Sports Medicine Research: In the Lab & In the Field: Shake It Up: Vibration Training Improves Balance for Chronic Ankle Instability Group (Sports Med Res)

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Wednesday, April 18, 2018

Shake It Up: Vibration Training Improves Balance for Chronic Ankle Instability Group

Whole-Body Vibration Training and Balance in Recreational Athletes With Chronic Ankle Instability

Sierra-Guzmán R, Jiménez-Diaz F, Ramírez C, Esteban P, Abián-Vicén J. J Athl Train. 2018;53(3):000–000. doi: 10.4085/1-62-6050-547-16.

Take-Home Message: Recreational athletes with chronic ankle instability may benefit from balance training, especially with whole-body vibration.

https://commons.wikimedia.org/wiki/File:Ankle.jpg
Whole-body vibration is an increasingly popular technique to challenge and train a patient’s proprioception to improve balance outcomes, especially in patients with chronic ankle instability (CAI). There is also limited evidence that whole-body vibration may increase leg muscle mass. Therefore, the researchers explored the effect of whole-body vibration training on balance and lean muscle mass among 51 recreational athletes with CAI compared to balance training without vibration and a control group. Participants in the whole-body vibration group stood on their unstable ankle limb and performed different balance exercises on a BOSU half-dome ball with vibrations applied in 3 sets of four 45-second bouts with 45 seconds rest between. This was repeated 3 times a week for 6 weeks, with exercise progressions at 3 weeks and increased vibration frequencies every 2 weeks. The group without vibrations performed the same exercises and exercise progression with the BOSU ball on the floor, and the control group maintained their current activity levels. Pre- and post-training balance was assessed with the Star Excursion Balance Test (SEBT) and Biodex Balance System Test in which participants were required to balance on an unstable platform with visual feedback. Body composition was measured using dual-energy x-ray absorptiometry (DEXA). The authors observed no differences over time between the three groups; however, both balance groups had hints of improved balance with the SEBT compared with the control group. Only the whole-body vibration training improved stability on the Biodex Balance System. However, there were no differences in lean muscle mass for any group.

The results from this study highlight that balance training with or without vibration may improve balance among recreational athletes with CAI. Furthermore, adding vibration to balance training may lead to unique improvements in balance outcomes compared to balance alone. It may be beneficial for future larger studies to verify these results. Vibration training may especially benefit patients with CAI since balance impairments are common in this population. It would be interesting to see if adding this additional layer of difficulty to balance training could help reduce ankle sprain injury risk in the future. It is important to note that there is no commonly accepted dosage or method to apply vibrations, which may explain why some studies have found lean muscle mass adaptations and the current study did not. It may be important to individualize vibration training based on the patient’s abilities and on the desired clinical outcomes. In all, clinicians should use balance training for recreational athletes with CAI to improve balance. Furthermore, vibration training is an additional challenge that may be beneficial and is feasible to implement in clinical rehabilitation for patients with CAI or others with balance deficits.

Questions for Discussion: Have you implemented vibration training in your rehabilitation setting, and if so how did you incorporate this training? What other groups do you think would benefit from this form of training?

Written by: Alexandra F DeJong
Reviewed by: Jeffrey Driban

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6 comments:

Sarah said...

Alex, thanks for sharing this article. I think this whole-body vibration technique is a very interesting tactic and could be successful in challenging a patients’ proprioception. I have used perturbations to challenge patient’s proprioception, but have not implemented vibration training. It seems that perturbations and whole-body vibrations have similar concepts, but I could be misinterpreting them. I would be interested in a similar study to this one that compares the effect of whole-body vibrations to perturbations during balance exercises. I also think that any athlete returning from an ACL injury may also benefit from this form of training.

Alex said...

Hi Sarah, Thank you for your response! I completely agree; although there are no studies to my knowledge that look at a direction comparison between perturbations and whole body vibrations, there is a study by MacIntyre and colleagues that found that, after exposure to whole body vibration, the trunk muscles responded more quickly to unexpected perturbations (https://www.ncbi.nlm.nih.gov/pubmed/25241645). I would agree that these treatments are both working towards the same end goal and likely have some amount of crossover, but more research is certainly warranted.

Amy said...

Thanks for sharing! Ankle sprains are very common in high school athletics, and any extra techniques to use to help the athletes would be beneficial.Despite doing the recommended rehabilitation for ankle sprains, some athletes still develop chronic ankle instability. I have not used vibration balance training with my athletes before but it is a good additional treatment to consider. I think that vibration balance training may also be beneficial for individuals with exercise related lower leg pain, such as shin splints. The vibration may address bone density and tibial stress reactions, while the balance training may address the strength and biomechanical aspects of shin splint injuries.

Alex said...

Hi Amy,

Thanks for the response! I certainly agree that we have not yet found the perfect combination of exercises for CAI prevention, and I think a lot of that is shown in on-going research looking for risk factors for CAI (https://www.ncbi.nlm.nih.gov/pubmed/26912285). Vibration training is definitely an interesting technique to try to address some of the sensory deficits seen in this group, so keeping this treatment as an additional consideration as you said may be helpful for CAI rehabilitation. Employing vibration training in lower leg pain is an interesting idea as well - this would likely help target lower leg muscle activity to mitigate some of the issues seen in this group, so it would be great to see more research done in this area as well! Thanks again Amy!

Kim Twait said...

Thank you for sharing this article Alex! I have used perturbations for the upper extremity and lower extremity, but I have never used full body vibration training during rehab before. I have found great results with adding perturbations, so I would be interested to see how the results of the two training techniques would compare to each other. It's interesting to see that the vibration training increased performance on the biodex, and both of the training protocols increased performance on the SEBT. So it seems that the whole body vibration training improves both static and dynamic balance, while the non-vibration training improved dynamic balance.

I think patients that suffer from balance deficits post concussion could benefit from this type of training.

Alex said...

Hi Kim,

Thank for the response! I definitely agree that this area of research is warranted, there are a lot of gaps in the literature comparing the effectiveness of these different treatment types, and the use of this treatment in other populations. Postural stability training following concussion is a great idea. Thanks again!

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