethe Myklebust, Oslo Sports trauma Research Centre, Norway; Chris Richter, Head of Sports Medicine Research & Development, SSC;  Neil Welch, Lead Strength & Conditioning Coach, SSC and Mark Jackson, Consultant orthopaedic Surgeon specialiaing in knee surgery at SSC)
Greg’s research began 20 years ago when he set out to try and find why young female athletes were suffering a greater number of injuries compared to their male counterparts, with injury rates for females peaking at 16. They looked at the whole school district, from age 10 up, studying the kids’ biomechanics as they matured and what factors led to higher injury risk.
What he found was that female athletes jump as high as they’re ever going to jump at puberty – as they mature they don’t get any more powerful. He likens it to building a bigger car but without adding any additional horsepower. Males, on the other hand, become more powerful with each successive stage of puberty.
The relevance of all this? It highlights how crucial early motor skills can be for kids if we want them to play injury-free sports later on.
“Obesity is the number four killer worldwide but kids aren’t getting exposed to proper motor skills in their physical education in schools,” he says. “Yet they’re still going out and playing sport, and playing at a very high rate, but they’re not developing the prerequisite motor skills that will help them play sports safely.”
These kinds of motor skills Greg speaks of should be taught to kids early in life prior to risk factors setting in, ideally “as soon as they can take instruction”. In addition to being taught how to jump and land, they should also be taught resistance training.
The key message coming through is that if you want your children to play sports, get them to play a variety – don’t have them focus on one particular sport, especially if they are under the age of 12. Most importantly, don’t underestimate the value of free play, which has been edged out in favour of more parent and coach-led activities in recent times.
“Free play is so important,” says Cathal. “It builds core strength, brain signalling to muscles, and a multitude of other factors that they can then apply to their sport.”
Both medics agree that injury prevention should be top of the agenda when dealing with kids in sport, not only so that they can stay healthy but also so that they can remain playing sports throughout their lifetime.
The good news is that there is a vast amount of research now being done in the area of injury prevention and treatments and rehabilitation protocols are improving all the time.
“We’re always trying to understand why these injuries happen,” says Professor Moran. “For example, we have just had a paper from Trinity and SSC accepted to the British Journal of Sports Medicine looking at video analysis of ACL injuries in rugby.
“It demonstrates that two thirds of them are caused by contact and that many of these happen in the last quarter of the game. This is all new data, and
something that allows us to think about best techniques to keep players safe.”
Previously ACL injuries were thought to be mainly non-contact, with an even risk throughout the game.
Last year Proessor Moran also helped establish a sports medicine pilot programme that assists injury management in Trinity’s student athletes, the first of its kind in the country. Working with Trinity Sport and Trinity Health Centre, it has been a big success and the hope is that the knowledge gained can be rolled out to school-going children in due course.
Part of being a parent these days involves continually educating yourself so that you can guide and advise your kids as best you can. But we can’t do it on our own.
“For me, there’s a mechanism that can reach all our kids and that’s our school system,” says Greg. “That’s where we’re failing them because what’s happening now is there’s competition to get into better schools. To do this they need to spend more time studying and there’s this perception that you can just get rid of physical education classes because they’re the ‘fun’ class.
“Physical education builds motor skills that last a lifetime. It doesn’t make sense why we’re taking it away,” he adds.
So let the Go Games, blitzes, training sessions and tournaments continue, because mixing up their sports like this is actually one of the best ways we can keep our children from injury. But bear in mind too that other important activity – free play. Anyone for a game of tip the can?
For further information on this subject please email info@sportssurgeryclinic.com

UPMC Sports Surgery Clinic appoint GP Liaison

UPMC Sports Surgery Clinic is delighted to announce the appointment of Louise Fleury as GP Liaison.
Louise will liaise with GP’s, Consultants, their secretaries and patients to provide you with appointments at SSC. Louise is also there to support you should you have any difficulty contacting any of our consultants, departments or services.
Our GP Liaison provides you with:
• Rapid access to appointments with our Hospital Consultants
• One telephone number and one initial phone call – we look after the rest
• Peace of mind knowing that your patient is being looked after.
Services are available between 9.00 am – 5.30 pm, Monday to Friday.
Tel: +353 1 5262300; Fax: +353 1 5262081; Email: gp@sportssurgerycliinc.com
Operating theatre at UPMC Sports Surgery Clinic

Anterior cruciate ligament injuries – are they becoming more common?

by Anne O’Donoghue for The Irish Times on Friday 8th July.

ACL Surgery at UPMC Sports Surgery Clinic

‘It doesn’t take great force to do it. A certain amount of bend, a certain amount of what we call valgus – inward bend at the knee – and a certain amount of rotation.” Put that all together and you have the “perfect storm”; a recipe for disaster described by Mr Ray Moran. The result? A ruptured anterior cruciate ligament, also known as ACL.
Moran is an orthopaedic surgeon, based at the UPMC Sports Surgery Clinic in Santry, Dublin. He reconstructs hundreds of ACLs every year.
The ACL is located in the knee, joining the tibia and femur. The injury does not occur through wear and tear; the rupture is a traumatic incident, specific and acute. In its simplest form, the ACL ruptures due to a twisting of the knee. A tear may be partial or complete.
When the athlete lands and their foot comes in contact with the ground during a change of direction, the force can hit the knee a certain way which twists it. The quadriceps muscles pull and the twisting motion overloads the knee, causing the ACL to rupture.
An ACL rupture is particularly devastating to athletes because of its long recovery time, which can be anywhere between six to 12 months.
Studies show women are three to four times more likely to rupture their ACL than men. There is no single reason for this and experts are not entirely sure why injuries are more common in women. However, some theories include the fact that women have a naturally wider pelvis, causing the knee to fall towards the centre more. Women also tend to be more supple than their male counterparts and have a smaller bone surface area.

Real-life ramifications

One woman who can explain the real-life ramifications of an ACL injury far better than any scientific term is Galway camogie player Therese Manton. Manton was a late bloomer when it came to camogie, only taking up the sport at the age of 11, but since then she has flourished.
The Mullagh club woman won two Ashbourne cups during her time at University College Dublin and a senior All-Ireland camogie final with Galway in 2013. In 2015, Manton contested two All-Ireland finals, first a club All-Ireland final against Wexford’s Oulart The Ballagh and the senior All-Ireland camogie final against Cork.
They were fruitful in neither challenge, but the 28-year-old returned at the start of this season hoping to right the wrongs of last year. However, that perfect storm occurred.
It was a challenge match against NUIG in Ballinasloe – a minor match, just a chance to give the whole panel a run and test different combinations of players.
Manton was beginning what would have been her 10th year playing camogie with Galway, a seasoned hand at this stage. Towards the end of the match, she was driving forward from the full-back line and went to dodge the player in front of her. That movement caused her to fall to the ground.
“I actually don’t remember much. The girls told me I screamed when I went down, but what really made me nervous, what I can remember, the most horrifying thing was that I could hear the crack in my knee and I think that is what frightened me most.”
At this stage, Manton was unaware that she had just ruptured her ACL. In the days and weeks afterwards, she did not experience much pain, just soreness and tenderness. She worked on getting the swelling down in her knee and thought she had not done much damage.
Manton, a nurse, thought it was a little excessive when a physician suggested she go for an MRI, but she took the advice anyway. “Even the morning I was going for the MRI I felt like a bit of a fraud, that I didn’t have a genuine injury. I thought the MRI was a bit excessive, but I went and had it done.”
Sure enough, the rupture was discovered. A visit to Moran ensued and then surgery. Manton underwent the surgery at the end of March and is in the third month of her rehabilitation programme. She is not alone or even in an exclusive group of sportspeople who have ruptured their ACLs – many athletes have done it and there have been a lot of high profile cases.

More common?

The question, discussed in serious tones on sidelines and debated in dressing rooms after matches, is are ACL injuries becoming more common? There is no definitive answer, says Moran, because there is no concrete data from yesteryear from which we can use to draw a comparison.
“If you go back 20 or 30 years you have a situation where the MRI scan was only coming into its own. If you go back about 40 years and you got a rotational injury to a knee and players had any sense of giving, it was assumed to be cartilage. I still see patients today in their 50s and 60s who have ruptured their ACL and don’t know it.”
Enda King, a physiotherapist and head of performance rehabilitation at the UPMC Sports Surgery Clinic, says ACL injuries are more common among those who play field sports, because the movements required are riskier to the knee.
“A runner can [injure their ACL], but it is all about risk. The high-risk positions are single leg landing and single leg change of direction. So, cyclists, swimmers and track and field athletes are moving straight ahead; I can’t remember the last person I saw doing their ACL like that.”
King, currently doing a PHD in rehabilitation and return to play after ACL injury, says prevention is possible.
There will always be a certain amount of ACL injuries which are contact – they cannot be prevented – but non-contact injuries, which have to do with the way an athlete moves, can be reduced through improving movement and lower body strength.
Manton is very passionate about injury prevention and it is something she says she will push for when she finishes her recovery. “Obviously going through this myself, I wouldn’t want anyone else going through it and if we can try prevent it I think we should. We need to start working on it now rather than later.”
ACL rehabilitation can take anywhere between six to 12 months, but King is quick to warn that there is no one-size-fits-all scenario for returning to sport. Your return should be guided by how well you move, not how many months you have been in rehabilitation, he says.
Manton has a very positive outlook on her injury. She is progressing well in her rehabilitation programme, which she does five to six days a week with her husband, who is also recovering from an ACL injury.
“The programme really helped me in that I am progressing very well, but it also helps keep your mental health in check, knowing that you are doing all you can to get back to the game you love.”
King’s advice to those who may be dejected because they are injured is that “every injury is an opportunity” to come back a better athlete then you were before.
“If you ruptured your ACL and it wasn’t a direct hit to the knee, that is clearly a sign that athletically speaking or from a movement competency point of view, you weren’t really moving as well as you could.
“Obviously no one wants to take six to 12 months out to try to improve their movement, but it is an opportunity to come back stronger and fitter.”
For further information on this subject please contact 353 1 5262030

Nursing Careers at UPMC Sports Surgery Clinic

The nursing service of the UPMC Sports Surgery Clinic is patient-centred and patient-focused. The UPMC Sports Surgery Clinic goal is to provide exceptional levels of quality care with a major focus on positive outcomes and patient satisfaction.

The nursing department strives to recognize the uniqueness of each individual and aims to develop a therapeutic relationship with the patient that is based on trust understanding and empathy and serves to empower both patient and staff. We are committed to ongoing training and development of all our Nursing Staff.

Our inpatient beds provide a contemporary relaxing surrounding. Each patient will have an individual entertainment centre with television, internet access, telephone access, treatment information, support services that are nurse monitored. A revolutionary quality of service to patients.

The CSSD department supports the theatre, wards and other clinical areas with re-processable medical devices, equipment and materials. These devices are required to undergo a validated process of cleaning, decontamination and sterilization by suitably qualified staff. A tracking and traceability system is in place for sterile processing and documentation of sterile supplies.

We will be recruiting for a number of nursing positions across a variety of specialities including the following:

  • Theatre
  • Anaesthetics
  • Recovery
  • Inpatient ward
  • Day Ward
  • Bank Nurse
For further information please contact Mary O’Brien on +353 1 5262175 or maryobrien@sportssurgeryclinic.com

Strength Training for Beginners

All too often people taking up exercise overlook their body’s core – their back, abdominals and hip muscles. A strong core is essential to help you progress and reduce the risk of injury. Your core acts as a shock absorber and a stabiliser between your limbs, absorbing the energy your arms and legs generate when you’re exercising. Research shows that resistance training is likely to improve your performance and reduce your risk of injury.

1. Bridge

Strength exercises bridge
Lie on your back with your arms down by your side and your feet planted on the floor directly below the knees. Press down on your feet, and lift your torso and buttock up until your shoulder, hip and knee are in a straight line. Keep your back straight. Hold for 5 seconds.
(7-10 reps x 2 sets)

2. Bridge with arm raise

Lie on your back with your arms down by your side and your feet planted on the ball. Press down on your feet, and lift your torso and but-tock up until your shoulder, hip and knee are in a straight line. Keep your back straight. Raise your arms to the ceiling, hold for 5 seconds
(7-10 reps x 2 sets)

3. Gym ball bridge

Lie on your back with knees bent and heels upon the ball or small step. Maintain neutral lumbar spine by drawing abdominals inward and dig heels into ball or step. Squeeze your bottom and lift hips off the ground. Lower down and repeat.
(7-10 reps x 2 sets)

4. Side lying leg lift

Lie on your side with your legs extended out straight. Your lower arm can rest under your head; your top arm can rest on your hip. Lift the top leg up while keeping your hips steady and facing forward (do not rotate backward). Lower down and repeat. For an added challenge, wear a light ankle weight.
(7-10 reps x 2 sets)

5. Gym ball plank

Lie on your front with knees straight and feet on the ball or small step. Lift up into a push up position, maintain straight lower back by drawing abdominals inward. Lower down and repeat.
(7-10 reps x 3 sets each side)

6. Lunge

Take a big step forward, keeping upper body as straight as possible. Lunge until your front thigh is parallel to the ground and your back knee is close to the floor. Both knees should be bent at approximately
90 degrees. Make sure your front knee doesn’t go past your toes. Return back to the standing position, alternate legs and repeat.
( 7-10 reps x 2 sets )

If you are confident exercising on your own then these are some simple core exercises for you to try!

Tel: (01) 526 2030. Email: sportsmedicine@sportssurgeryclinic.com

Strength Exercise Plan available to download by clicking below.

‘How should I warm up before a run?’ – Warm Up and Running Drills

A thorough warm-up for running or jogging is often overlooked but remarkably important for improving performance and decreasing the chance of injury. Whether you are a track specialist or road runner the drills in this article will help to promote a more efficient, dynamic running technique, improve range of motion and muscular function, whilst providing the appropriate intensity for your intended training session.

Part 1 – General warm-up exercises

At this stage, you are probably feeling cold, tight, sore and not ready to perform. The aim is to loosen the muscles and joints here and start to warm the body system. The following movements can be incorporated into the general warm-up; the aim here is active preparation.

  • Light to Moderate Jog 400m
  • Leg Swings – Lunges – Squats
  • Grapevine – Side to Side Skip – Backwards Run

Note: Static stretching is not specifically included in the ‘active warm-up’ however if you have any defined areas that require specific stretching in order to improve range of movement (flexibility) this can be added here.

Part 2 – Pre-run drilling

The aim at this stage is to improve running efficiency and technique, enhance energy recoil from the ground and to promote a positive running gait (stride). E.g. running on the forefoot.

Marching

Purpose: Promotes correct leg action and active foot plant
Description: Hands on hips – Drive heel to butt – Stomp on forefoot under hips
Cues: Front of shoe points in the direction of travel – Heel of shoe pulls up to butt
Sets & Reps: 3 sets x 15m

Knee Drives (skips)

Purpose: Promotes recoil (bounce from the ground), switches on key muscles and is an active progression from the marching drill (drill 1)
Description: Similar to the march (drill 1) with a skipping action (small air time) included
Cues: Skip and actively plant foot back under hips Sets & Reps: 3 sets x 15m

Butt Flicks

Purpose: Promotes correct leg action in the swing leg – Builds towards running specific action and tempo
Description: Running action with heel coming to butt – Slowly transitioning forward Cues: Pretend there is a hurdle in front of each step – Fast leg recovery
Sets & Reps: 3 sets x 15m

Marching

Knee Drives (Skips)

Butt Flicks

Part 3 – Running/jogging specific intensity

The final stage of the warm-up should involve working your running efforts towards the intensity required for your specific run or jog. This will be extremely individual depending on the distance and speed of the session. The golden rule here is basic, you must get up to your race or planned session speed prior to competing or participating. For endurance-based athletes, you should take your body close to or above session pace for a short duration. It takes time for your body to start delivering oxygen to your muscles at its most efficient rate, thus it’s important to prime the system by ramping up intensity to the desired level. This will improve the start of your session substantially.

  • 2-6 minutes of near lactate threshold (beyond talking pace) running or of a similar rate to the planned session

For track-based athletes, the aim is to take your body to the speed at which you will run the session or competition.

  • 4-6 efforts of 60-100m building intensity from 80-100%
  • Maintain rest periods of 2-3 minutes between repetitions as the intensity increases

Nick Richardson, Strength & Conditioning Coach SSC

For further information on this topic or to make an appointment with a physiotherapist please email sportsmedicine@sportssurgeryclinic.com or call +353 1 5262030
UPMC Sports Surgery Clinic's Educational Meeting in Gorey

Photographs from ‘An evening for Runners’ at SSC

On Monday 15th February approximately 90 people attended ‘An evening for Runners’ in UPMC Sports Surgery Clinic.
This event took place in SSC’s 3D Biomechanics Laboratory and comprised of presentations from our Physiotherapy and Strength & Conditioning teams.
Colin Griffin, Lead Running Coach at UPMC Sports Surgery Clinic presented on ‘ Running biomechanics and training programme design’ and this was followed by Evin Scanlon,Musculoskeletal Physiotherapist at SSC presenting on ‘Injury prevention and strength training for runners’.
For further information on Running Services offered at SSC please contact +353 1 52662030 or email sportsmedicine@sportssurgeryclinic.com

An evening for golfers at UPMC Sports Surgery Clinic

Golfers at UPMC Sports Surgery Clinic
At this event, Neil Welch, Lead Strength & Conditioning Coach and James Carolan, SeniorMusculoskeletal Physiotherapist presented to over seventy golfers from a variety of clubs throughout Dublin and Leinster.
James Carolan’s presentation was on ‘How to prevent back pain in golf ‘ and Neil Welch discussed ‘Five minutes trainig that will improve your game’
Following their presentations Neil and James gave practical demonstrations of the exercises covered in their presentations.
There was a fantastic atmosphere at the event and a great night was had by all.
Some of the slides used on the night are available to download here.
For further information on this event please email fiachraoconnor@sportssurgeryclinic.com