EP. 15: Interview with Dr. Alicia Barnes, DC, CCSP
Dr. Alicia Barnes has seen an increase in knee, elbow, and shoulder surgeries in student-athletes in her practice alone. These injuries and general strain have increased risks of degenerative joint disease.
The American Psychological Association recommends 2-3 months off a sport each year. We need to ask ourselves whether the physical, mental, and emotional toll youth athletics are taking on our kids is worth the payouts. The percentage of high school students becoming D1 college athletes is small, not to mention the likelihood they'll become professional athletes. It needs to be about balance, especially in these developmental years...
Alicia is a good friend and knowledgeable youth sports practitioner. This episode has a ton of good insight!
Show Notes
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0:00:00
So today we have one of my very close friends, one of my best friends, Alicia Barnes, Dr. Alicia Barnes. She is in upstate New York and we went to school together. We were in the same class. If I could choose to practice there, I certainly would have because it's a beautiful area. And she stayed there and is raising her family there and has a very successful practice. She has a specialty in sports management with chiropractic and also with sports nutrition.
2
0:00:34
So we're having her on the show today to talk about overuse injuries with kiddos as well as overtraining, what we can do as far as diet intervention, supplementation, and just how to, again, reach that good, better, and best with having healthy kiddos. So Alicia, why don't you go ahead and share your background
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0:00:52
with all of our listeners.
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0:00:54
So my name's Dr. Alicia Barnes. I'm a third generation chiropractor. I practice in upstate New York. I have a very family-focused practice with an emphasis on sports. My chiropractic degree is from what used to be
1
0:01:11
New York Chiropractic College, now Northeast College of Health Sciences. I worked with that college in the research department for many years following graduation and then recently went and got my master's degree in exercise and health sciences and rehab from Logan University. I am a mom. I've got two kiddos, 12 and 10 year old girls for fun. I don't know if that gets you get to be fun working full-time but I like to garden and read and exercise, walk my dog.
1
0:01:50
That's pretty much it. And hike. You guys hike when you're 82. We do. We do a lot of hiking. We just got back from a really great trip out to the Canadian Rockies where we got to hike some real mountains which was awesome. I love that. I bet the girls enjoyed that. They loved it a lot. They're tougher than we are I think. We did like 10 mile hikes in the snow and we were like oh a little sore and they're like why are you sore? What did we do? Yeah so a lot of my days, you know, I practice full-time and then it's, you know, coming home, running kids around.
2
0:02:33
Yeah, and rinse and repeat and do it again.
1
0:02:38
Yep, every day.
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Every day.
1
0:02:41
It's all good, though. All good things.
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0:02:46
So I know a lot of our listeners, of course, are moms and have young kids, kids in travel sports, of course in our area and I think yours as well, travel sports is huge. There's like never a down season. So just go ahead and discuss a little bit about, you know, over training, injuries, all of that with with sports and kids and their mental health
1
0:03:08
and physical health. Yeah, I think we're seeing this trend of travel sports starting earlier and earlier. It used to be that you didn't really travel unless you were maybe like on a high school team or you had like a real developed skill set to be recruited for these teams and something that you're hoping to pursue further. And now it seems the trend is that everybody does travel sports. There's a lot of different options available. And the only, you know, the negative side of that
1
0:03:42
is sports used to be seasonal. We used to be a little bit more weather dependent. You know, we're gonna do maybe like football in the fall and then we're gonna do basketball in the winter or something like skiing. And then in the spring, it's more like track
1
0:03:58
or up here, lacrosse is very big. So you had the chance to allow your muscles to basically to rest and recover. So each of these different sports we have a specific movement pattern. We're using certain muscle groups more than we're using others. And when you start to get away from that seasonal sport shift, you are constantly using the same groups of muscles and you really start to set yourself up for potential injury,
1
0:04:28
repetitive use injury, and overuse injuries. So we're seeing a big trend of sports injuries in youth athletes that we up until, you know, more recently, like a decade or so ago, only really saw in like collegiate or professional athletes. So So you see the increase also of treatment for those athletic injuries, you know, not just like chiropractic and PT, but now you're seeing a lot more surgical interventions as well. We're just we're stressing joints out way too much way too young.
1
0:05:04
So I always tell my patients, you know, a good rule of thumb is take your child's age. That's the number of hours that they should spend doing a sport each week. So if you have a 10 year old, your 10 year old shouldn't be spending more than 10 hours doing that particular sport. And so that includes not just competition, but practice. And I don't know if you guys see this where you're at, but I'm seeing an increased trend by me strengthening and conditioning in much younger, like school-age children as well. So I would count that in that towards those hours as well.
1
0:05:43
It's hard because I think kids really, they like to play sports. We like to have them something to do that's physically active. But we've kind of more an industrial thing and it's you get very wrapped into trying to make your kid you know the best athlete that they can be and I do think that there's some balance of between are we doing this because they like it and because we think that there's a benefit in the sport being physically active the social benefits of the team sport learning to cooperate
1
0:06:24
with others work as a team having to listen to another adult a coach Developing those cultural attitudes. These are all really great things that I think Really help develop children into you know, really a good person and self-sustainable person But again, we're going to balance that with are we doing it just for that or are we doing it because we think Our child should be this elite athlete and at what age do you really need them to be an elite athlete?
1
0:06:54
And I would say the benefits really are not there for them having this high performance level in their sport. You run, like we talked about the risk of physical injury, but mental injury too. So you're seeing a high rate of increased youth burnout and they attribute a lot of that to sports. And now people think,
1
0:07:18
you know, burnout is just, you don't want to do this one thing. And maybe, you know, that's kind of like the beginning of burnout. I don't want to do this for all. So your kid says to you, I want to quit. I don't want to do this. And you're like, well, I thought we were doing so great. Our team is winning. We do all these different clubs and activities. We've gathered all these different works just about our sport and all of a sudden they're like, I want to quit. So really what we're seeing is it's too much.
1
0:07:42
We're wrapping all their time and their identity into this one particular activity. And so you see that first step of burnout on a quit, I don't want to do this anymore. And then burnout leads to other aspects of life. It leads to academic and social aspects of life. Of now we're not performing well at school. You can see like signs of being depressed. You can see a lot of fatigue. So I think that we do a disservice to our youth athletes
1
0:08:16
when we take that approach and we go really hard, really strong. That we run that risk. So again, when you have a youth sport, what is it that you're looking to get out of that sport? You know, for your child, maybe for yourself as well, and then weighing the risk and benefits. Because there are some downfalls of constantly participating in a sport, same sport, all year round. that you know they recommend I think it's the American Psychological Association recommend having two to three months off a sport a year. So for
1
0:08:58
us we try to change our sports seasonally a lot of times we'll take a break in the summer we'll try to do some other activities also try not to have something every single day of the week and make sure that our kids are getting some downtime as well as going to bed at a reasonable time. And you have to be careful because a lot of these sports you'll look at it and you'll like you know so you will sign your eight-year-old up for sport and they're like okay we're gonna practice at seven o'clock at night and you're
1
0:09:34
like they're eight who's practicing at seven o'clock at night, like they go to bed, you know, 8 o'clock. Right. I think it's hard, and I know where you guys are on this path, but there's many years that we said no to a lot of activities for that reason. We kind of had a hard and fast rule of we're not doing anything that starts after 6 o'clock at night. You know, when they're younger, we're like, we'll do something right after school,
1
0:10:04
because I think it's good to go out to move your body. But after six, like, that's it, we're done. We're going home, we're having dinner, we're getting cleaned up, we're going to bed. It's a good time, we're getting some downtime then.
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0:10:14
Yeah, that's a good rule of thumb.
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0:10:15
I know so many patients of mine, they get home on a school night at like nine, 10 o'clock, they've had fast food for dinner, so they're burnt out, they're tired, then they're getting junk food, they're not healing, and then yeah they have to get
1
0:10:33
up and go to school the next day. So yeah, it's crazy to me. It is crazy, you know, and then sleep deprivation for kids is huge and you know that also increases risk of injury, it increases behavioral problems with children. You know, I think you can look at certain kids, like if we're talking school aged kids, they need nine to 11 hours of sleep a night. So if you're going, if you're not getting home till nine o'clock, like what time
1
0:11:01
are kids going to bed and then what time do you have to get up if you have to go to school in the morning? That's not a lot of sleep. I think we ask a lot of these kids and you know I ask my patients I'm like you know whether them personally I'm like how many adults do you know that work you know seven eight o'clock in the morning till four o'clock in the afternoon and then go to
1
0:11:27
the gym for three or four hours like do you know anybody like that because I don't they're not doing that but then yet we ask our kids to do that and so
2
0:11:36
So that's a good point.
1
0:11:37
Yeah. The other part of it is acknowledging that our children, you know, again, if you're in school or whether you're homeschooling, you are putting a structure on their day for several hours. So we're asking them to really kind of be still, to focus on something for many hours. And then we take them and we put them in a structured sport where now, again,
1
0:11:58
we have to like, not maybe not so much be still, but we have to be really attentive and be really focused. And so they don't get a chance really to rest their brains either, which I think is, you know, can be a problem. More on that like mental health side of things. And again, to contribute to some of that youth burnout and sports.
2
0:12:20
Yeah, they need that unstructured play, even as preteens.
1
0:12:26
Unstructured play is so important. And you know, we always take that issue with our children that it's not my job to entertain you. Like, that's not what I do as a parent. I'm not suggesting things for you to do, especially at the age that my kids are, 10 and 12.
1
0:12:42
They don't need me to tell them what they can do to go play. So a lot of times, it's like, it's nice outside. Go outside and play. What am I going to do outside? I don't know, you'll figure it out, go outside. And they do, and they find great creative things to do,
1
0:12:56
which is wonderful, but our kids get annoyed because they'll just say, I'm bored. And I'm like, well, research says it's good for you to be bored, so be bored. I wish I could be bored right now.
2
0:13:06
Exactly, yeah, because I feel like there's this following as a parent that you have to always have structured something for your kid, art or sports or something, and you have to actively do that. And that's just not how it is. I think it's just a cultural trend for whatever reason.
1
0:13:24
I don't know if it's like the pendulum swing from the 80s kids were like completely unsupervised for most of the part of the day. Now our generation's like we must supervise 24 hours but I feel like there's a there's probably a really good middle balance there. Yeah. You know what we strive for. The other part like you mentioned you know the running around and the fast food so that's that's huge for sports and sports injuries right so now what's exercise is breaking down
1
0:14:01
this muscle tissue. So now we've broken down this muscle tissue through our physical activity. And what did we put back in our bodies to help repair that nothing but pro-inflammatory food, right? So now we get this dysregulated tissue repair process. And then you'll see again, an increase in athletic injuries. So I think having good sports nutrition, if you're going to have these kids in these activities, is super important for keeping them healthy.
1
0:14:34
And then so, again, what's your goal? Is your goal to get your kid to play a college sport or a professional sport? I would, one, say the statistics of them playing in college are so, so small and then playing anything professionally like so much even smaller infinitesimal right like it's just I Don't know that that I would use that as the general rule of how I was acting and the motivating force behind making those decisions For my kid, but let's say that that is your goal. You have a super talented athlete. They really want to do this Okay, so we need to keep them healthy to actually get them there because what we're seeing is a
1
0:15:17
Lot of athletes are hitting these early adolescent years and they're breaking down. We have knee surgeries. We have elbow surgeries You know soldiers shoulder surgeries. That's not That's not going to help them have a long career and playing the other part of that you start off with some of these injuries, with them comes an increased risk of degenerative joint disease earlier in life, right? So now we've worn out joints much earlier than we ever have before. And what's the rest of their life look like? And how do
1
0:15:54
they be physically active and participate going forward? Exactly. I know
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0:16:01
I had a patient ask me the other day if I'm gonna put my daughter in gymnastics and I said hell no I'm not putting her in gymnastics. I did that it's done in my growth. I have joint pain from it. I'm not doing that.
1
0:16:13
It's not natural. Yeah, gymnastics is really hard and it's funny that you say that because my youngest peach she really likes gymnastics and I just outright said I'm like we can do recreational gymnastics but we're never doing gymnastics team. I'm not doing that. You know, and you see it especially if they they get good then they stick them in the
1
0:16:47
gym 30 hours a week. What eight-year-old should be in the gym 30 hours a week? They shouldn't but you see all the injuries that go along with it and like you're saying you get to feel the effects of that much later in life and
1
0:16:53
you know, that were competitive for much earlier in their career. So it's the same thing, right? So she likes gymnastics. What do we have? We have an hour and 15 minute gymnastics class once a week. I like it. She goes, she does some work on her muscles. She gets to work some extension, which I think is great. She also likes to play ice hockey. So she spends a
1
0:17:17
lot of time in that kind of squat and bent forward position. Now we have an activity to take her the other direction. But same thing, like, I, she was one of those kids, she likes to do a lot of different things. I think she would do all the sports that she could, if it was up to her, but it's not. So I get to say to her, you know, like, we can try that. But what are we going to let go? What do you want to switch? What do you want to give up to do this thing? And so we do switch things seasonally. So, you know, hockey is a ridiculously long season. But hockey ends, what are we doing now? We just did theater club. So we did something completely different. We did something arts, we did something creative. We didn't fill it necessarily with another sport and now that's over and then we have this summer
1
0:18:06
What are we going to do in the summer?
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0:18:08
You know like
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0:18:10
Just have some time off Exactly number one you're using different parts of your brain doing arts versus sports
2
0:18:16
Do like you mentioned you know you're using different directional directional Movement with gymnastics versus hockey, you know, like my kids that are just runners and just run they need that side-to-side backwards motion and a lot of kids don't get different directions I Didn't see like more of a trend of
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0:18:35
Hey
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0:18:36
Kids are encouraging. Oh fair switching a sport seasonally They're encouraging to a sport that has a very similar movement pattern to the sport that is their main sport, which I would say really defeats the purpose.
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0:18:56
Yep.
1
0:18:56
Oh, I see we have, um, while hockey players go to lacrosse, you know, they say lacrosse and hockey are similar in the way that game is played. And yes, well, now you do have, instead of having a stick below your waist, you've got a stick above you. But what are we doing?
1
0:19:10
We're running around, like, in squats positions with the cutting movements still the same, we're ice skating and using those same muscle groups and that same multi-directional plane. So I think trying to find these activities that truly are different to give your kid a chance to rest is really important. Exactly. Are you seeing in your
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0:19:35
growth plate issues or anything like that?
1
0:19:39
Yeah, I see a lot of, you know, I see like the growth plate fractures. Let's say more commonly I'm seeing just a lot of strains, of sprains. Like that's the big one. That's how I see it start. And then also tendonitis. A child shouldn't have tendonitis. It's the overuse, it's the repetitive use of that tendon.
1
0:20:03
Tendinopathies are actually difficult to treat and to fully get to resolve. And starting off very young with that, it just does not bode well for overall sports and health. Exactly. And I think, you know,
2
0:20:17
it's important for parents to realize that if they're having something like tendonitis, that's the body telling them it's enough. Because as you know, if you kind of push through it and just do PT and a cortisone injection and keep going, then you're going to have compensation above and below that joint and then it just messes up the rest of the body. Right, and then we
1
0:20:42
have to, you know, address too, like what caused the tendinopathy, you know, these things don't just break down. We obviously had some altered biomechanical process, we had a pro-inflammed state that made these tissues more susceptible to injury, right? So we have to address that. We can't just focus on, you know, if we got a tendinopathy of say like the forearm elbow area, we can't just treat that. We've got to look at the wrist, we've got to look at the shoulder, we've got to look at the neck, we've got
1
0:21:11
to look at the back, and all these other mechanics that go into that final point of stress on that joint. And I think that's where we lose a lot of people, but I also think it's where chiropractic itself, sports chiropractic really is helpful in that we're looking at all those areas and that we're really trying to get the body to move most optimally to try to prevent those injuries to begin with. That being said, you know, you can only do so much. If you're overdoing it, you're overdoing it. And I don't know about you, but it is, you know, you never want to tell someone, you can't do that activity anymore, right? Like, we always want to help support them and be successful in their sport, in their exercise that they're trying to do. So it's not fun when you have to say, the only way that this is going
1
0:22:03
to get better is you have to rest, you have to you have to stop doing what you're doing, you need to rest and let the tissue recover. And I don't know about you, but I find that there's this attitude that if they do that, then you know, these athletes will, they'll lose so much ground, right? Like they'll somehow be behind in their sport. And you're like,
1
0:22:27
do you want them to play at all? Or, because what you don't, if you don't actually start treating those things when they first show up, now we're talking about much larger injuries that, you know, then may require some kind of surgical intervention. And then that joint's never the same again.
1
0:22:42
Oh yeah, exactly. And they're young,
2
0:22:44
so they're in the middle of a full life ahead of them of dysfunction.
1
0:22:46
Yeah. And you know, it's interesting. You're mentioning the cortisone shots and I do, you know, I feel like I see some of these cortisone shots and trigger points and younger and younger populations. And I don't understand it. We know like it's, can be, you know,
1
0:23:04
sometimes helpful in breaking up that pain and inflammation response. So, so, you know, when we do have a patient needs to do that, we're going to have to take, we're going to take advantage of the fact that now we can actually touch this area, we can work with this area and do all the things physically that we need to do to rehab it
1
0:23:20
and get it better. But if you're just relying on that shot, you have to keep in mind that it's stopping this inflammatory process, right, but that's part of tissue healing. So we're impeding tissue healing, we're not fully healing that spot. And it also causes joint degeneration. So a lot of times the things people are trying to treat with it is the thing that it causes later on if you're doing
1
0:23:46
it you know repetitively. So it's I think it's a nice thought like I'll just get this and I'll be pain-free which goes to the measure of you know what is injury, it's not just pain. It's altered function, it's altered biomechanics. Pain is usually like the last thing to show up, right? And like the first thing to go away, which makes it hard. Some of these things of being like, I know you feel better, but we're not actually 100% better. Exactly. So besides,
2
0:24:24
of course, you know, chiropractic care, listening to their bodies, changing their sports activities, what are some tips or tricks that you can share with our listeners on like packing sports nutrition snacks or anything like that to help them with recovery and healing?
1
0:24:42
Yeah, so, you know, it's really important to make sure, one, that they have enough good whole foods throughout their day. The biggest thing you can do for you know youth sports nutrition is just eating a well-balanced diet with real food, not processed food. So starting with that is huge. The other thing you know you can get into some of the nutrient timing of trying to get a snack in them one to two hours before their activity. And I always try to make that like a complex carbohydrate type snack, for
1
0:25:21
example, maybe I'll do, I'll have them have like some apple slices, something like that, or do like a smoothie, a fruit and veggie smoothie. The other thing having them eat after an activity, that's when we want to replace again, some of like the carbohydrates and the proteins. And that's going to really help repair their tissue, right. So
1
0:25:46
if we can get that in, you know, 30 to 60 minutes, post activity. So a lot of times, again, I think like fruits and veggies can do like some yogurt and granola and fresh fruit. I'll do like a hard boiled egg, some veggies, some hummus, like those are big ones that we do. And then the, before, you know,
1
0:26:10
eating the meal three to four hours before an activity, giving it enough time to actually digest so we're not running around with a bunch of food in our stomach is huge. All of these things, so these are all focused on some good, like, complex carbohydrates. And I say that like those are our fruits and vegetables, right?
1
0:26:36
Not like a bag of pretzels or a granola bar. I do try to avoid some of like the heavier things with my kiddos right before sports. I'm not going to give them a bag of Troumex, you know, 15 minutes into going to play. That's not gonna feel good as you're running around, it's gonna sit really heavy. That's something maybe you can have like earlier as a snack, a couple hours beforehand or afterwards would work well. The other thing that I try to focus on
1
0:27:06
is fiber earlier in the day, you know, whether we're doing like some avocados or doing some like raw nuts earlier. Trying to do that, which will help keep the blood sugar more stabilized just throughout the day, which I think is just good for them overall, but especially going into the sport. One of the biggest things I see is kids walking around with a bag of candy like during warm-ups and then we're getting ready to go out to play and so what happens we have that spike in our blood
1
0:27:53
sugar they're like really hyped and amped up maybe that first period and then they are crashing in between and then what do you see? Like, oh, just here, have some more candy, have some, you know, whatever sugar goodness to bump you back up. Right? So it's just, it doesn't feel good. I think if any adult has ever done it, if you binged out on something highly sugar or candy, you feel terrible. At your best is really not setting you up for success So we really avoid any of those like ultra processed foods You know before and after activity. I mean normally we do anyway, but especially
1
0:28:34
When we have a situation like that so Any um with your sports background any
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0:28:41
Supplements that you do with your kiddos or that you recommend for kids that do sports?
1
0:28:53
Yeah, I think probably the biggest ones that we do are omega-3 supplementation, EPA, DHAs. Again, you know, we need that for building, keeping our joints healthy and cartilage. The other one, vitamin d3 as well for them and then probiotics and that all of course ties into how our body does its tissue repair right and tissue healing so I would say those are those are the biggest ones we do a collagen supplement as well same reason, you know, more for joint health, tissue repair, and gut. I think, you know,
1
0:29:44
it depends on the age of your child. So I would say those are the big ones for my 10 year old. My 12 year old, I actually have her take an addition of B-complex and B12 supplement too. And obviously that's going to be more our nervous system and part of it is she's a little bit older. And so I think her body needs a little bit more of those supports, you know, as she's developing and growing.
2
0:30:10
Yeah. Getting to that preteen adolescence with the hormones. Yes. Yeah. Yeah. These are critical for that. Yeah. Yeah. Yeah. That's what I get my kiddos. Um, and yeah, I, we do college and it's cute. Cause um, Flynn will call it, it's a banana smoothie, but he calls it banana soup. So it's just like grass-fed milk, banana, some collagen
2
0:30:34
powder, a little bit of peanut butter and honey. Yeah, that sounds great.
1
0:30:40
Yeah. You do something similar, I'll do like frozen banana, spinach, a little cashew milk, and cocoa powder. And it's like, you know, it's like they're like having a chocolate milkshake.
3
0:30:58
And it's really great, right?
1
0:31:00
Yeah, yeah, it's like a win-win. But that's like, that's a great snack. So a lot of times my kids will have something like that before they go do a sport or I'll have I'll make one for them afterwards. And then I think just we pack also a lot of fresh fruit, like apples, oranges, and then I'll pack a lot of times, like baby carrots hold up really well.
1
0:31:23
So if we have a couple games back to back or you're traveling, baby carrots and blue berries are like one of those things that just can stay out at room temperature and be great. And it's a great little pick me up.
7
0:31:35
Yeah, that's perfect. And you know just planning ahead, you know getting that little cooler ready those lunchboxes
2
0:31:37
Yeah, I think that you know, I think that's the hard part and obviously having kids is busy and running around
1
0:31:43
I do feel like if you are Committing to doing that and that's that's what how you want to spend your time then planning dinner and or like having something to go is super helpful and not only keeps you know your kids healthier but keeps you healthier and yes it is it is more work but I do think it makes a huge difference. I can't say we ever you know
1
0:32:09
we don't do it. So I know some people will try to say, oh, what's the healthy option? What can I get at McDonald's? Nothing, you can drive away from McDonald's and not eat there.
1
0:32:36
And they're never gonna get me to say, there's a healthy option at McDonald's for you. I just, there's not. It's not real food.
6
0:32:44
It's not.
2
0:32:45
It was funny, both Flynn and Riley eat probably a pint of berries every day each. And Colin was kind of complaining. He's like, oh my gosh, this is so expensive. And I said, yes, but we're not paying any medical bills.
1
0:33:01
Correct. It's one of those. You can pay for it now or you can pay for it later, right?
5
0:33:05
Exactly.
1
0:33:06
I'm messing up with you. It's so funny that you say it because I saw this little meme the other day and it was like, what is one of the hidden costs of children that you never saw coming? And it was, the answer was berries. It's berries. I left, I bought a thing of raspberries the other day, and I, you know, mistakenly left it on the counter.
1
0:33:27
I came back, Paige is, she's shoveling the raspberries in. And I was like, no Paige, I need those. Like, she picks up the case, she runs with the raspberries and she's just like popping them in. Like you don't have fruit like every single day somehow you're deprived. But yes, berries never last long in our house either. Yeah, no it's like six dollars gone in two seconds. It really is and it's one of those you
1
0:33:56
know it's like you said it's healthy it's gonna keep them healthier. You can spend that little bit on berries now, or you can wait and spend a lot more medical bills later. And I think that's, you know, what we say of nutrition overall and trying to prevent some of these lifestyle diseases. Yeah, 100%. Yeah.
4
0:34:16
Well, thank you so much for coming on the show.
2
0:34:18
Any of our listeners have any questions, I'll certainly have you back on and share all of those with you. And it was nice touching base with you.
1
0:34:32
Yes, you too. It was great to see you. Thanks for having me on the show.
2
0:34:36
Yeah. I'll see you later, sweetie. Yeah. I'll see you later, sweetie.
3
0:34:38
Okay. Have a good one.
Transcribed with Cockatoo