An Interview with Steve Marshall and the UNC Injury Prevention Research Center

Steve Marshall, PhD, is the director of the UNC Injury Prevention Research Center. He is also a researcher and professor within the Department of Epidemiology and the Department of Exercise and Sport Science at the University of North Carolina-Chapel Hill. 

1. What is your organization’s interest in the Osteoarthritis Action Alliance?

UNC Injury Prevention Research Center has a long-standing interest in sports and recreational injuries and their consequences in latter-life.  We know that knee injuries, for example, anterior cruciate ligament (ACL) injuries, are major accelerators of progression to knee OA.  If we can prevent the initial injury, we can prevent early-onset OA. Given this evident link, we are delighted to partner with Osteoarthritis Action Alliance to help them with their mission of preventing OA.

2. What do you think is the most important issue today related to osteoarthritis?

Without a doubt, the most important issue is to keep people with or at risk for OA moving safely so they remain fit and healthy as they age. Physical activity should promote joint health and cardiovascular benefits, while minimizing injury risk.

In close second place is the risk of pharmacologic treatment for OA, particularly if prescription opioids are used.  Prescription opioids provide wonderful short-term pain relief, but in the long-term they can present risks for people with OA.  These risks include the potential for opioid misuse disorder (“getting hooked on the pills”), overdose, and death.  An opioid overdose sounds like a dramatic event, but the mechanism is simple respiratory suppression.  When people take too much opioid medicine (or combine it with other medicines), they can go to sleep and not wake up.

3. How does your work connect to issues in osteoarthritis?

We are very interested in research aimed at preventing post-injury progression to OA.  We have two research projects in progress in this area.  One – a follow-up study of a large ACL-injured cohort -addresses progression to OA following injury. Results from this study could determine biological and clinical tests to help us identify people who are the most likely to progress to OA after injury.  Our second project addresses boosting patient knowledge and skills for managing OA. OAAA members and researchers at the Thurston Arthritis Research Center have been wonderful partners for us in this area.  We are developing a smartphone app and testing it in a military population.

4. What is a headline you’d like to see about osteoarthritis in five years?

The headline we would like to see is: “New Treatments for Joint Injuries Prevent Osteoarthritis!” We know that we reduce the population burden of OA by preventing musculoskeletal injuries or by providing effective treatments after injury.  We are currently leading research efforts in the military to determine important factors, such as biomechanics (movement patterns) and markers in blood, that predict future injury and OA.  Understanding these factors could inform approaches for preventing OA.

5. What is one interesting fact you’d like people to know about your organization?

Founded over 30 years ago, the UNC Injury Prevention Research Center has established itself as a world leader in interdisciplinary community-based collaborative efforts to reduce the incidence and consequences of injury.  Our center and the OAAA members are clearly equipped in our joint efforts to advance injury prevention in order to reduce the long-term consequence of OA in communities.