Publication by interdisciplinary team sheds light on interventions to prevent re-injury in athletes
The excitement watching a basketball player sprint down the court, leap into the air, and slam dunk the ball is like no other. But from the athlete’s point of view, especially those who just returned from an injury, the question is often how might this damage their knee? How likely is it that they are going to tear their anterior cruciate ligament (ACL) again?
These types of questions are addressed in a recent publication by Robin Queen, the Kevin P. Granata Faculty Fellow and a professor in biomedical engineering and mechanics, in the journal Physical Therapy in Sport. Queen, alongside Virginia Tech colleagues and in collaboration with Carilion Clinic Orthopaedic Surgery, looked at the effectiveness of a novel biofeedback intervention to improve landing mechanics in patients following ACL reconstruction.
A member of the Virginia Tech faculty since 2015, Queen pursues an interdisciplinary approach that integrates foundational engineering, patient care, and the development of novel tools. Through therapeutic interventions, her research identifies movement and load asymmetries to prevent overuse and degenerative injuries of the lower extremity.
For this study, she developed a novel therapeutic intervention in collaboration with other experts, namely Tina Savla, a professor of human development and family science in the College of Liberal Arts and Human Sciences; Thomas Ollendick, University Distinguished Professor Emeritus of Psychology in the College of Science; Thomas K. Miller, a sports medicine doctor at Carilion Clinic Orthopaedic Surgery; Stephen Messier, a professor of health and exercise science and director of the J.B. Snow Biomechanics Laboratory at Wake Forest University; and Alex Peebles, who earned a Ph.D. in 2020 from Virginia Tech’s Department of Biomedical Engineering and Mechanics.
The study’s novel biofeedback intervention incorporated visual feedback – such as seeing the real-time graph of the force under the athlete’s feet – and tactile feedback – such as placing a resistance band around one’s knee while doing squats. To assess the effectiveness of the biofeedback intervention, researchers worked with participants in a 12-week clinical trial. All participants had injured their ACL previously and were intending to resume their sport activity.
The goal of the intervention was to heighten awareness of asymmetrical limb loading during squatting. By utilizing visual and tactile feedback, physical therapists can retrain an athlete to move more symmetrically during squatting, which could improve how they move during more dynamic tasks such as landing, Queen said. For comparison, researchers had a second group of participants (the control group) receive educational lessons on risk factors for second ACL injuries and what to expect when they return to their sport. They were given quizzes to ensure they understood the lesson content.
At the completion of the clinical trial, researchers found that those who used the biofeedback intervention had more symmetrical movement in certain outcome measures, a significant factor in injury prevention. Symmetrical movement means that one limb isn’t bearing more of the load, or weight, than the other. One of the main factors in re-injury of an ACL after rehabilitation is movement deficits, or asymmetrical movement, during activities such as running or jumping. These deficits can last for years after rehabilitation from a previous injury, increasing re-injury risk.
Queen’s results are promising to help athletes decrease their risk of re-injury. While the study participants’ symmetrical movement faded over time, researchers think incorporating real-time visual biofeedback consistently would be effective treatment for injury prevention programs.
“Developing effective methods to improve lower extremity biomechanics during landing is an important step toward reducing the high incidence of second ACL injuries in athletes returning to sport following rehabilitation of an injured ACL,” said Queen.
In the Granata Biomechanics Laboratory, Queen conducts and directs research on musculoskeletal biomechanics. The aim of sports biomechanics is to improve athletic performance by identifying and applying optimal techniques to prevent injuries or speed up recovery.
“These results have provided us with insights into how to alter rehabilitation programs for athletes interested in returning to high-level sports, while decreasing the risk of them sustaining a second ACL injury,” said Queen.
The next phase of this research will focus on translating these results from the laboratory to the clinic setting using load sensors within the shoe instead of force plates. Research team members will continue to collaborate in a recently funded grant from the National Institutes of Health to determine risk factors for second ACL injuries that can be collected in non-laboratory environments.
Previously, Queen’s research contributions and work in ankle osteoarthritis and total ankle replacement earned her the 2017 Kappa Delta Young Investigator Award. Kappa Delta recognizes the best of orthopaedic scientific exploration through this award, first given in 1950, and it remains one of the most sought-after and prestigious achievements in musculoskeletal research worldwide. Queen was also selected as a fellow of the American College of Sports Medicine in 2014, a fellow of International Orthopaedic Research in 2019, a fellow of the American Society of Biomechanics in 2021, and a fellow of the American Institute for Medical and Biological Engineering in 2022. Queen was presented the Adele L. Boskey Award from the Orthopaedic Research Society in 2020 for her pioneering research contributions and excellence in mentorship.
Queen received her bachelor’s degree in applied science with a focus on biomaterials from the University of North Carolina at Chapel Hill as well as her master’s degree and Ph.D. in biomedical engineering.