Research insights informing policy and care

This means injuries to this biomechanical system can severely disrupt our lives, says Dr. Angelica Lang (PhD), assistant professor at the Canadian Centre for Rural and Agricultural Health, University of Saskatchewan (USask). “When these injuries happen, no matter how they start, they can affect your work and leisure activities – and impact every part of your life.”

From studying the clinical biomechanics of the upper limb, Lang and her team aim to improve our understanding of musculoskeletal health, such as the dysfunction experienced by breast cancer survivors.

“For breast cancer patients, the top priority is obviously to cure the cancer, and treatments have fortunately advanced to where they are now over 90 per cent effective,” she notes. “However, we also need to consider the quality of life after treatment, and that’s what we aim to do with our research.”

When Lang began researching post-breast cancer treatment effects, with a focus on women who had undergone a mastectomy, she found that half her study participants were already experiencing shoulder pain without having been diagnosed with a musculoskeletal injury. Curious to learn more about the origin of the pain, the team started to look at breast cancer survivors on a larger scale – including patients who had undergone different therapies and surgeries and various kinds of breast reconstruction – to look for connections.

They found that after breast cancer treatment – whether that’s surgery, radiation or chemotherapy – it is common for patients to experience some upper limb limitations, says Lang. “Evidence suggests that breast cancer survivors are more likely to experience a secondary injury like a rotator cuff disorder.”

Leaving such injuries undiagnosed and untreated presents considerable risk, both in breast cancer survivors and other patient groups, she explains. “Generally, we found that the longer individuals have pain, the more harmful their movement patterns become. The way you move can contribute not only to the development of an injury but also to the progression of the injury.”

People going through “cancer treatment just want to be able to get back to life rather than deal with physical challenges that may leave them unable to work or do the things they enjoy,” says Lang. “My interest is in understanding these injuries so we can better treat them, better prevent secondary injuries – and provide information to patients and health-care providers.”

At the Musculoskeletal Health and Ergonomics lab at the Canadian Centre for Rural and Agricultural Health at USask, of which Dr. Lang is the director, the team has access to sophisticated motion-tracking equipment “similar to the technology used for animation and video games.

“Our primary equipment is a system called a Vicon system, where we use a set of 10 cameras to track motion,” she explains. “Placing reflective markers on a person’s body allows these cameras to track the motion of these markers in three dimensions with infrared light.”

Information from these measurements allows for the creation of movement maps that include body angles, Lang says. “We typically look at the torso, the upper arms and the shoulder blade to calculate scapulothoracic and thoracohumeral angles, which describe movements in the general shoulder area.”

In addition to these sensors, the team uses “electromyography to measure electrical muscle activity. This serves as a stand-in for direct measurement of muscle force generation because actual muscle forces are difficult to obtain,” she explains. “If you have a high amount of electrical activity, this more or less means your muscles are doing a lot of work.”

Measuring angles and seeing “which muscles are activating (or not) can provide insights on particular postures and movement patterns associated with injury,” says Lang. “The underlying basic science is biomechanics, and we’re able to apply that to both clinical and occupational ergonomics questions.”

Beyond boosting health and wellness in patient groups, as with the breast cancer project, the team also aims to uncover risk factors, with other research efforts looking at the impact of using different farming equipment on musculoskeletal health, she adds. “We also have wearable sensors, called inertial measurement units, that allow measurements in work settings, for example, on farms.”

Lang’s aim – to translate research insights into tangible benefits and to work directly with community members to understand their challenges – is a hallmark of many efforts as USask strives to be “the university the world needs,” says USask President Peter Stoicheff. “We have three missions that include teaching and learning; research, scholarly and artistic work; and community engagement. As a result, we have a strong focus on being outward-facing and community-oriented to find out what is needed.”

Just as Lang works in rural communities, “you see our nurses, doctors, dentists, veterinarians and other experts out in far-flung places across Saskatchewan,” he says. “We’re constantly challenging ourselves to see where we can make a meaningful contribution.”

Among the strengths that make USask uniquely equipped to tackle some of the most critical issues of our time are cutting-edge research infrastructure, world-leading talent and “a high number of disciplines that provide fertile ground for collaboration,” says Stoicheff. “We have 17 colleges and faculties, more than most Canadian universities, and this is especially meaningful when you look at today’s big challenges, such as food security, global pandemics and environmental sustainability, which cannot be solved by a single discipline or a single lab alone.”

Such tough questions can also require collaboration between different academic institutions and across the globe, he notes. “During the COVID pandemic, for example, international vaccine labs were able to produce a vaccine in the space of 13 months when this is something that typically takes a decade to achieve.”

While the pandemic inspired collaborative action on an unprecedented scale, the foundation for the vaccine technology had been laid by “decades of curiosity-driven research, including at our Vaccine and Infectious Disease Organization [VIDO],” says Stoicheff, adding that as Canada’s Centre for Pandemic Research, VIDO is at the forefront of efforts to address emerging disease threats.

Funding support for VIDO is enabling the creation of “Canada’s second – and only university-based – level 4 containment facility,” he says. “The only other level 4 facility is the government’s National Microbiology Laboratory in Winnipeg.”

This enhances VIDO’s research and development capabilities and contributes to pandemic preparedness globally; for Stoicheff, such investments and support “are a real vote of confidence in the quality of the research that goes on here.

“We have many researchers who do terrific work, including in the area of health, in local communities as well as across the world, and this makes us a sought-after partner for collaboration,” he says. “It is incumbent upon universities – and the larger research community – to engage with the most challenging questions of our time to help achieve some useful goals.”

Dr. Lang also values the collaborative aspect of her work. “It’s been a team effort where we work closely with clinicians with different expertise, including the surgery and rehabilitation perspectives for the breast cancer project.”

In addition to Dr. Soo Kim, professor in the School of Rehabilitation Science; Dr. Gary Groot, professor in the Department of Surgery; and Dr. Tracey Carr, assistant professor in the Department of Community Health and Epidemiology, Dr. Lang wants to acknowledge “every woman who has come through this program.

“Everyone was willing to go above and beyond for the study, even when it didn’t bring any direct benefits for them,” she says. “We do hope our findings can help us refine approaches to treatments in the future.”

One objective is to improve outcomes by contributing to informed decision-making at multiple levels, including patients, health-care providers and policymakers, says Dr. Lang, who notes that currently, many breast cancer survivors have to seek care related to shoulder pain themselves – and possibly pay out of pocket. “The more awareness we can create, the more changes we can effect, both in clinics and at the policy level.”

By providing data on the impact of biomechanical challenges on quality of life, Dr. Lang hopes to catalyze positive change to “enable everyone to thrive.

“We all use our hands for everyday tasks, so this affects everybody,” she says. “I’ve always played a lot of sports, so that started my interest in body movement and performance. I still play recreational sports, including hockey. It’s a ton of fun, and I would be very sad if I had an injury that would prevent me from enjoying this.”

Originally published via the Globe and Mail.