Effect of Whole-Body Vibration on Sagittal Plane Running Mechanics in Individuals With Anterior Cruciate Ligament Reconstruction: A Randomized Crossover Trial

An Investigation of Running Kinematics with Recovered Anterior Cruciate Ligament Reconstruction on a Treadmill and In-Field Using Inertial Measurement Units: A Preliminary Study

Anterior cruciate ligament reconstruction (ACLR) may affect movement even years after surgery. The purpose of this study was to determine possible interlimb asymmetries due to ACLR when running on a treadmill and in field conditions, with the aim of contributing to the establishment of objective movement assessment in real-world settings; moreover, we aimed to gain knowledge on recovered ACLR as a biomechanical risk factor. Eight subjects with a history of unilateral ACLR 5.4 ± 2.8 years after surgery and eight healthy subjects ran 1 km on a treadmill and 1 km on a concrete track. The ground contact time and triaxial peak tibial accelerations were recorded using inertial measurement units. Interlimb differences within subjects were tested and compared between conditions. There were no significant differences between limbs in the ACLR subjects or in healthy runners for any of the chosen parameters on both running surfaces. However, peak tibial accelerations were higher during field running (p-values < 0.01; Cohen's d effect sizes > 0.8), independent of health status. To minimize limb loading due to higher impacts during field running, this should be considered when choosing a running surface, especially in rehabilitation or when running with a minor injury or health issues.

Does the Addition of Whole-Body Vibration Training Improve Postural Stability and Lower Limb Strength During Rehabilitation Following Anterior Cruciate Ligament Reconstruction: A Systematic Review With Meta-analysis

OBJECTIVES

To investigate whether the addition of whole-body vibration therapy to standard rehabilitation improves postural stability and lower limb strength following anterior cruciate ligament (ACL) reconstruction.

DATA SOURCES

A computer-based literature search of MEDLINE, AMED, SPORTDiscus, Embase, CINAHL, CENTRAL, and Physiotherapy Evidence Database (PEDro) included studies up to October 2019.

MAIN RESULTS

Seven randomised controlled trials of moderate-to-high methodological quality involving 244 participants were included. Meta-analysis found statistically significant improvements in medial-lateral stability [standardized mean difference (SMD) = 0.50; 95% confidence interval (CI), 0.12-0.88] and overall stability (SMD = 0.60; 95% CI, 0.14-1.06) favoring whole-body vibration therapy, but effects were not significant for quadriceps strength (SMD = 0.24; 95% CI, -0.65 to 1.13), hamstring strength (SMD = 0.84; 95% CI, -0.05 to 1.72), lower limb strength (SMD = 0.76; 95% CI, -0.16 to 1.67), or anterior-posterior stability (SMD = 0.19; 95% CI, -0.39 to 0.76).

CONCLUSIONS

The addition of whole-body vibration therapy to standard postoperative rehabilitation following ACL reconstruction does not appear to significantly improve lower limb strength and anterior-posterior stability but may improve medial-lateral and overall postural stability. We found small sample sizes in all included trials, statistical heterogeneity, and methodological quality concerns, including publication bias, suggesting that larger high-quality trials are likely to be influential in this field. Registration: PROSPERO 155531.

The effectiveness of vibration therapy for muscle peak torque and postural control in individuals with anterior cruciate ligament reconstruction: a systematic review and meta-analysis of clinical trials

Objective

This study aimed to review and summarize the existing evidence on the effectiveness of vibration therapy (VT) in comparison with conventional rehabilitation in anterior cruciate ligament (ACL)-reconstructed patients considering muscle peak torque and postural control.

Methods

We searched available online databases for relevant studies published up to February 2020. All randomized clinical trials investigating the effect of VT on quadriceps peak torque, hamstring peak torque, and postural control (closed-eye and open-eye) were included. Overall, 13 clinical trials with a total sample size of 407 participants were included for the meta-analysis. We used the pooled mean difference with random effects model for meta-analyses. We assessed the heterogeneity of the studies using the I² and Cochran’s Q test. Meta-regression analysis was used to assess the source of heterogeneity.

Results

We found that VT significantly improved hamstring peak torque [weighted mean difference (WMD) 12.67, 95% CI 4.51–20.83] and quadriceps peak torque (WMD 0.11, 95% CI −0.06 to 0.29). However, subgroup analysis showed a significant increase in mentioned muscles’ peak torque in studies employing interventions including both local muscle vibration (LMV) and vibration frequency higher than 100 Hz (WMD 20.84, 95% CI 11.75–29.93). With regard to postural control, we observed a significant improvement only in open-eye mediolateral postural control (WMD 0.26, 95% CI −1.26 to 1.77).

Conclusion

This study suggests that VT, especially LMV type with vibration frequency higher than 100 Hz, can be effective in rehabilitation of ACL-reconstructed patients. Although improvement in the peak torque of hamstring and quadriceps muscles was seen, there was no significant improvement in postural control, especially closed-eye, in comparison with conventional rehabilitation.

Level of evidence

1.

Highlights

Vibration therapy can increase hamstring peak torque in individuals with ACL reconstruction.

Local muscle vibration type in comparison with whole-body vibration is recommended for ACL-reconstructed patients.

Vibration frequency higher than 100 Hz is preferred in ACL-reconstructed rehabilitation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10195-021-00589-5.

Effects of Whole-Body Vibration Therapy on Quadriceps Function in Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review

CONTEXT

Quadriceps dysfunction is common for patients after anterior cruciate ligament reconstruction (ACLR). Whole-body vibration (WBV) could effectively treat quadriceps dysfunction.

OBJECTIVE

To summarize WBV protocols for patients with ACLR and to evaluate the effects of WBV on quadriceps function.

DATA SOURCES

PubMed, CINAHL, SportDiscus, Web of Science, Medline, and Embase were searched from inception to January 2020.

STUDY SELECTION

Randomized controlled trials recruiting patients with ACLR, using WBV as intervention, and reporting at least 1 of the following outcomes, strength, rate of torque development (RTD), and voluntary activation ratio of quadriceps, were included.

STUDY DESIGN

Systematic review.

EVIDENCE LEVEL

Level 3.

METHODS

This systematic review was reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality of evidence was determined by PEDro criteria and GRADE system. Participant characteristics, interventions, and the relevant results of the included studies were extracted and synthesized in a narrative way.

RESULTS

In total, 8 studies were included. Of these, 2 studies had serious risk of bias. Five of 8 studies implemented a series of WBV program ranging from 2 to 10 weeks in duration, while the other 3 studies implemented a single session of WBV. Eight WBV protocols were reported. The reported outcomes consisted of quadriceps strength, RTD, and central activation ratio. WBV protocols were heterogeneous. Low quality of evidence supported that exclusive conventional rehabilitation was more effective than exclusive WBV therapy in increasing quadriceps strength. Low quality of evidence supported that WBV combined with conventional rehabilitation was more beneficial in increasing quadriceps strength when compared with conventional rehabilitation alone. Very low quality of evidence supported the efficacy of a single session of WBV on quadriceps function.

CONCLUSIONS

There is no standardized WBV protocol for patients with ACLR, and the effectiveness of WBV in rehabilitation on quadriceps function remains inconclusive.

Managing Vibration Training Safety by Using Knee Flexion Angle and Rating Perceived Exertion

Whole-body vibration (WBV) is commonly applied in exercise and rehabilitation and its safety issues have been a major concern. Vibration measured using accelerometers can be used to further analyze the vibration transmissibility. Optimal bending angles and rating of perceived exertion (RPE) evaluations have not been sufficiently explored to mitigate the adverse effect. Therefore, the aims of this study were to investigate the effect of various knee flexion angles on the transmissibility to the head and knee, the RPE during WBV exposure, and the link between the transmissibility to the head and the RPE. Sixteen participants randomly performed static squats with knee flexion angles of 90, 110, 130, and 150 degrees on a WBV platform. Three accelerometers were fixed on the head, knee, and center of the vibration platform to provide data of platform-to-head and platform-to-knee transmissibilities. The results showed that the flexion angle of 110 degrees induced the lowest platform-to-head transmissibility and the lowest RPE (p < 0.01). A positive correlation between RPE and the platform-to-head transmissibility was observed. This study concluded that a knee flexion of about 110 degrees is most appropriate for reducing vibration transmissibility. The reported RPE could be used to reflect the vibration impact to the head.

Whole-Body Vibration for Individuals with Reconstructed Anterior Cruciate Ligament: A Systematic Review

Background

ACL ruptures are a prevalent condition, affecting daily living activities, associated with high financial burden.

Objective

To assess the effect of whole-body vibration (WBV) in the rehabilitation of patients with reconstructed anterior cruciate ligament. Methodology. An electronic search in Pubmed, Scopus, Web of Science, and PEDro databases was conducted and randomized controlled trials (RCTs) in humans that analysed the effects of WBV in patients with ACL injury subjected to reconstruction surgery, published in English, Portuguese, Spanish, Italian, or French were included. Records were identified through database search and reference screening by two reviewers, which independently examined titles and abstracts and irrelevant studies were excluded based in eligibility criteria. Relevant full texts were analysed for eligibility, and all relevant studies were included in the systematic review.

Results

Ten studies were included in the systematic review with a mean methodological quality score of 6. Results demonstrate positive effects of WBV in relevant outcomes such as knee function, electromyographic activity, balance, and muscle strength.

Conclusions

WBV demonstrated a positive effect in strength, balance, electromyographic activity, and knee function.

Bilateral Alterations in Running Mechanics and Quadriceps Function Following Unilateral Anterior Cruciate Ligament Reconstruction

BACKGROUND

Following anterior cruciate ligament reconstruction (ACLR), individuals have quadriceps muscle impairments that influence gait mechanics and may contribute to an elevated risk of knee osteoarthritis.

OBJECTIVES

To compare running mechanics and quadriceps function between individuals who have undergone ACLR and those in a control group, and to evaluate the association between quadriceps function and running mechanics.

METHODS

In this controlled, cross-sectional laboratory study, 38 individuals who previously underwent primary unilateral ACLR (mean ± SD time since reconstruction, 48.0 ± 25.0 months) were matched to 38 control participants based on age, sex, and body mass index, and underwent assessments of quadriceps muscle performance and running biomechanics. Quadriceps muscle performance was assessed via isokinetic and isometric knee extension peak torque and rate of torque development (RTD) over 2 time frames: 0 to 100 milliseconds (RTD100) and 0 to 200 milliseconds (RTD200). Running evaluation included assessment of the knee flexion angle (KFA), knee extension moment (KEM), rate of knee extension moment (RKEM), vertical instantaneous loading rate, and vertical impact peak.

RESULTS

On average, there was a smaller KFA (P = .016) in the involved limb compared to the uninvolved limb in the ACLR group. Compared to limbs in the control group, involved limbs in the ACLR group had lower RTD100 (P = .015), lower peak torque at 60°/s (P = .007), lower peak torque at 180°/s (P = .016), smaller KFA (P<.001), lower KEM (P = .001), lower RKEM (P = .004), and higher vertical instantaneous loading rate (P = .016). Compared to limbs in the control group, uninvolved limbs in the ACLR group had lower RTD100 (P = .003), lower peak torque at 60°/s (P = .017), and smaller KFA (P = .01). For the involved limbs in the ACLR group, there was a low correlation between isokinetic peak torque at 180°/s and RKEM (r = 0.38, P = .01), and a negligible correlation between RTD100 and RKEM (r = 0.26, P<.05). No differences were found in isometric strength for any comparison.

CONCLUSION

Individuals who have undergone ACLR have bilateral alterations in running mechanics that are weakly associated with diminished quadriceps muscle performance. J Orthop Sports Phys Ther 2018;48(12):960-967. Epub 22 Jul 2018. doi:10.2519/jospt.2018.8170.

Active versus local vibration warm-up effects on knee extensors stiffness and neuromuscular performance of healthy young males

OBJECTIVES

To compare the effects of local-vibration and active warm-up on knee extensors muscle stiffness and neuromuscular performance.

DESIGN

Experimental crossover study.

METHODS

Thirteen participants performed three 15-min warm-up protocols of control (CON), active (ACT) and local-vibration (LV) in separate testing session. Passive stiffness of vastus lateralis (VL) and vastus medialis (VM) by shear wave elastography and neuromuscular performance were assessed before and 2-min after each condition.

RESULTS

A decrease in muscle stiffness was reported after ACT for VL (-16.0±6.6%; p<0.001) and VM (-10.2±8.7%; p=0.03) while no changes were reported after CON (p=0.46 and p=0.34 for VL and VM, respectively) and LV (p=0.07 and p=0.46 for VL and VM, respectively). Maximal jump performances increased during squat (+8.5±6.6%; p<0.001) and countermovement jump (+5.2±5.8%; p<0.001) after ACT while no changes were reported after CON and LV during squat (p=0.16 and p=0.81, respectively) and countermovement jump (p=0.18 and p=0.31, respectively). We further report that each condition was ineffective to inducing changes in maximal voluntary isometric contraction force (p=0.18), rate of force development (p=0.92), twitch parameters (p>0.05) as well as central modulations as reported by the unchanged voluntary activation level (p=0.24) and maximal electromyography (EMG) recorded from the VL (p=0.44).

CONCLUSIONS

The active warm-up acutely reduced muscle stiffness and increased muscle performance during maximal dynamic tasks. With regard to LV, further studies are required to determine optimal parameters (frequency, amplitude, duration) to significantly increase muscle performance.