The Effect of Early Whole-Body Vibration Therapy on Neuromuscular Control After Anterior Cruciate Ligament Reconstruction A Randomized Controlled Trial

Physiotherapy Department, Prince of Wales Hospital, Hong Kong.
The American Journal of Sports Medicine (Impact Factor: 4.36). 03/2013; 41(4). DOI: 10.1177/0363546513476473
Source: PubMed


BACKGROUND:Despite rehabilitation training, deficiency in knee joint position sense, muscular performance, postural control, and functional ability is common after anterior cruciate ligament reconstruction (ACLR). Whole-body vibration therapy (WBVT), which is initiated from 3 months postoperatively, has proven benefits. However, the effect of earlier WBVT is unknown. PURPOSE:To investigate the effect of early WBVT on neuromuscular control after ACLR. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1. METHODS:A total of 48 patients with unilateral complete isolated ACL tears were recruited. Single-bundle hamstring ACLR was performed in all patients. After surgery, they were randomly assigned to either the reference or treatment group. Reference group patients received conventional ACL rehabilitation, while treatment group patients received 8 weeks of WBVT in addition to conventional rehabilitation, starting from 1 month postoperatively. Joint position sense, postural control, and knee isokinetic performance were assessed before surgery and at 1, 3, and 6 months postoperatively using the Biodex dynamometer, Biodex Stability System, and Cybex NORM, respectively. Knee range of motion (ROM), stability (manual testing and KT-1000 arthrometer), and functional ability (single-legged hop test, triple hop test, shuttle run test, and carioca test) were also examined. Two-way repeated-measures analysis of variance and the Mann-Whitney U test were used for statistical analysis. RESULTS:There was no complication throughout the rehabilitation. All patients achieved full knee ROM and stable knee joints at 6 months after surgery. The WBVT group demonstrated significantly better postural control, muscle performance, single-legged hop, and shuttle run (P < .05) than the reference group, but there was no significant difference in knee joint position sense, triple hop, carioca, ROM, and stability (P > .05). CONCLUSION:Early WBVT started from 1 month postoperatively was an effective training method without compromising knee ROM and stability. It improved postural control, isokinetic performance, single-legged hop, and shuttle run but not knee joint position sense, triple hop, and carioca.

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    ABSTRACT: The suitability and effectiveness of whole body vibration (WBV) exercise in rehabilitation after injury of the anterior cruciate ligament (ACL) was studied using a specially designed WBV protocol. We wanted to test the hypothesis if WBV leads to superior short term results regarding neuromuscular performance (strength and coordination) and would be less time consuming than a current standard muscle strengthening protocol. In this prospective randomized controlled clinical trial, forty patients who tore their ACL and underwent subsequent ligament reconstruction were enrolled. Patients were randomized to the whole body vibration (n=20) or standard rehabilitation exercise protocol (n=20). Both protocols started in the 2nd week after surgery. Isometric and isokinetic strength measurements, clinical assessment, Lysholm score, neuromuscular performance were conducted weeks 2, 5, 8 and 11 after surgery. Time spent for rehabilitation exercise was reduced to less than a half in the WBV group. There were no statistically significant differences in terms of clinical assessment, Lysholm score, isokinetic and isometric strength. The WBV group displayed significant better results in the stability test. In conclusion, preliminary data indicate that our whole body vibration muscle exercise protocol seems to be a good alternative to a standard exercise program in ACL-rehabilitation. Despite of its significant reduced time requirement it is at least equally effective compared to a standard rehabilitation protocol.
    Journal of sports science & medicine 09/2014; 13(3):580-9. · 1.03 Impact Factor
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    ABSTRACT: Anterior cruciate ligament reconstruction has been reported to produce normal or near-normal knee results in > 90% of patients. A recent meta-analysis suggested that, despite normal or near-normal knees, many athletes do not return to sports. Rates and timing of return to competitive athletics are quite variable depending on the graft type, the age of the patient, the sport, and the level of play. Even when athletes do return to play, often they do not return to their previous level. Graft failure, subjective physical factors, and psychological factors, including fear of reinjury and lack of motivation, appear to play a large role in patients' ability to return to sporting activities.
    The Physician and sportsmedicine 11/2014; 42(4):71-9. DOI:10.3810/psm.2014.11.2093 · 1.09 Impact Factor
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    ABSTRACT: Objective Quadriceps arthrogenic muscle inhibition (AMI) is a common complication following knee pathology that produces quadriceps dysfunction and increases the risk of post-traumatic osteoarthritis. Direct (local muscle vibration-LMV) and indirect (whole body vibration-WBV) vibratory stimuli facilitate quadriceps activity and may minimize quadriceps AMI. The purpose of this investigation was to evaluate the effects of WBV and LMV on quadriceps function following experimental knee effusion (i.e. simulated pathology). Design Randomized controlled trial. Setting Research laboratory. Participants Forty-three healthy volunteers were randomized to WBV (n=14), LMV (n=16), and Control (n=13) groups. Interventions Saline was injected into the knee to induce quadriceps AMI. All groups then performed isometric squats while being exposed to WBV, LMV, or no vibration (Control). Main Outcome Measures Quadriceps function was assessed at baseline, immediately following effusion, and immediately and 5min following each intervention (WBV, LMV, or Control) via voluntary peak torque (VPT) and Central Activation Ratio (CAR) during maximal isometric knee extension on a multi-function dynamometer. Results CAR improved in the WBV (+11.4%, p=0.021) and LMV (+7.3%, p<0.001) groups immediately post-intervention, but not in the Control group. Similarly, VPT increased 16.5% (p=0.021) in the WBV group and 23.0% (p=0.078) in the LMV group immediately post-intervention, but not in the Control group. The magnitudes of improvements in CAR and VPT did not differ between the WBV and LMV groups. Conclusion Quadriceps strengthening following knee pathology is often ineffective due to AMI. WBV and LMV improve quadriceps function equivocally following simulated knee pathology, effectively minimizing quadriceps AMI. Therefore, these stimuli may be used to enhance quadriceps strengthening, thus improving the efficacy of rehabilitation and reducing the risk of osteoarthritis.
    Archives of Physical Medicine and Rehabilitation 11/2014; DOI:10.1016/j.apmr.2014.07.393 · 2.57 Impact Factor
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