Sports Medicine Research: In the Lab & In the Field: Shaking Up ACL Rehabilitation (Sports Med Res)


Wednesday, April 17, 2013

Shaking Up ACL Rehabilitation

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

Fu CLA, Yung SHP, Law KYB, Leung KHH, Lui PYP, Siu KH, & Chan KM.  American Journal of Sports Medicine. 2013, E-pub ahead of print. DOIL 10.1177/0343546513476473

Take Home Message: Whole body vibration therapy may improve strength and postural control among post-ACL reconstruction patients as an adjunctive therapy to rehabilitation.

Deficits in strength, proprioception, and postural control are often evident post anterior cruciate ligament (ACL) reconstruction and can last from 6-months to 4-years post-surgery.  Whole-body vibration therapy (WBVT) improves balance and postural control in many populations, and if introduced early after an ACL reconstruction it may help avoid the previously mentioned deficits.  Therefore, the purpose of this randomized trial was to compare the effectiveness of early WBVT plus conventional rehabilitation with isolated rehabilitation on knee proprioception, functional performance, postural control, and peak torque among 48 participants post-ACL surgery.  The patients assigned to the WBVT group started WBVT 1 month post ACL-surgery and completed the treatment 2 times a week for 8 weeks.  A blinded therapist assessed postural control, function, peak torque, and joint position sense at baseline, 3-months, and 6-months post-surgery.  The groups had similar position sense throughout the rehabilitation process.  WBVT participants scored better in postural control tests with eyes closed at 3- and 6-months post-surgery, as well as generated greater peak torque at 6-months post-surgery in the quadriceps and hamstrings.  WBVT participants also performed better during functional testing – shuttle run and single legged hop test – at 6-months post-surgery.

Introducing early WBVT along with traditional rehabilitation may improve patient outcomes at least to 6 months post-surgery.  However, it is unclear whether or not this benefit is from the additional time the WBVT group exercised compared with the control group or specifically the WBVT.  It would be interesting to continue to follow these participants out to later time points to see if they plateau earlier or have fewer complications in the long-term.  The authors admitted that one important limitation was not assessing patient’s perceived outcomes and function.  It would have been interesting to capture this information to see if one group suffered more feelings of pain, stiffness, or disability.  Lastly, it would be interesting to see if WBVT has any affect on return to play timeframe, confidence, fear of reinjury, or performance overall.  Despite these lingering questions, this trial provides some support for the short-term benefits of early WBVT among patients after an ACL reconstruction. However, the use of WBVT requires access to a machine capable of delivering this type of therapy.  Has anyone had any experience utilizing a machine like this as an adjunctive therapy for ACL reconstruction patients?  What are your thoughts about potentially integrating this into your clinical practice?     

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

Fu CL, Yung SH, Law KY, Leung KH, Lui PY, Siu HK, & Chan KM (2013). The effect of early whole-body vibration therapy on neuromuscular control after anterior cruciate ligament reconstruction: a randomized controlled trial. The American Journal of Sports Medicine, 41 (4), 804-14 PMID: 23460328


Jake Meyer said...

These are some very interesting findings, as I am interested in these types of disinhibitory modalities for AMI. I am unfamiliar with WBVT, and am wondering how practical it is to use this type of therapy with functional movement? What types of exercises did the treatment group perform throughout the study while using WBVT? What was the effect size? Were there any inclusion/exclusion criteria? It will be interesting to see if there will be more studies like this in the near future based on these findings.

Nicole Cattano said...

Jake-Thanks for your comments. WBVT therapy is an older concept being utilized in new ways. There are some limited functional movements that can be integrated while doing the therapy treatments. However, this is a relatively newer area that we are seeing more research on. The exact treatment and rehabilitation programs are posted in the supplementary section of this article. It goes into great lengths about the rehabilitation and treatment protocols. Regarding inclusion/exclusion. It only included isolated ACL tears that were being reconstructed using the hamstring autograft. So they excluded any other ligaments/meniscal injuries that may be commonly seen.

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