Sara van Deun (29) studied Physical Therapy at the University of Leuven in Belgium, graduating in 2000. She went on to complete a Masters degree in Manual Therapy, also at Leuven, in the following year. The prestigious Catholic University of Leuven, which dates from 1452, is a world renowned centre of excellence for the teaching and research of Musculoskeletal and Rehabilitation Sciences. Sara is currently engaged in clinical work at the University Hospital in Leuven. She also teaches on both the undergraduate and masters programmes of the university’s Faculty of Kinesiology and Rehabilitation Sciences. Her own PhD studies concentrate on strategies for postural control in subjects with lower extremity injuries, with the main focus of her doctorate being upon chronic ankle instability.
What influenced your decision to study Physical Therapy and Rehabilitation Sciences?
Both my parents were doctors and when I was growing up, I suppose I just presumed I would follow them into the medical profession. Certainly, I knew that I wanted to work closely with people. Then, as I went through secondary school, I became increasingly interested in physical education. I was very active myself and played a lot of team sports, particularly volleyball. I suppose it was then that I started to consider specializing in physical therapy and in the application of scientific and medical approaches to optimize performance for sports and athletics and for general health and well-being.
Your initial Physical Therapy degree entailed a total of five years of study. The course must be extremely comprehensive?
Rehabilitation Sciences and Physical Therapy has been an independent department at Leuven for several years. It admits more than 1200 students every year and is particularly well-known for research, awarding around a dozen doctorates annually. The undergraduate course is very comprehensive indeed and it offers a range of clinical and research-based options. I was able to learn about every conceivable application of physiotherapy, whether in a purely medical context, in physical education, sport and leisure, fitness and general community health.
What is the main aim of your doctoral thesis?
The aim of my research is to establish whether existing impaired muscle activation predisposes subjects to develop chronic ankle instability. We suspected that the impairments in question were not restricted to the area immediately around the injured ankle, but that these impairments might actually originate, not within the ankle complex itself, but in the more proximal joint complexes. If we could prove this, it would enable us to modify existing treatment strategies, focusing more on the motor control of the muscles which determine core stability.
How did you structure your clinical research?
We decided that the best method to achieve concrete conclusions was via a controlled laboratory study. Twenty healthy and physically active control subjects – most of them volunteers from the Leuven student body - took part, alongside 20 subjects who had already exhibited signs of chronic ankle instability. Every subject underwent a range of different tests, designed both to measure their overall postural control and the precise degree of movement of key joints, including the knee, hip and throughout the trunk and lower body – in other words, not just their ankle movements. We measured the onset of muscle activity of 14 lower limb and trunk muscles during the transition from a double-leg stance position to a single-leg stance position - in a an eyes-open, eyes-closed test condition, and while standing on a balance pad with eyes open.
What were your initial conclusions?
Analysis of our main data suggested that the subjects who were already suffering with chronic ankle instability showed significantly later onset times for the ankle and hip muscles compared with the healthy control subjects. They appeared to use a similar muscle activation pattern in both test conditions, whereas the healthy control subjects always adjusted their activation pattern appropriately, according to the conditions. As part of the study, we also examined the overall effects on postural control when subjects were using the Donjoy Velocity Ankle Brace.
Did the inclusion of the Donjoy Velocity Brace affect your initial findings?
To be honest, I was a little puzzled by the initial results of those studies. The very first data seemed to show no improvement in postural sway but, on subsequent, closer, examination, we came up with some interesting results. It appeared that some subjects had performed significantly better during the tests when wearing the brace, while others performed worse. When we re-examined the data, we realized that the subjects who were benefiting were those who relied on hip and knee muscles to correct their balance – presumably in an unconscious attempt to compensate for their existing ankle instability. Subjects who performed worse, were those who relied on the ankle muscles, and with the brace they were forced to change that. These studies have been enormously helpful. It has allowed us to rethink our existing treatment strategies for ankle instability. We will now be using a combination of prescribed physical therapy and suggested use of the ankle brace to optimize postural control, hopefully correcting the original problems and also evading any future complications.
When will you be awarded your PhD and what are your plans for the future?
I’m hoping to receive my doctorate in October 2008. I’ve very much enjoyed my research and I am obviously pleased that my own conclusions are going to contribute significantly to improvements in existing therapeutic strategies. I suppose one option would be to finally leave academia and take up an in-house job within the physical therapy industry itself. However, I’ve particularly enjoyed teaching the undergraduates at Leuven; I really enjoy the interaction with the younger students who are all so enthusiastic to learn. I suppose a combination of teaching and a more conventional job would be ideal. However, I’m currently also extremely busy outside the workplace, looking after my two children. The eldest is now three but the youngest is only nine months old, so I’ve pretty much got my hands full for the next couple of years.