WTUN Secretariat had the pleasure of speaking with Theresa Heering to find out more about her research and what it means to be awarded the WTUN BC Scholarship Prize
Originally from Germany, Theresa first studied Human Movement Science at undergraduate level. Currently a Cotutelle PhD student at WTUN member Coventry University, UK and Deakin University, Australia, the title of her research is ‘The increased prevalence of childhood anterior cruciate ligament injuries – Identifying those at risk’.
Among all proposals, Theresa’s application to the BC Scholarship Prize was highly regarded by the assessment panel who each noted that it “demonstrates global collaboration and aligns with the SDG goals and WTUN vision” and that the accompanying endorsement from industry and academics at both institutions is “indicative of the quality and potential impact”.
Could you tell us a little about your research and what made you pursue this area for your PhD?
During my undergraduate degree (in Germany),I had the opportunity to do an internship with my now supervisor in Australia. Through this and work experience prior to starting my PhD, I had an insight in to the areas she was working on and where our shared interests were. My PhD journey started in 2020 which was a challenge in itself, delayed from January to September due to Covid. Restrictions also meant that we couldn’t do anything in the lab or in-person.
I was just really interested in how to improve, or prevent injuries, because they have a major impact on one’s life. Sources such as the Olympic committee (IOC) have published a consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. We spoke with experts from different sources and found that they were reporting seeing many more injuries now in young children. It was by speaking to different sources and hearing similar reports that made us think, maybe we need to investigate that a little bit further.
You said that your research has consisted of two phases, could you explain how you approached phase one and where your focus is now?
When we first saw that there was a pattern of increased incidence of children presenting with ACL injuries we decided to investigate further. Due to the constraints of Covid-19 restrictions, we decided to first conduct a systematic review to see what was out there already on this subject. After this systematic review we then looked at specific risk factors that could predispose someone to an injury like an ACL injury. The review was a bit inconclusive and so we wanted to dig deeper into why this was and get expert opinion on why the literature that we needed wasn’t available.
Your chosen area of research has received a lot of positive feedback from experts in the field, that must be reassuring whilst working towards your PhD?
I have spoken to experts from a number of different regions including North America, Europe, Japan and Australia. Most of (the experts we spoked to) were saying similar things, that they were seeing increasing numbers of ACL injuries in children. I talked to a couple of surgeons who mentioned that when they started their practice they would operate on older young people, 15 years of age etc but that in the last number of years they’ve seen much younger patients with these injuries, children as young as 5 in some cases.
When you imagine someone as young as 5, with their whole lives ahead of them, an ACL injury is going to impact their overall well being as the knee is used for everything – walking, cycling and being active. This is why this areas is so interesting to me and why now in phase two, my focus is to try and find a way to identify children as early as possible, to be putting them into intervention programmes and making sure that they have good movement, not getting injured. There is not proper strategy for this intervention in place at the moment- what to do, what to look at.
It was really reaffirming to have the expert interviews say that yes, there is this gap and to have others outside of you bubble agree and hear others say that there is a need for more work done in this area.
Being a technology focussed Network we would love to hear more about the technological solutions and developments you are using in your research
Currently we are investigating one route to see whether it could be a successful way to identify risk in children as early as possible. This is where the technology comes in.
So for the second phase we went to the lab. We had children coming in and used 3D technology. We put markers on specific anatomical points and using 3D cameras to capture the movements we wanted them to do, and can now use the data to analyse, for example knee joint angles when jumping, running, slowing down, slowing down after sprint. All these different movements that are used for screening in adults or adolescents and older populations. And that’s what I’m doing at the moment, we’ve completed the data collection. I’m just sitting here, at my computer now processing all the data- and it’s a lot of data, to look at to see what we’ve got, what we can use, and then see whether we can put a strategy forward that can be used for children to identify those at increased risk. This is the overall idea of my PhD. I have just over year left before submitting.
I have provided a couple of pictures from my current analysis. We are processing the data with two different software. The first software (pictures named Nexus) show the connected dots recorded during data collection. We then import those dots into Visual3D to create the model that we are then calculating our variables of interest with (e.g., knee flexion at initial toe contact).
The pictures show parts of a jump-landing movement, so called drop-vertical jump, where we asked participants to drop down from a 30cm box onto our force plate (fields forming the floor), and on touching the ground, to jump vertically as high as they can and land a second time on the force plate.
Good luck with this final stage and over the next year! Can we ask how you heard about the prize and what made you apply?
My supervisor (at Coventry University) mentioned it to me as he thought it would be a good opportunity to apply and also get a reach for my research. I saw that one of the requirements was the global engagement aspect and I thought that is one criteria that I definitely cover due to the nature of my programme (being a Cotutelle student)…and also with the expert interviews I have conducted. I have had a global reach there from speaking to so many different people.
And then I decided to go for the ‘cutting edge, challenge led research with direct impact to society’ because we think that by designing a screening tool (for early risk interventions) we will have a major impact on individual level on this specific child, that they don’t get that injury, that they have proficient movement to continue sports that they develop to be healthy adults later on. And then, as ACL reconstructions are very expensive, and the rehabilitation period is really long, up to 2 years, we can potentially save some money by putting children into intervention programs early and hopefully not having this injury.
How will be being awarded this prize support you and your work?
I had a discussion with my supervisor when I found out that I had won as there are so many options we can do (with the scholarship prize). One area would be further education for myself. Developing more skills to perform my research, to develop more sophisticated data processing knowledge and skills. There are so many tools to support this. This is definitely one potential area that the funding can go towards. The funding offers the opportunity to support other research projects that are related to my topic- moving into different areas that open up new skill sets, I can experience with different devices and technology that I have not been using at the moment.
Please do update us with how you are getting on during the final year of your PhD. We’d love for you to join us at the WTUN Congress in October.
Thank you, I’ll definitely be able to share the overall findings of my PhD with the Network once the data processing and analysis is complete.
Thank you for your time Theresa, and congratulations once again on being awarded this prize. On behalf of the WTUN we wish you all the best in the final stage of your PhD- and enjoy Australia!