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Ellen Bloom (left) and Lily Lin, UD doctoral candidates in
biomedical engineering, work in their lab on the Science, Technology and
Advanced Research (STAR) Campus. Alongside professors Dawn Elliott,
Karin Grävare Silbernagel and Justin Parreno, they’re studying tendon
From age 3 through high school, Lily Lin was an award-winning gymnast, placing in state and regional championships.
“It’s such a high-impact sport. I suffered from a herniated disc and
tendinopathy, and so I know the impact and how debilitating it can be,”
Inspired by her own past injuries, the gymnast-turned-biomedical
engineering doctoral student at the University of Delaware is now
studying tendon overload. She’s part of an interdisciplinary team, led
by primary investigator Dawn Elliott, Blue and Gold Distinguished Professor of Biomedical Engineering within the College of Engineering (COE). Elliott, along with co-investigators Karin Grävare Silbernagel, professor of physical therapy in the College of Health Sciences (CHS), and Justin Parreno, assistant professor of biology in the College of Arts and Sciences (CAS), have been awarded a nearly $2.4 million, five-year R01 Grant from the National Institutes of Health (NIH) to investigate multi-scale tendon damage and abnormal cellular responses in tendinopathy.
Elliott has been wanting to study the tendon for some time because
musculoskeletal disorders are the leading cause of disabilities in the
world. The tremendous impact of musculoskeletal disorders also motivated
Elliott to build a team of UD leaders to launch the Delaware Center for Musculoskeletal Research, a National Institutes of Health-designated Center of Biomedical Research Excellence, established through an $11.8 million grant,
that will build research capabilities in this area. The new tendon
collaboration and grant showcase what promises to be a tremendous future
for musculoskeletal research at the University.
“All of the musculoskeletal tissues are extraordinary materials that
undergo tremendously large loads that last for decades,” Elliott said.
“For me, tendons and the meniscus are fascinating from a mechanical,
structural system, and musculoskeletal tissues are incredibly important
because their proper function is essential to a normal life.
Musculoskeletal injuries have a devastating impact on your quality of
life, to the point where sometimes you can’t live on your own. To me,
it’s a combination of a fascinating engineering problem and an important
One severely debilitating injury is an Achilles tendon rupture that happens, often in athletes, without warning.
“One day they jump, and their Achilles tendon ruptures, and it’s very
painful, and has a long healing time,” Elliott said. “We don’t know how
it happened or how it got to that point. We believe it’s related to
overloading efforts like weightlifting or other high forces on the
Silbernagel, who’s an expert in the Achilles tendon, often sees runners suffer from pain in their Achilles.
“They have morning stiffness,” Silbernagel said. “A lot of them might
have started training for a marathon, and the weather has been bad, and
they haven’t trained enough. They think they need to run more to get
better, so they increase their running load without giving their body
enough time to recover. The tendon, when it’s overused won’t function as
well and won’t give you your energy back.”
She points out that scenario is overuse of the tendon over time. When
a football or basketball player ruptures their Achilles tendon, often
it’s due to a high load on the tendon for a short period of time.
“That’s an extreme overload injury, and the tendon simply can’t tolerate it,” Silbernagel said.
Move this whole section up, swapping places with the section above it.
From left to right, Karin Grävare Silbernagel, professor of
physical therapy; primary investigator Blue and Gold Distinguished
Professor of Biomedical Engineering Dawn Elliott; and Justin Parreno,
assistant professor of biology, have been awarded a $2.3 million grant
from the NIH to study multi-scale tendon damage and abnormal cellular
responses in tendinopathy.
Through an animal model, the researchers are looking to determine
how overload leads to tendon disorders, damage to the tissue, and
Picture the human tendon like a large, stretchy rubber band made of collagen.
“Too much stretch is a bad thing, and the stretch on the collagen can
lead to a breakdown of communication, so the cells can no longer
interpret those mechanical signals from the tendon,” Parreno said. “If
the cells can’t sense the load anymore, it leads to the degeneration of
On the same day they received notice of the NIH award, Parreno broke a tendon in his finger playing basketball.
“It’s like motivation,” he said with a laugh. “I guess I’m a case in
point. I’ve always been interested in mechanical loading of your tissues
when you exercise, and when you play sports and how your body responds
After overloading a key tendon, over the course of four months,
investigators will study the degeneration or changes in its structure,
mechanical properties, and the cellular response.
“Over time, we expect to see the structure of the tendon to become
less organized and its mechanical properties will continually go down,”
If the trio can determine when the tendon degenerates or fractures,
they can determine the cause and how to prevent these debilitating
injuries. That has clinical implications that interest Silbernagel, who
works with numerous professional teams to help players return to sport
after Achilles tendon injuries.
“These injuries are costly,” Silbernagel said. “Athletes can take a
year to recover, and some can never return to football, and it’s hard to
know how to prevent these injuries because we don’t know when they’re
going to happen. But if we start understanding the pathology, perhaps we
can start thinking about science-based prevention. We currently do a
one-size-fits-all for the tendinopathies and the ruptures. By
understanding more, we can design better treatments for patients.”
Ellen Bloom, a Division I swimmer in college, suffered from that one-size-fits-all approach.
“I suffered from a lot of tendinopathy, and most of the treatments
don’t work,” Bloom said. “I hope after the data collection period is
through, we can really understand the underlying mechanisms of how these
tendon overuse injuries happen.”
Bloom, who’s preparing to graduate from UD with her doctorate in
biomedical engineering in December, did a lot of the work that made this
grant attainable. She received an F31 Individual Fellowship from the NIH that made this possible.
“My thesis on tendon overuse injuries contains a lot of the pilot
data for this grant,” Bloom said. “So, this grant does feel kind of like
my little baby. But it’s also such a huge project, and I’m very proud
Bloom and Lin point to Elliott as the driving force behind their
studies. Bloom called Elliott a supportive mentor as she watched her own
transition from an undergraduate to becoming a colleague and
“Dawn gave me the confidence in myself as a scientist, but also the
humility to acknowledge that I don’t know everything,” Bloom said. “She
taught me to be open to making mistakes and sometimes that’s how you can
have really exciting science.”
As Bloom prepares to defend her thesis, she’s leaving her work in the capable hands of Elliott, Parreno, Silbernagel and Lin.
“We’re just starting to get to a point in this collaboration, where
we can start to ask new questions,” Bloom said. “I’m excited to see what
they come up with after I leave because it’s a great group and so fun
to see a collaboration where everyone is so invested and so interested
to learn from one another.”
Beyond their intrigue in studying the tendon, all five researchers are equally excited about the interdisciplinary approach.
“We couldn’t do this project without the expertise from the College
of Health Sciences and the College of Arts and Sciences,” Elliott said.
“We all bring a unique skill set, and it’s impossible to do the work
without the collaboration.”
The three faculty and their lab members meet monthly for a journal
club to share their insights and expertise. Parreno finds tremendous
value in interdisciplinary research.
“The students in my lab, they don’t all work on tendon research, and
they feel it’s really eye-opening,” Parreno said. “We’re stuck in the
minutia of the real molecular mechanisms of disease, whereas they’re
focused on a clinical problem, and if there’s more of this
cross-disciplinary collaboration, we can align our research better with a
Lin added, “We talk about different articles from our respective
fields. It’s cool seeing things from a pure biological standpoint and
seeing how it translates clinically.”
Silbernagel called the interdisciplinary approach key to success.
“I think more people should listen to people with broader
perspectives,” Silbernagel said. “I train all my students that we’re not
in silos so they understand how all parts of research can help to
inform each other to move ideas forward.”