Catching Up with Sandra Shultz

September 1, 2015

The following article appears in the September 2015 issue of Training & Conditioning.

When Training & Conditioning first spoke with Sandra Shultz, PhD, ATC, CSCS, FACSM, for our December 1993 issue, she was Associate Director of Athletic Training and Rehabilitation at UCLA, and the topic was using ankle braces to protect Bruin athletes. Nearly a quarter-century later, Shultz is Chair of the Department of Kinesiology at the University of North Carolina at Greensboro and one of the world’s preeminent voices on ACL research.

Shortly after offering her thoughts for the article “Active Support,” Shultz moved from the clinic to the laboratory, earning a doctorate at the University of Virginia and beginning in-depth study on ACL injuries. Though giving up her day-to-day interactions with athletes was difficult, Shultz found the work in the lab and classroom fulfilling and quickly discovered that she was exactly where she was meant to be.

She has since published well over 100 articles on ACL risk factors, focusing mainly on identifying and minimizing injury triggers more prevalent in female athletes. Her work has earned her numerous awards and acclaim. This past June, Shultz’s accomplishments propelled her to the pinnacle of the profession as she was inducted into the NATA Hall of Fame.

We recently caught up with Shultz to talk about her career and the issues facing today’s athletic trainers. She also shares advice on working in academia and an update on the most recent ACL research.

Do you remember being interviewed for our article on ankle bracing back in 1993?

I definitely do. The story talked about how we used the Active Ankle device at UCLA on a number of our athletes with great success. It was one of the first rigid supports that fit within a shoe and wasn’t as prone to loosening like some of the lace up ones. Back then, I thought it was a great product, and I think it’s continued to prove itself. I enjoyed being part of that article and sharing information on a product that was really worthwhile for athletes and athletic trainers.

Why did you leave UCLA for academia?

I worked clinically for about 13 years before I decided to get my doctoral degree. I loved treating student-athletes at UCLA but also enjoyed teaching, so I thought I’d get my PhD, then work in a clinical setting and do some teaching and research on the side. When I got to Virginia, I fell in love with the research process. It didn’t take me long to go all in on that side of the profession.

Some people get the research bug, and some don’t. I got it in a big way. I kept learning new things and found it fascinating to see what other researchers were working on.

How did your work as a clinician play into the type of research you pursued?

During my years at UCLA, I was constantly seeing ACL injuries and very much wanted to figure out what was causing them—especially in female athletes. There was one year when we had eight females with ACL tears. It was also pretty bad across the entire Pac-10, which prompted athletic trainers from conference schools to come together and discuss ways we might be able to reverse the trend. Our discussions didn’t uncover any great answers, and that was a big reason I went into this area of research.

Back then, we had an idea that males and females probably activated their muscles differently and that hormones were also a likely variable. But we didn’t know much of anything for certain. I was curious to find out the role gender might play in injury risk.

What was the ACL research scene like when you began pursuing your PhD?

If you do a PubMed search on ACL injury risk in females before 1995, you’ll find just 26 articles on the subject, and most of those were on the periphery. If you do a search on the topic after 1995, you’ll find more than 1,000 articles. I was starting my research just when ACL tears in women became a hot-button topic and an exploding area of study.

Has your clinical background affected the research phase of your career?

Yes, definitely. It’s really important to me that my research is relevant to the clinical setting. Sometimes, if questions don’t have a clinical foundation, you end up doing research for the sake of research. But because I have been on the other side, rehabilitating knee injuries, it fueled my interest in finding ways to stop them from occurring in the first place. In addition, there were things that I learned as a clinician that I still tap into today, such as being able to recognize inefficient movement patterns.

Looking back, what have been the biggest “aha” moments from your research?

I don’t know if I’ve had any true “aha” moments. Research is a cumulative race won by the steady. I’m most proud of the body of work we’ve put together, especially what we’ve learned about joint laxity and how it helps explain the higher-risk movement patterns for most females. That has, in turn, caused us to think a little differently about prevention strategies.

Everyone talks about the fact that males and females move differently and that the way females move puts them at greater risk, but I want to know why that is. What is it about being female that places someone at higher risk? My interest has always been getting to the root source so we can make our prevention programs even more successful and effective.

What is your research currently focused on?

We’re focused on exploring the variables that affect structural integrity. We’ve figured out how joint laxity can affect movement strategies and hinder an ACL’s ability to handle external loads, and the next step is to back up even further and study why someone develops more laxity to begin with. This is where we are exploring and identifying genetic and hormonal influences.

For example, some recent research found that women who had higher relaxin values were at greater risk for ACL injury. Because relaxin is known to have a pretty profound effect on the metabolism of collagen, it was proposed that higher relaxin levels probably affect the laxity and strength of the ligament. We’re trying to test that theory now.

How will that information help prevent ACL tears?

That’s the next question. We need to use the information we uncover to determine if there is some training or procedure we can perform to modify the structure. This type of research will likely continue long past my career is over.

Currently, an athlete’s genetic and hormonal makeup is very hard for clinicians to measure and track. So what we’re really trying to do is identify a phenotype or physical trait that results from all those physiological effects—one that athletic trainers can readily screen for.

Is there anything you miss about the clinical setting?

I loved working with athletes who wanted to get better, and I got great satisfaction out of seeing them return from injury to their full capacity. I also enjoyed being on the sidelines and feeling like I was part of the competition. But now I have the opportunity to train future clinicians and researchers and hopefully inform them through evidence-based research, which is just as rewarding.

What don’t you miss?

The crazy schedules. Although I probably work just as many hours now as I did then, I have a lot more control over them.

In giving advice to new athletic trainers, you have talked about the value of taking risks. How was that important in your career?

I’m not naturally a risk-taker, but it has always paid off for me when I’ve gone outside my comfort zone. For example, when I was pursuing my doctorate, my advisor asked me to help write a textbook. I was intimidated by the idea at first, but I accepted the challenge and it paid off. That book is now in its fourth edition.

Taking a risk was also important when I was considering pursuing a doctoral degree. At the time, I had a great job at UCLA, and I was very happy living in Southern California. Joining the PhD program at Virginia would mean leaving everything I had to move across the country. It wasn’t until I sat down with a mentor and talked it through that I convinced myself to go through with it. But I am so, so glad that I did.

What’s your advice for anyone considering a career in research?

Get some clinical experience first—at least three to five years. I think that if you’re going to ask clinically relevant questions, you have to have spent time working with athletes. You don’t lose anything by doing this, and if you have that research bug, it’s not going to go away.

In what ways has the athletic training profession advanced most over the last 25 years?

We’ve continued to build our education component, which has advanced our credibility within the allied health care field. The same holds true for the research being done by athletic trainers. Also, the whole movement toward evidence-based practice has been very important for the profession.

What do you see as problem areas?

I think that we are sometimes our own worst enemies when it comes to the hours we allow ourselves to work. We could also probably do a better job of marketing ourselves. Athletic trainers tend to be a humble group and care most about what’s best for the athlete. There are times when the profession could be better at promoting the great things we do.

Congratulations on your NATA Hall of Fame induction. How did that experience impact you?

I have watched the Hall of Fame ceremonies ever since I was a student, and I’ve always thought it was the coolest thing. It was a thrill to get my Hall of Fame ring and go through the receiving line consisting of the Hall of Fame members. Those folks are my heroes, and it’s an honor to now be a part of such a special group of people.

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