Angela Jackson is a Chartered Physiotherapist who has spent the last 35 years seeking to understand why some young athletes get injured, yet others don’t. Her determination to educate young athletes on reducing their injury risk, has fuelled a career that has taken her from Canada, to working with national teams, clubs and schools across many sports becoming an expert in understanding all aspects of youth athlete development. She is the physio to the Cheshire Cricket Board and has a particular interest in low back stress fractures. She is a passionate educator through her online and in person courses and lectures to health and exercise professionals both in the UK and internationally.
In this episode she discusses:
- Why it’s wrong to apply adult diagnoses to children.
- The increase of stress fractures seen after Covid Lockdowns.
- Why any child with Lower Back Pain on the opposite side to their throwing arm should be treated as a stress fracture.
- Her simple test for lower body stress fractures.
- The important of managing Training Volume, Nutrition and Sleep in preventing stress fractures.
- Her mobile phone analogy for kids to explain how stress fractures occur .
You can listen to the episode in full here.
You can keep up to date with Angela via her Twitter: @angiejphysio and via Instagram @angiejphysio as well as her website www.angelajacksonphysio.com .
To learn more about the LTAD Network check out www.ltadnetwork.com or follow on Instagram: @ltadnetwork or Facebook: https://www.facebook.com/ltadnetwork . You can keep up to date with Athletic Evolution via our www.athleticevolution.co.uk , Instagram: @athleticevouk and Twitter: @athleticevouk .
Rob Anderson
Angela, good morning! Welcome to the broadcast. It’s fantastic to have you on this morning. Thank you very much for inviting me. I hope you’ve had a good couple of weeks. Sounds like you’ve been busy around the world jet setting.
Angela Jackson
Yeah, well, I wouldn’t call it jet setting. But I had a visit out to Copenhagen to the World Congress for sports physios, which was brilliant, and then just being back doing some work with FC Copenhagen. So not all pleasure, but I did sneak a little visit into the Champions League game with Man City. So that was a bonus.
Rob Anderson
So before we dig into, I guess your particular area of interest around stress fractures give us a bit of an insight into what your own sporting journey was, like, as a youngster, you know, were you an individual who’s in love with particular sports or just generally being active? What did that look like?
Angela Jackson
So I think I was probably every physios nightmare, in that I loved anything, where I could get involved get moving, I played probably three or four sports simultaneously. And I was just one of those kids that wasn’t outstanding at any of them. But I was pretty good at them all. So everything I tried, I got involved in. And so sort of, around the age of 11, I started playing some higher level tennis and certainly a lot more of it. So had that kind of early specialisation. And given that my mum and dad had to change the rules to be allowed to let me into the club at that point that was still early, even though tennis now started much, much earlier. So played tennis and hockey to a pretty high standard and then sadly got injured. And at that time, there weren’t no kids, sports physios, there really wasn’t much in the way of sports physiotherapy available, and kind of I bumbled through and eventually had lots of failed surgery, until sadly, I had to stop playing at 18. So at that point, it was sort of I didn’t really know what to do with myself. And I think being that athlete with full of energy only ever had one focus, all my sort of social life was totally around sport. I was quite lost, I think, and the only thing I knew anything about was physio. So off I went to physio school, a bit naive, I think, to what perhaps it involved and, and what I was letting myself in for.
Rob Anderson
So I take it that you know, your own frustrations as an athlete, not being able to do the things you love, were kind of part of a fuel for the fire. I think I wanna understand this area a bit more and potentially look at it as a career.
Angela Jackson
Yeah, I think early on, the physio course, then was very much sort of quite theoretical to start with. And I found it really difficult to be tied into a classroom without that ability to kind of get out there and do something. And so I then ended up on a spinal injury ward. And there were lots of guys my age, motorbike accidents, different stuff that got themselves into with paraplegics and tetraplegia X. And I got a bit of a reality check. I had a sore knee, but they had a very different life ahead of them really. And so they engaged with me and sort of said, well, look, how can you get us involved in sport again, and so we started doing some wheelchair basketball, we started looking at some athletics and this was very much early on in in the days of disability sport. And I felt very privileged to be able to facilitate some kind of sporting programme for them. And through that, really, I kind of got sort of a bit more empowered and suddenly found that passion to start to look at, well, why did I get injured? Why did lots of my friends who had very similar sporting load I guess, why did I get injured and they didn’t. And so that started that sort of desire to really explore it. And my brain me my brain was I went into it in massive detail, and have done for the last 35 years.
Rob Anderson
So you’ve obviously been involved in physiotherapy for a while. Tell us about some of the notable stops in your career. I mean, obviously, you’ve been in a lot of organisations, a lot of different sports. Give us a bit of a, I guess, a Reader’s Digest version of, you know, your career has unfolded.
Angela Jackson
Yeah, so initially, when I first qualified, you had to do sort of what they then called basic grade rotations, you had to do a little bit of Orthopaedics, you had to do a bit of cardiac everything that a physiotherapist might do. And with the knee troubles I was having that wasn’t really viable. And so and I didn’t really have the passion for that. But an opportunity came up for me to go out and work in a kids sports injury clinic in Canada. And so I went out there for nearly two years and and it was such a catalyst working in a multidisciplinary team environment. And the sports medicine world was so so far ahead then that I just learned so much. So started getting involved in some ice hockey teams while I was out there, and then came home and kind of worked out that I needed more specialist skills. So was working in a teaching hospital and started to do what was then the equivalent of a master’s. And it kind of gave me that confidence to really try and set something up like I had experienced in Canada. So I set up a physio clinic up just initially working in evenings, and was volunteering for people like sale sharks and England, Junior volleyball. So lots of different volunteer situations to gain that frontline experience. Really? Hmm. Yeah,
Rob Anderson
that’s interesting. An interesting point you make obviously, the industry itself evolved over time. So what do you how do you think the lay of the land is now when it comes to paediatric specialists in physiotherapy,
Angela Jackson
how there aren’t any. So we don’t actually as physiotherapists. And I think I can speak for sports rehabilitator, sports therapists, I think we’re very much all a cohort of great skill clinicians, rather than just looking at the physio stuff these days. And we do very little. So on a standard physiotherapy course, you’d be lucky if you did any paediatrics. And you certainly not going to do any sporty paediatrics. So when they come out of university, they’ll have no knowledge really, and I always kind of use that mantra of you don’t know what you don’t know. So in front of them, they’re going to have to apply adult sports knowledge, adult sort of diagnoses to children, and they’re in Canalys, my dream to sort of see if we can plug that gap and raise awareness of how kids aren’t the same. So that’s been one of my driving forces really, is to start to highlight those differences and how we can actually plug them in that physiotherapy and Sports Therapy world.
Rob Anderson
It’s interesting to hear, because I think, you know, certainly from a sports science Australia conditioning perspective, you know, it’s much the same, you’d be lucky if you get a module, you know, within a special populations module where maybe you’re covering off, you know, as you mentioned, maybe disability athletes, you know, children get lumped into that. So you may have a lecture or two on youth athletes. But then, interestingly enough, the vast majority of jobs are in academies. So the population you’re dealing with on a day to day basis, you actually have very little specialist knowledge about. And it’s not until you maybe have your own back, go and dive into growth and maturation, and I was good Schlatters and sevens before you think, Okay, this is a bit more complex than perhaps it was first led to believe. And, as you said, I can’t necessarily copy and paste what works then out population unto a kid. And it’s interesting to hear that, you know, from a physiotherapy side is it’s essentially the same sort of struggle.
Angela Jackson
Yeah, I think very much so. And I think if we look at that sort of typical football academy model, where a lot of youngsters I mean, certainly one of the interesting things now is that I’ve owned a physio clinic for 30 odd years. And the therapists coming through aren’t necessarily prepared now to go and graft in the same way I did. And that’s not an old lady ranting. It’s just the reality is that they expect and probably need to be paid for the work they do. And whereas we did loads of free sort of apprenticeship type things in all of the different settings, kids aren’t really prepared to do that now, and that I think they’re missing out on this massive opportunity to shadow and learn. And so what they’re going to try and do is get jobs in things like a football academy setting. And the irony being that there’s no way they’re going to let you loose on multimillion pound soccer players in the first team. So they start you with the very youngest kids, who you’ve actually got absolutely no idea how to manage. And so I’ve been working with quite a few clubs now to try and fill that need when they first get them and, and turnover is quite high, because the hours aren’t sociable. And the poor football clubs are basically trying to keep a pace of making sure that their staff have got this knowledge, both on an s&c point of view and a therapy point of view.
Rob Anderson
To the I completely agree it’s exactly the same, I think from the sports site versus EU perspective. And that exactly the same principles never let you loose with the first team. So we’ll let you know in the academy. But as you say, the turnover is really high as a conveyor belt people because maybe they just see it as a stepping stone to the 18 for the reserves the first team so maybe you’re making, you know, if you’re a good practitioner, you’re making mistakes, and you learn from learning from them. If you’re not perhaps not learning from them, but the problem is the person behind you comes in and does all the same errors and all the same mistakes. So ultimately, the people that suffer over kids who maybe aren’t getting the best treatment or the best training, etc. So that I hadn’t thought about it from a physiotherapy perspective, but it totally makes sense this this decision was scary. So a big area of interest for yours is stress fractures. Why particularly stress fractures. Why do you think it’s maybe an area that’s not talked about as much?
Angela Jackson
So when I well I have two children. They both reached international level. So I think one of the things that’s probably unique to me as a physio is, I was that athlete. I then became a youth athlete physio, but I’m also a parent to to international athletes. And so that’s given me a huge insight into the practicalities of weekend as essences and and physios we can sort of prescribe all these very complex sort of interventions for kids. And yet the reality is we’ve got to be able to find time to put them into family life and, and things like that. So when my eldest child was 10, we went on a cricket tour with Cheshire cricket. And we got a rainy day. And basically, I was able to sort of go, Well, how are we going to entertain them for the day, we had something like 16 kids, they’re all under 10s. And so a physio friend of mine was there. And we both actually said, well, let’s screen them. Let’s see what you know, what they look like whether we can start to do some s&c interventions with them? And how would that look, and we were absolutely gobsmacked as to how many reported low back pain at the age of 10. And also, the thing that I’ve also sort of discovered along the way, and is now well into the research is that their shoulders had already changed the range of movement. So when we were looking at their ability to rotate their arm back, and their ability to rotate their arm forwards, their left arms and their right arms most been dominant, right just weren’t the same, they’d already changed. And now we understand that that’s actually a shift in their actual growth plate due to what we do to them. And it happens really young. So I think we’re blissfully unaware of what sort of impact we’re having on this skeleton. So I kind of knew that that kids were getting back pain, but I didn’t really, at that point, quite understand what the diagnoses were. And over time, we’ve become much more aware now that these are probably so I have a mantra that any child with low back pain on the opposite side to their throwing arm. So for example, a right arm, say cricketer or tennis player, presenting with left sided low back pain in that athletic population is a stress fracture until proven otherwise. And until we get that message out, that sort of I had a cause for coaches, bowling without back pain, and it’s trying to make all of the coaches the essences, the parents, the kids understand that back pain in the adolescent population in the sporty population is not normal. And what we’ve come to understand is that there’s a very normal process of adaptation goes on, whereby you put extra load on it, let’s say we’re at the beginning of the cricket season, or the baseball season, if we’re over in the States. And at the beginning of that season, we’re going to do probably way more than we’ve been used to, and the bones really clever, and it goes, gosh, if they’re gonna do that again, then I’d better lay down some more bony tissue. And it’s much the same as we do in the gym, laying down muscle in response to a stimulus. And what happens is, I liken it to like the rings on a tree where we get a new ring every year. Well, in essence, bone does the same thing. And it’s the outer shell, that if we start applying that load quickly, again, is going to be the bit that fractures before it toughens up. So what we’ve started to see is that kids do have these spikes in activity throughout the year throughout the seasons. And what they’re susceptible to in that window is a bone stress injury.
Rob Anderson
That’s really interesting, because I’ve, you know, not necessarily from a stress fracture perspective, but I’ve experienced the same thing, working with kids, and they come off in our summer camp, or preseason training, or, you know, a week long sports camp, regardless of the sport and their loads gone through the roof, you know, they’ve travelled what they normally do, and then suddenly, it can pick a joint because something’s going to complain is that when you travel someone’s workload, it’s never gonna go well. So yeah, it makes perfect sense. So are you seeing Do you think over the years an increase in the prevalence of stress fractures or just a better as your diagnosis, and you understand is better that you just became better at identifying them? What do you think?
Angela Jackson
Both? I think we are much, much more aware. Now. If I’d have said to a cohort sort of 1015 years ago, what’s the past fracture, which is what we call the low back pain fractures, they probably wouldn’t have had a clue. And certainly, I would say that now awareness is much more out there. And we’re definitely my threshold for diagnosis, as I say is any kid with back pain for a week is one until we prove it otherwise, but they’re not just in the lower back. What we’ve been interestingly seeing since COVID, is that I’m picking up stress fractures in the knee, in the hip, in the foot, all over the place. We’ve even seen one in the prelim recently. So what we’re seeing is that in that period after the COVID lockdown is that there’s I’ve got several theories really one being that there was this period of relative inactivity. So the normal adaptations that we see through kids doing more activity, that bones toughening up, just didn’t occur. And some really good research from the States, has shown that the actual circumference the size of the or the diameter of the upper arm bone, the humerus actually gets bigger in kids quite rapidly through that growth spurt. So we know that that’s the normal process. So only on the dominant arm does it increase in size, it toughens itself up in response to what we do. So I think that what happened is that during COVID, they didn’t have those adaptations. They didn’t get any more rings around the bone. And as a result of which they came back, they were bigger because they’ve probably jumped up at least one age group, if not to, they probably in in one cohort will have also gone through their big growth spurt, and they are bigger and more physically mature, and therefore they’re doing things at a higher intensity. So they then came back with this massive spike in activity relative to the previous year. And boom, we have this huge catalyst of not only stress fractures, but all the different sort of what we call a puffer situs, the the Osgood Schlatters, the Severs were tendons attached to bones, they’ve also taken a massive hit as well.
Rob Anderson
Yeah, I think it’s a bit of a double whammy, isn’t it? There’s a period of inactivity, and then there’s almost compensation that came out the back end, particularly if you were involved at a relatively decent level people thinking, well, I need to now make up for that season or two that we lost. So it’s like a perfect storm, isn’t it? You know, period of inactivity by not adapting anomaly should then this massive surplus of stimulus compared to what you would have normally done in those seasons or two, because we’ve got to have to make up for lost time.
Angela Jackson
Yeah, I mean, I think you’ll have probably seen it even more than me, certainly when I go into, say a Cheshire cricket session for are under fifteens. Last year, it was really alarming to see the movement competency or movement literacy, depending on which language you use. And I was quite astounded, they were probably the furthest behind. And yet they were our most talented group. So we have this absolute super cohort as you get every now and then coming through. So the but the scary part was that a lot of them lose lost that sort of competency that they had prior to their growth spurt prior to COVID. And then we came back and we’ve had to really, really, you know, ramp that back in. And I’m sure you’re seeing that way more than I am.
Rob Anderson
So yeah, it’s an interesting one, because I think we’ve already mentioned, you know, okay, any child with low back pain, the opposite side, you know, to their throwing arm, you know, particularly if it’s been longer than a week should treat as a stress fracture. So what about the other stress factors we’ve mentioned, the knee, the hip, the foot, obviously, that doesn’t necessarily translate across what sort of the things that we should look out for in those situations.
Angela Jackson
Indeed, there’s one test that everybody can use. And it’s not only my diagnostic test, but it’s also my return to play test. So if we talk talking about any pain, that at the site of a bone, so it’s obviously like, you can feel it’s bony, it doesn’t feel like a muscle. And it’s not where the muscle attaches to the bone. So what we’re basically talking about is sort of in the foot, and it feels like it’s the inside of the foot where the arches and it’s tender. There’s a bone there called the navicular. And that’s really prone to stress fractures. And what’s interesting is that we thought that the majority of heel pain in in the nine to 11 year olds was always going to be Severs, but interestingly either is it vitamin D, is it nutrition, but there’s a tonne of different reasons. But what we’re starting to also see is that heel bone, the calcaneus is also getting stress fractures in it. So we can’t just assume that every heel pain has Severs, because the the management of these is radically different. And then sort of up in the knee. We see a lot of Osgood Schlatters, where that big quads muscle attaches onto the shin bone. But if it’s not on that little nodule at the very front, it isn’t Osgood Schlatters. And if it’s not on the kneecap, it’s not going to be what we call patellofemoral pain. So those more diffuse knee pains that we might think sound like a cartilage tear or something like that, that we might see in an adult, the probability is it’s to do with their bone, and those all needs scanning. And then up in the hip. They’ll be the ones that sort of, they don’t have usually a limit of of range of movement, they’re not stiff, they’re just saw and they’ll always be sore on activity. So the ideal test for you is a hop test. Just pogoing up and down on one foot. And if they get pain on hopping number one is they can’t go running because running is a series of hops. So at the end of the day, it’s a brilliant test for going actually, I’ve got now a really high suspicion index that this could be a stress fracture, and it isn’t until proven otherwise. And then couple that with they can’t go back to doing any running or any acceleration, deceleration work until that’s painfree.
Rob Anderson
That’s great. A real simple basic test, isn’t that, yeah, you’re not restricted with equipment, which is why I always love tests like that, where, you know, there’s no access to entry for something like that. So, you know, we’ve got that initial suspicion. And perhaps in a child’s been diagnosed by you know, by a medical professional, that’s important to highlight, there shouldn’t be anyone who’s not medically qualified making a diagnosis. What’s the typical treatment? Or what should people be expecting to be a treatment for a child with a stress fracture, obviously, may vary limb to limb in terms of what they can and can’t do. But what’s the general
Angela Jackson
approach? So my first sort of thing that I’ve got to get into is, why did they get it so enough, inevitably, we would normally shut everybody down. Depending on the fracture, some sites like the hip and the foot, tend to be a little bit harder to heal. So we generally shut them down for longer. But let’s, I think probably the easiest things to take the low back and use it as an example is that we would shut them down from all activities for a minimum of two weeks, which are based around extension. So they’re allowed to do things that are in a sort of more flexed position, like sitting on a bike, as long as that’s pain free, but we’d shut them down from throwing, kicking and running. So when we’re talking about extension, we’re talking about that overarched spine. And that’s what tends to cause a lot of these problems. So we shut them down from that. But in the meantime, that’s your perfect window to start them on some of the corrective strength and conditioning that we want to bring in. So we’ll bring in some low level, abdominal work, maybe some glute work, starting to help them to learn to keep that spine a little bit more isolated when they move their hips and their arms, because they’re often sort of waving around in the wind during this growth spurt. But for me, the big bit is why did it happen? So I will have filled got them to fill in a huge long questionnaire about everything they eat, how do they sleep, what their growth spurts been, like? There’s many, many factors that are associated with getting a stress fracture. So first things first, if we haven’t got nutrition, right, maybe inadvertently, this kids growing like a weed, and mums still feeding them the same calories and energy as the rest of the family. Even worse, if Mum and Dad are on a real health kick, and they’ve kind of gone a bit low carb, or they’re being very mindful of what they eat, we could have a young athlete, maybe a rugby player who could need easily 3000 calories a day. And yet mums sort of surviving on, let’s say, I probably eat about 1600 calories a day. And so I think parents are just so under. They just don’t have enough information. They’ve got to be the high performance director covering nutrition and strength and conditioning and everything. And it’s a it’s not an enviable job. So I think the first things first, our kids probably are just unaware, there’s so many kids not eating breakfast, I would say at least 20% of kids don’t have breakfast. And with that, there’s not a chance that they’re going to get enough protein in there for the rest of the day if they don’t start to front end it. So first things first is they’ve got to buy into the idea that we need to investigate there. Any disordered eating. Occasionally we do see eating disorders, which is a whole different ballgame. But each of those will have a massive impact on the bone health. So without going into masses of detail, I liken it and it’s a great example for coaches to use that the the body’s very like a mobile phone, and kids get this analogy. So if you sort of say to them, Look, at the end of the day, what happens to your phone, if it’s running out of energy, and they’ll go it goes into power saving mode. And what does that mean to you? Well, it means that we’re going to shut down the nonissue essential systems in my phone. And that’s exactly what happens in the human body is that if we haven’t got enough energy, and perhaps we’re not getting enough calories in per day or protein in per day, then what starts to happen is the body begins to panic a bit and begins to say, Well, hang on a minute, where’s the next load of energy coming from? Perhaps I’d better prioritise it to my essential systems. And what gets shut down is our reproductive system them. And that has a sort of chain reaction in our hormones. And means that things like calcium leach out of our bones and levers really vulnerable to stress fractures. So all the strength and conditioning programmes that you and I might put in, aren’t going to have any benefit unless we create the fuel not only to build those muscles, but also to re energise those bones to toughening up again. So I think nutrition and with vitamin D, are two of my biggest things. So they’re my frontline, because doesn’t matter what happens thereafter. If I’ve got that wrong, then we’re not going anywhere.
Rob Anderson
Yeah, I think it’s a really important point you’ve made and I think you actually hit the nail on the head, because I see this all the time. You know, it’s this kind of double whammy again, I guess, with kids doing loads of activity, but also under fueling, because, you know, maybe they eat like their palates. But they’re, you know, he plays a bit of PE, and maybe, you know, a recreational footballer, but he’s in an academy training, playing for the school playing for the county, you know, inevitably, if you’re a relatively talented young athlete, you’re probably getting pulled to play for every you know, Tom, Dick and Harry club because they want you because you’re going to score a goal or get an assist or whatever. And yet, you’re eating as if you’re already training recreationally. And I see that all the time. And often, one of the one of the issues I see is people say, Well, I don’t feel like eating, I’m not hungry. And it’s a difficult one, isn’t it? Because like, well, actually, your needs are almost different. You need to be thinking, I’ve got training tonight, I need to make sure I’m fueled for training or fueled for recovery. And I think the combination things you said around the calorie intake and having a few and the protein is something that I see. I can echo that on a daily basis, you know, having that conversation with parents and trying to provide the resources, particularly around the breakfast side of things, as you’ve just said, it’s, you’ve almost echoed a conversation I’ve had just this week, in those exact three points.
Angela Jackson
Yeah, I know, I’ll quite often send them off, you know, you’re going to take this athlete, and if that stress fractures in the foot, or if that stress fractures in the hip, we’re probably talking. Certainly, they’re going to be weeks and weeks without even maybe putting the foot to the ground, or they’re in a boot or something like that. So consequently, you’ve got to give them something to do. So at which point, we start to talk about what can they control, and how they’re going to come out of this better. And nutrition is one of them. So I’ll send them off to start to explore what they might have for breakfast. And if they’re not hungry, when they first wake up, how could they take things to school. So for example, Andrew and Sarah, my two, we used to send them with things like a chicken sandwich to eat at break. So what we have to remember is that when they get to school, there’s usually like a grab and go type bread break or a vending machine. And invariably, what comes out of that isn’t going to have any of the right calories or protein content in. But not only that, we had a kid who was a stress fracture, she was 12. And she just didn’t get up in time. She wasn’t that she was one of those night owls. biological clock had always already shifted, wasn’t having breakfast, and then invariably sort of didn’t have the right kind of food at that break. And then she usually missed school lunches purely and simply because she was playing sport. So this kid was playing sport before school, not fueling, paying sport at lunchtime, not fueling. And then invariably, by the time we got to dinner, she was so hungry. But you can’t possibly in a small tummy, get all that food in. So we helped her by sort of, and she knows my my older kids. So she basically kind of went, Well, how did they do it, and we started helping her to make her own smoothies. And so she started experimenting, and we made her go off and learn some recipes for making little protein balls that tasted good with chocolate in. And so we kind of get around it by helping them to realise that they need to learn how to maybe make the food and it gives them something positive to do whilst there whilst they’re injured.
Rob Anderson
Yeah, I think that’s again, that’s funny, because that’s my go to as well, you know, because you do get a lot of kids that either I typically I work with a lot of teenage boys, so they are waiting to the last possible minute to get out of bed, check their school uniform and run out the door. So I’m always saying to them as well, the same thing, you know, okay, in three or four minutes, you can make a smoothie, you could even make it the night before and then you’ve got it the fridge and you just shake it on your way out. And you know, you don’t have to make it when you wake up but you can have on the school bus or on your way in. Because I think that is a big issue. As you said kids, not maybe being you know, early morning birds wanting to wake up and spend half an hour making breakfast, it needs to be practical. And it needs to be as you said, something they can grab on the go. But it’s equipping them with those tools to go okay, what does that look like? That doesn’t look like smoked salmon and scrambled eggs on toast. That’s gonna take you 20 minutes. It looks like something that is a couple of minutes. But as important, as you said, to communicate with the parents to get that stuff on the shopping list. Because if it’s not the fridge, you can’t use it.
Angela Jackson
Yeah, I think one of the other things that they all get quite shocked about is we’ve shown that one of the factors that boosts your bone health So you have different kind of like a chemical in a way that helps you to lay down more bone. And that’s inhibited if you don’t get the really deep quality sleep. And this is one of the things that if you’ve got that very busy athlete isn’t invariably they’re buzzing by the time they go to bed. Or they may have had a late night training or an early morning training. And so sleep quality can often just be limited by what’s been going on in their world. But also, I think we can’t underestimate how isolated these kids can get without social media. So they’re kind of falling off the sports field and then suddenly wanting to catch up with what their mates are doing. So they fit in at school the next day. And as such, then they can be on social media till quite late at night. And there’s some scary research out there that says, you know, some kids could check their phones up to six to 10 times a night, and sort of half wake up, check their social media half wake up. And so certainly, we kind of really start to hone in on that if they don’t put these things in place, it’s a bit of a deal breaker, you might as well not bother training, if you’re not going to actually look after the controllables you know, on a day by day basis, and I always give them the why, you know, this is important because and I think if you give those kids the why they’ll almost always buy into it, the my sort of parents will come back going, I can’t believe you’ve actually got them to leave their phone downstairs. And I’ll give them examples of what my kids have done and how nasty I was to the kids, but how it’s worked and where they are now. So I think it’s about the why, as opposed to just saying you need to do this, you need to do that, we’ve got to help them understand that there’s a good reason behind it.
Transcribed by https://otter.ai