6:33 p.m., Nov. 5, 2009----Lynn Snyder-Mackler, Alumni Distinguished Professor of Physical Therapy at the University of Delaware, delivered the 2009 Francis Alison Lecture on Wednesday afternoon, Nov. 4, at the Roselle Center for the Arts. The event drew a large crowd of academic colleagues, family members and friends, including Delaware's first lady, Carla Markell.

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Snyder-Mackler was also honored by a surprise visit from Vice President Joe Biden's wife, Jill, and his sister, Valerie Biden Owens. The pair delivered flowers to Snyder-Mackler, whose work on knee injuries and rehabilitation has affected the lives of many in Delaware and beyond.

“Someone told me that people asked me more questions at the Alison luncheon than any other award recipient has gotten,” Snyder-Mackler said. “That's just because everyone has knees.”

Snyder-Mackler's lecture -- “When Can I Walk (Run, Drive or Play) Again?” -- demonstrated that she is not only a scholar-schoolmaster like the 18th century educator for whom the award is named but also a clinician.

“I am a physical therapist,” she said, “and I always want to bring research back to the clinic.” Snyder-Mackler's entire career has been geared toward providing laboratory evidence to back clinical treatment decisions.

She began her presentation by showing photos of the many doctoral candidates she has advised and mentored during her 20 years at UD. “Most speakers save this part for the end,” she said, “but I'm starting with my students because they are how the work gets done.” Many were in the audience, including Kristin Briem, who is now an assistant professor of physiotherapy at the University of Iceland.

One of Snyder-Mackler's areas of research and clinical interest is knee injuries, particularly rupture of the anterior cruciate ligament, or ACL. More than 100,000 new cases of this injury are treated annually.

Treatment of ACL ruptures, however, is controversial. While two categories of patients, known as copers and noncopers, have been identified, a lack of effective screening methods to predict whether an individual will cope or not has resulted in an overwhelming push toward early surgery in the United States.

Snyder-Mackler and her research team are developing and testing a screening examination, consisting of hop tests and other measures, that will help in identifying candidates for nonsurgical treatment. She has had to turn to institutions overseas, where standard practice is to wait at least six months for surgical intervention, for access to a group of nonoperatively managed patients.

“What we're starting to see,” she said, “is that some people previously identified as noncopers are actually candidates for nonsurgical rehabilitation. But we would not have learned that just by studying patients here, because in the U.S. just about everyone goes to surgery within six to eight weeks of sustaining the injury.”

“We're challenging tradition,” she said, “by showing that the blanket practice of surgical intervention is not supported.”

Snyder-Mackler admitted that clinical research is messy. “It's not black and white,” she said. “Most of the time it's shades of gray. But as long as your findings are stronger than your errors, you're moving in the right direction.”

For Snyder- Mackler, the right direction is always toward a high level of functioning for the patient.

“Close to 500,000 total knee replacements are performed every year,” she said, “and the number is increasing because we're getting older and we're getting heavier.”

While most patients report reduced pain and improved range of motion after surgery, they are functionally not comparable to age-matched healthy control subjects.

“We're seeing a 40 to 50 percent deficit in quadriceps strength,” Snyder-Mackler said. “Is this good enough? As a physical therapist, I don't think it is.”

UD's Physical Therapy Clinic provides a living laboratory for the research Snyder-Mackler and her students are doing, as well as a setting for her students to learn practical clinical skills. “The clinic is where the rubber meets the road,” she said. “It's where we test out a lot of our research.”

After two decades at UD, Snyder-Mackler remains excited about both her ongoing work and the host of new opportunities here in health science, including the recently formed Delaware Health Sciences Alliance and the planned Delaware Rehabilitation Institute. The newly acquired Chrysler site also offers the potential for new collaborations and clinical practice options.

During the ensuing question-and-answer session, someone in the audience asked Snyder-Mackler how she plans to “crack the 77 percent of surgeons” who believe that surgery should be the first response to an ACL tear. “Evidence,” she responded. “It's slow, but it's happening.”

“One of the best things about having so many people go through our program and then go out and work throughout the country,” she added, “is that I know in 10 years we'll have more answers.”

After the lecture, UD President Patrick Harker presented Snyder-Mackler with a medal and officially inducted her into the Alison Society.

In his brief testimonial, Harker recognized Snyder-Mackler for not only the high quality of her work but also her enthusiasm for it and her determination to get answers. “You keep digging, keep asking, keep looking,” he said.

“We all saw the pictures at the beginning of her presentation,” he continued. “Among Lynn's most remarkable gifts is her love of teaching and her generous interaction not just with fellow researchers, colleagues and clinicians, but with students -- students who have lined up to add their praise to the quickly deafening chorus.”

“There are not many who could keep up a research agenda as significant as Lynn's -- as internationally lauded -- without sacrificing time dedicated elsewhere. And, yet, Lynn collaborates with scientists worldwide, she drives the research advancing knowledge and clinical practice in her field, and she writes and lectures prolifically.”

An international leader in the field of orthopedic rehabilitation research, Snyder-Mackler is the first faculty member in the College of Health Sciences to be named an Alison Scholar and the third woman among the 29 recipients of the award to date.

She currently is an investigator on more than $6 million in research projects funded by the National Institutes of Health and several foundations.

She also is the recipient of numerous awards from the American Physical Therapy Association, which named her a Catherine Worthingham Fellow, the highest honor in the profession, in 2003.

A prolific author, Snyder-Mackler has written more than 100 research articles, 30 book chapters and monographs, and textbooks on electrotherapy and sports physical therapy. She serves on the editorial boards of the Journal of Orthopedic and Sports Physical Therapy, Journal of Sports Rehabilitation and Physical Therapy in Sport and has given more than 165 presentations on her research in the U.S. and 12 foreign countries.

Her study results also have been reported by The New York Times, USA Today, United Press International and other major media.

Article by Diane Kukich
Photos by Ambre Alexander