Angie Brown, Quinnipiac University

Knee injuries are common in athletes, accounting for 41% of all athletic injuries. But knee injuries aren’t limited to competitive athletes. In our everyday lives, an accident or a quick movement in the wrong direction can injure the knee and require medical treatment. A quarter of the adult population worldwide experiences knee pain each year

As a physical therapist and board-certified orthopedic specialist, I help patients of all ages with knee injuries and degenerative conditions.

Your knees have a huge impact on your mobility and overall quality of life, so it’s important to prevent knee problems whenever possible and address pain in these joints with appropriate treatments.

Healthy knees

The knee joint bones consist of the femur, tibia and patella. As in all healthy joints, smooth cartilage covers the surfaces of the bones, forming the joints and allowing for controlled movement.

Muscles, ligaments and tendons further support the knee joint. The anterior cruciate ligament, commonly known as the ACL, and posterior cruciate ligament, or PCL, provide internal stability to the knee. In addition, two tough pieces of fibrocartilage, called menisci, lie inside the joint, providing further stability and shock absorption.

All these structures work together to enable the knee to move smoothly and painlessly throughout everyday movement, whether bending to pick up the family cat or going for a run.

Causes of knee pain

Two major causes of knee pain are acute injury and osteoarthritis.

Ligaments such as the ACL and PCL can be stressed and torn when a shear force occurs between the femur and tibia. ACL injuries often occur when athletes land awkwardly on the knee or quickly pivot on a planted foot. Depending on the severity of the injury, these patients may undergo physical therapy, or they may require surgery for repair or replacement.

PCL injuries are less common. They occur when the tibia experiences a posterior or backward force. This type of injury is common in car accidents when the knee hits the dashboard, or when patients fall forward when walking up stairs.

The menisci can also experience degeneration and tearing from shear and rotary forces, especially during weight-bearing activities. These types of injuries often require rehabilitation through physical therapy or surgery.

Knee pain can also result from injury or overuse of the muscles and tendons surrounding the knee, including the quadriceps, hamstrings and patella tendon.

Both injuries to and overuse of the knee can lead to degenerative changes in the joint surfaces, known as osteoarthritis. Osteoarthritis is a progressive disease that can lead to pain, swelling and stiffness. This disease affects the knees of over 300 million people worldwide, most often those 50 years of age and up. American adults have a 40% chance of developing osteoarthritis that affects their daily lives, with the knee being the most commonly affected joint.

Age is also a factor in knee pain. The structure and function of your joints change as you age. Cartilage starts to break down, your body produces less synovial fluid to lubricate your joints, and muscle strength and flexibility decrease. This can lead to painful, restricted movement in the joint.

Risk factors

There are some risk factors for knee osteoarthritis that you cannot control, such as genetics, age, sex and your history of prior injuries.

Fortunately, there are several risk factors you can control that can predispose you to knee pain and osteoarthritis specifically. The first is excessive weight. Based on studies between 2017 and 2020, nearly 42% of all adult Americans are obese. This obesity is a significant risk factor for diabetes and osteoarthritis and can also play a role in other knee injuries.

A lack of physical activity is another risk, with 1 in 5 U.S. adults reporting that they’re inactive outside of work duties. This can result in less muscular support for the knee and more pressure on the joint itself.

An inflammatory diet also adds to the risk of knee pain from osteoarthritis. Research shows that the average American diet, often high in sugar and fat and low in fiber, can lead to changes to the gut microbiome that contribute to osteoarthritis pain and inflammation.

Preventing knee pain

Increasing physical activity is one of the key elements to preventing knee pain. Often physical therapy intervention for patients with knee osteoarthritis focuses on strengthening the knee to decrease pain and support the joint during movement.

The U.S. Department of Health and Human Services recommends that adults spend at least 150 to 300 minutes per week on moderate-intensity, or 75 to 150 minutes per week on vigorous-intensity aerobic physical activity. These guidelines do not change for adults who already have osteoarthritis, although their exercise may require less weight-bearing activities, such as swimming, biking or walking.

The agency also recommends that all adults do some form of resistance training at least two or more days a week. Adults with knee osteoarthritis particularly benefit from quadriceps-strengthening exercises, such as straight leg raises.

Treatments for knee pain

Conservative treatment of knee pain includes anti-inflammatory and pain medications and physical therapy.

Medical treatment for knee osteoarthritis may include cortisone injections to decrease inflammation or hyaluronic acid injections, which help lubricate the joint. The relief from these interventions is often temporary, as they do not stop the progression of the disease. But they can delay the need for surgery by one to three years on average, depending on the number of injections.

Physical therapy is generally a longer-lasting treatment option for knee pain. Physical therapy treatment leads to more sustained pain reduction and functional improvements when compared with cortisone injections treatment and some meniscal repairs.

Surgical interventions for knee pain include the repair, replacement or removal of the ACL, PCL, menisci or cartilage. When more conservative approaches fail, patients with osteoarthritis may benefit from a partial or total knee replacement to allow more pain-free movement. In these procedures, one or both sides of the knee joint are replaced by either plastic or metal components. Afterward, patients attend physical therapy to aid in the return of range of motion.

Although there are risks with any surgery, most patients who undergo knee replacement benefit from decreased pain and increased function, with 90% of all replacements lasting more than 15 years. But not all patients are candidates for such surgeries, as a successful outcome depends on the patient’s overall health and well-being.

New treatments on the horizon

New developments for knee osteoarthritis are focused on less invasive therapies. Recently, the U.S. Food and Drug Administration approved a new implant that acts as a shock absorber. This requires a much simpler procedure than a total knee replacement.

Other promising interventions include knee embolization, a procedure in which tiny particles are injected into the arteries near the knee to decrease blood flow to the area and reduce inflammation near the joint. Researchers are also looking into injectable solutions derived from human bodies, such as plasma-rich protein and fat cells, to decrease inflammation and pain from osteoarthritis. Human stem cells and their growth factors also show potential in treating knee osteoarthritis by potentially improving muscle atrophy and repairing cartilage.

Further research is needed on these novel interventions. However, any intervention that holds promise to stop or delay osteoarthritis is certainly encouraging for the millions of people afflicted with this disease.

Angie Brown, Clinical Associate Professor of Physical Therapy, Quinnipiac University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Pamela L. Geller, University of Miami

When I started my research on the Samuel George Morton Cranial Collection, a librarian leaned over my laptop one day to share some lore. “Legend has it,” she said, “John James Audubon really collected the skulls Morton claimed as his own.” Her voice was lowered so as not to disturb the other scholars in the hushed archive.

As my work progressed, I uncovered no evidence to substantiate her whispered claim. Audubon had collected human skulls, several of which he then passed on to Morton. But birds and ornithology remained Audubon’s passion.

Nevertheless, the librarian’s offhanded comment has proven useful – a touchstone of sorts that continues to remind me of the controversy and confusion long surrounding the Morton Collection.

Morton was a physician and naturalist who lived in Philadelphia from 1799 until the end of his life in 1851. A lecture he delivered to aspiring doctors at the Philadelphia Association for Medical Instruction outlined the reasons for his cranial compulsion:

“I commenced the study of Ethnology in 1830; in which year, having occasion to deliver an introductory lecture on Anatomy, it occurred to me to illustrate the difference in the form of the skull as seen in the five great races of men … When I sought the materials for my proposed lecture, I found to my surprise that they could be neither bought nor borrowed.”

He would go on to acquire almost 1,000 human skulls.

Morton used these skulls to advance an understanding of racial differences as natural, easily categorizable and able to be ranked. Big-brained “Caucasians,” he argued in the 1839 publication “Crania Americana,” were far superior to small-skulled American Indians and even smaller-skulled Black Africans. Many subsequent scholars have since thoroughly debunked his ideas.

Certainly, condemnation of Morton as a scientific racist is warranted. But I find this take represents the man as a caricature, his conclusions as foregone. It provides little insight into his life and the complicated, interesting times in which he lived, as I detail in my book “Becoming Object: The Sociopolitics of the Samuel George Morton Cranial Collection.”

My research demonstrates that studies of skulls and diseases undertaken by Morton and his medical and scientific colleagues contributed to an understanding of U.S. citizenship that valued whiteness, Christianity and heroic masculinity defined by violence. It is an exclusionary idea of what it means to be American that persists today.

Yet, at the same time, the collection is an unintended testament to the diversity of the U.S. population during a tumultuous moment in the nation’s history.

Men of science and medicine

As a bioarchaeologist who has studied the Morton Collection for many years, I have sought to better understand the social, political and ideological circumstances that led to its creation. From my work – analyzing archival sources including letters, laws, maps and medical treatises, as well as the skulls themselves – I’ve learned that, over a lifetime, Morton fostered a professional network that had far-reaching tentacles.

He had plenty of help amassing the collection of skulls that bears his name.

The physician connected with medical colleagues – many of whom, like him, received degrees from the University of Pennsylvania – gentleman planters, enslavers, naturalists, amateur paleontologists, foreign diplomats and military officers. Occupational differences aside, they were mostly white, Christian men of some financial means.

Their interactions took place during a pivotal moment in American history, the interlude between the nation’s revolutionary consolidation and its violent civil unraveling.

Throughout this stretch of time, Morton and his colleagues catalyzed biomedical interventions and scientific standards to more effectively treat patients. They set in motion public health initiatives during epidemics. They established hospitals and medical schools. And they did so in the service of the nation.

Not all lives were seen as worthy of these men’s care, however. Men of science and medicine may have fostered life for many, but they also let others die. In “Becoming Object,” I track how they represented certain populations as biologically inferior; diseases were tied to nonwhite people, female anatomy was pathologized, and poverty was presumed inherited.

From person to specimen

Such representations made it easier for Morton and his colleagues to regulate these groups’ bodies, rationalize their deaths and collect their skulls with casual cruelty from almshouse dissecting tables, looted cemeteries and body-strewn battlefields. That is, a sizable portion of the skulls in Morton’s collections were not culled from ancient graves but belonged to those of the recently alive.

It is no coincidence that Morton began his scientific research in earnest the same year Andrew Jackson signed the Indian Removal Act of 1830. Men of science and medicine benefited from the expansionist policies, violent martial conflicts and Native displacement that underpinned Manifest Destiny.

The collection reveals these acts of nation-building as necropolitical strategies – techniques used by sovereign powers to destroy or erase certain, often already vulnerable, populations from the national consciousness. These skulls attest to precarious existences, untimely deaths and trauma experienced from cradle to beyond the grave.

In the specific case of Native Americans, skeletal analysis testifies to the violent effects of U.S. military campaigns and forced removal. Native skulls that Morton labeled “warriors” have evidence of unhealed fractures and gunshot wounds. Children’s skulls bear the marks of compromised health; such pathology and their young ages at death are evidence of long-standing malnutrition, poverty and deprivation or stress.

To effectively transform subjects into objects – human beings into specimens – collected crania were ensconced in the institutional spaces of medical school lecture halls and museum storage cabinets.

There, Morton first numbered them sequentially. These numbers along with information about race, sex, age, “idiocy” or “criminality,” cranial capacity and provenance were inked on skulls and written in catalogs. Very rarely was the person’s name recorded. If used as teaching tools, Morton drilled holes to hang the skulls for display and notated them with the names of skeletal elements and features.

As dehumanizing as this process was, the Morton Collection does contain evidence of resilience and heterogeneous lives. There are traces of people with mixed-race backgrounds such as Black Indians. Several people may have also bent gender to navigate dire conditions or in keeping with social norms, such as native Beloved Women, who were active in warfare and political life.

What these bones mean today

As anthropologists now recognize, it is through the repatriation of the remains of the people in the Morton Collection to their descendants, among other types of reparations, that current practitioners may begin to atone for the sins of intellectual forebears. Indeed, all institutions housing legacy collections must contend with this issue.

There are other, valuable lessons – about diversity and suffering – that the Morton Collection has to impart in today’s interesting times.

The collection demonstrates that the American body politic has always been a diverse one, despite efforts of erasure by men like Morton and his colleagues. Piecing together the stories of past, disenfranchised lives – and acknowledging the silences that have made it difficult to flesh them out – counters past white nationalism and xenophobia and their current resurgence.

The collection, I believe, also urges the repudiation of violence, casual cruelty and opportunism as admirable attributes of masculinity. Valorizing men who embody these qualities has never served America well. Particularly in the mid-1800s, when Morton amassed skulls, it led to a nation divided and hardened to suffering, an unfathomable death count and the increasing fragility of democracy.

Pamela L. Geller, Associate Professor of Anthropology, University of Miami

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Lisa Bosman, Purdue University

Diversifying the science, technology, engineering and math fields has long been a top priority of many universities and tech companies. It’s also a goal of the National Science Foundation, the biggest funder of university-led research and development in the U.S.

But in the field of engineering, at least, there hasn’t been a lot of progress in diversifying the academic pipeline beyond white men.

The share of engineering bachelor’s degrees awarded to Black students has barely budged over the past decade. Women and Hispanic students fared better, but their respective percentages are still well below their shares of the population as a whole. The shares of engineering professors who are Black or Hispanic are also little changed and remain in the low single digits.

Many reasons have been cited for this lack of progress, including stereotypes, lack of exposure, limited role models and the recent backlash against so-called woke policies that emphasize diverse hiring policies. But, as a scholar of STEM education accessibility, I believe there’s another culprit: poorly prepared professors. Unlike the other challenges, it happens to be a much easier problem for universities themselves to remedy.

Some progress – but not a lot

A quick look at the numbers shows there hasn’t been much to show for all the efforts to improve diversity of the engineering field.

For example, in 2011, 4.2% of engineering bachelor’s degrees were awarded to African American students. A decade later, 4.7% of degrees went to African American students.

Progress was better for women and Hispanic students, but the numbers are still far from proportional to demographics. In 2011, Hispanic students earned 8.5% of engineering degrees. That rose to 13.6% in 2021 – versus the group’s 20% share of the U.S. population.

Women similarly saw gains over the years, going from 18% to 24%. But 6 percentage points in 10 years doesn’t look as good when you consider that women make up over half of the population.

The situation is worse when you look at the share who become professors. In 2020, 2.5% of engineering professors were African American, the same share as 10 years earlier. The share of Hispanic engineering professors edged up to 3.9% from 3.7%.

Women fared slightly better, rising to 18.6% from 13.8%, but as noted, that’s still a pretty poor result from all those efforts to diversity the academy.

More broadly, there’s a deeper problem in engineering schools. Just 56% of engineering students complete their bachelor’s degree in six years, according to a 2021 report by the American Society for Engineering Education. That compares with 64% for all fields. A National Science Foundation survey from the same year found that only 65% of science and engineering college graduates were working in a field related to their degree.

In other words, roughly a third of engineering students aren’t getting their degrees, and among those who do, around a third are switching careers – despite investing a lot of money on their education. While there’s limited data available on women or specific racial groups, I don’t think I’m going out on a limb to argue that the numbers for them look even worse.

Engineering teachers lack much teacher training

Among the reasons cited for this, I believe that the roles of teaching and learning haven’t received enough attention.

A growing body of research suggests that the quality of teaching needs to improve to reverse trends of lower graduation rates and properly teach an increasingly diverse student body. And I believe this is especially true in STEM disciplines like engineering.

Engineering professors commonly have training in advanced technical areas, but few receive training in teaching and learning. This challenge of poor teaching preparedness is not limited to the engineering discipline, but the consequences are much worse, especially given the push to diversify STEM.

Effective teaching enhances retention and completion rates by promoting better understanding of the material and creating more student involvement in the learning process. When students are actively engaged, supported and motivated to learn, they are more likely to persist and complete their educational goals.

Teacher training for universities is starkly different than K-12 training. Most school districts require that teachers have a four-year bachelor’s degree in teacher education. The focus is less on content and more on implementing effective teaching practices. K-12 training includes lesson planning, differentiated instruction and best practices for classroom management. There is also often a strong emphasis on social, emotional and behavioral well-being.

Although some engineering doctoral students might gain teaching exposure through a graduate teaching assistantship, this experience is commonly limited to grading assignments and rarely includes course design and development.

To teach as a professor in colleges and universities, most accreditation boards simply require a minimum of 18 graduate credits – or about two semesters – in the topic area. Here, the focus is strictly on research content. No prior teaching experience or training is required.

As a result, newly minted doctoral graduates are thrown into the lion’s den of teaching unprepared. If they are lucky, they are provided with the latest available syllabus. However, new professors are typically unprepared to accommodate students with disabilities, teach Black and Hispanic students, work with remedial students or navigate sensitive topics. They are generally anxious about teaching.

The field of K-12 teacher education has strategies to deal with these challenges. Continuing education and ongoing professional development keep both experienced and inexperienced teachers up to date on inclusive teaching practices. These can include sharing gender pronouns, ensuring media is accessible, using inclusive language and offering diverse perspectives in teaching resources. And yet, keeping up with these changes can be daunting for new professors.

Teaching teachers to teach

But there is a solution: treating college-level teaching as a professional development opportunity.

Most colleges and universities offer professional development training for professors and other instructors who want to opt in to teacher training, but the programs often have limited scope and responsibility at a level to make a substantial positive impact on student learning and engagement.

One way to change this is to invest in Scholarship of Teaching and Learning programs. This is a scholarly approach in which educators systematically study their teaching practices, student learning outcomes and the effectiveness of various teaching methods and strategies.

At Purdue University, we created a Scholarship of Teaching and Learning Accelerator program to help engineering graduate students around the world improve their teaching methods and share what they learned with others. In 2024, we published a peer-reviewed article that reports the process and what we learned.

By providing comprehensive professional development opportunities tailored to the needs of engineering instructors, institutions can support their ongoing growth and development as effective educators, ultimately enhancing the quality of engineering education and preparing students for success in their future career.

And in turn, better-trained teachers will be better equipped to support students from diverse backgrounds and help those traditionally underrepresented in STEM.

Lisa Bosman, Associate Professor of Industrial Engineering, Purdue University

This article is republished from The Conversation under a Creative Commons license. Read the original article.