Can you tell us a little about your research area?
My research spans the lifespan. We investigate prevention and treatment and use joint damage as a risk factor for osteoarthritis. We conduct studies from young people with injury or risk of injury to older people with osteoarthritis and focus on exercise.
Can you tell us about your current research projects?
I-PROTECT is a project that deals with preventing joint injuries, where we implement injury prevention training in youth handball in collaboration with the Swedish Handball Association.
Why handball?
There were several factors that decided: Lund is a handball city, there are a lot of injuries in the sport and my children play.
This is a large project with researchers with different expertise, physiotherapy, sports medicine, sports psychology, implementation and health promotion. The unique thing is that we have users (players, coaches, club representatives and federations at district and national level) with us throughout the project. This makes it very complex, requires a lot from me as the project leader, we have to find a common language between researchers and between researchers and users, everyone should contribute what they contribute best and the project should be driven forward at the same time.
SHIELD is a project where we look at those who have had surgery for a knee injury. We do this in collaboration with Norway and then have data from both countries. We are investigating different factors to identify signs of early osteoarthritis.
Are they sports injuries, considering that you are looking at young people?
Not only that, but many are sports injuries, but also exercise and some everyday accidents.
The thesis was whether good muscle function can prevent signs of early osteoarthritis, which is examined in the form of the person's perceived knee pain. Preliminary results show that it does not, but that if you self-assess poorer function in sports and leisure after surgery, there is a connection with signs of early osteoarthritis later on.
We included the patients 1 year after surgery because rehabilitation is usually complete by then. Then they are also examined 3 years after surgery. We also have data from MRI and biomarkers, which remain to be analyzed.
HIPSTER is a project where we include people with long-term hip and groin pain, who are likely a risk group for early osteoarthritis in the hip.
We look at young people up to middle age and those who do not yet have osteoarthritis visible on X-ray. This is an ongoing clinical study where we compare 2 different physiotherapeutic treatment models in people who have been referred to specialist care, the Orthopedic Clinic, for assessment prior to possible surgery.
This study builds on a previous study of this patient population. Of those referred to the Orthopedical Clinic, only half had problems that could be amenable to surgery. The others were not helped at all by surgery. Then we need to get better at identifying those in primary care who need to be referred to specialist care.
This is an important result because both groups that were referred had poor muscle function and poorer self-esteem compared to gender- and age-matched controls. However, there was no difference between the patient groups. We interpret this result as indicating that we need a better training model and education for the patients.
MOTIFS is a study on knee osteoarthritis in middle-aged and older people where we use the treatment method "Train the Brain". This method has been developed by researchers in physiotherapy, sports medicine and sports psychology together with clinically active physiotherapists. In this new training program, psychological training is integrated into physical rehabilitation.
Psychological training can be different things and here we have chosen what is called dynamic motor simulation. This means that while you are doing a regular rehabilitation exercise, the person imagines themselves in a real situation so that it resembles the activity as much as possible that you need to get better at.
For example, a calf raise to train your calves and legs and practice that movement. The physiotherapist talks through with the patient when you need to be able to do this, either in everyday life or in sports.
The handball athlete should be able to jump up and shoot at the goal and if it is the case that the patient cannot jump yet, then you do it as similar as possible to how you would jump. Then you have a handball, and you have a goal that you can throw into. The patient gets an external focus, the goal of the exercise and the physiotherapist checks that the exercise is performed with the right quality. The exercises are more fun when they are realistic, and you integrate mental aspects. We have tested the model on young people with knee injuries and now we are trying the model on people with osteoarthritis in middle age and older, but then we use different exercises.
For example, the patient is given the task of going up and down a flight of stairs as an exercise. Then it is discussed with each person where you have to simulate a situation in everyday life where they go up and down the stairs in a positive situation, for example going up a flight of stairs to meet a friend.
Sofie: For me it would have been going up the stairs to take a hot bath.
Eva: Exactly!
We will look at how they experience and appreciate the exercises through a form. We also look at objective function, for example time, and use advanced movement analysis where we can look at the angle and load of the joints and how soft and supple the movement is.
The patient and the physiotherapist co-create exercises. It takes a little longer to plan, but if it results in actually doing the exercises, it is worth it. The patient owns the training themselves in a completely different way. We are now investigating through fMRI whether the brain is activated as we imagine when visual and physical training is combined.
What do you hope will happen in your research area?
In general, I hope that the research will contribute to preventing injuries and that treatment in the form of exercise, which is the basic treatment for injuries to muscles and joints, will be better for the patient and society for those with knee injuries, hip injuries or osteoarthritis.
What do you consider to be your greatest contribution to your research area so far?
I-PROTECT is a project that has been running for 10 years. The Swedish Handball Association has now taken over the intervention and the program that we developed with experts and users. The program has been launched widely throughout the country since the beginning of the year. This is the ultimate goal of the research that it is used by the target group.
We continue to collaborate with the Swedish Handball Association to continue compiling and using data.
NEMEX is a study that has also had a social impact. It is a training program that I developed together with others. It is based on principles for training that have been done for younger and middle-aged people with knee injuries, and then we tested this on people who were on a waiting list for a new knee or hip joint.
Neuromuscular training is also used to make it fun. Previously, simple strength exercises were mainly done, or people were just encouraged to be physically active. NEMEX is based on everyday movement and there are aspects of movement quality that are important. The aim is to improve the quality of movements in order to move more optimally in everyday life.
The study has been widely disseminated around the world and is highly cited. This is research that has had a great impact and is a program that appeals to both patients and researchers.
Any publication about the projects?
I-PROTECT https://portal.research.lu.se/sv/projects/implementing-injury-preventio…
SHIELD https://doi.org/10.1016/j.joca.2025.02.724
Train the Brain https://portal.research.lu.se/sv/projects/motor-imagery-to-facilitate-sensorimotor-relearning-motifs-integr
