Vibration platform training in women at risk for symptomatic knee osteoarthritis

Low-frequency whole-body vibration can enhance cartilage degradation with slight changes in subchondral bone in mice with knee osteoarthritis and does not have any morphologic effect on normal joints

PURPOSES

To evaluate the effects of low frequency whole-body vibration (WBV) on degeneration of articular cartilage and subchondral bone in mice with destabilization of the medial meniscus (DMM)induced osteoarthritis(OA) and mice with normal knee.

METHODS

Ten-week-old C57BL/6J male mice received DMM on right knees, while the left knees performed sham operation. There were six groups: DMM, SHAM DMM, DMM+WBV,SHAM DMM+WBV, DMM+ NON-WBV and SHAM DMM+NON-WBV. After four weeks, the knees were harvested from the DMM and SHAM DMM group. The remaining groups were treated with WBV (10 Hz) or NON-WBV. Four weeks later, the knees were harvested. Genes, containing Aggrecan(Acan) and CollagenⅡ(Col2a1), Matrix Metalloproteinases 3 and 13(MMP3,13), TNFα and IL6, were measured and staining was also performed. OA was graded with OARSI scores, and tibial plateaubone volume to tissue volume ratio(BV/TV), bone surface area to bone volume ratio (BS/BV), trabecular number(Tb.N) and trabecular thickness separation(TS) between groups were analyzed.

RESULTS

Increased OARSI scores and cartilage degradation were observed after WBV. BV/TV, Tb.N and TS were not significant between the groups. Significant reductions were observed in MMP3, MMP13, Col2a1, Acan, TNFα and IL6 in the DMM+WBV compared to SHAM DMM+WBV group. BV/TV, BS/BV, Tb.N, TS and OARSI scores were not significantly changed in the left knees. IL6 expression in the SHAM DMM+WBV group was significantly increased compared with the SHAM DMM+ NON-WBV group, while Col2a1, Acan and MMP13 expression decreased.

CONCLUSION

WBV accelerated cartilage degeneration and caused slight changes in subchondral bone in a DMM-induced OA model. WBV had no morphologic effect on normal joints.

Arthrogenic Muscle Inhibition: Best Evidence, Mechanisms, and Theory for Treating the Unseen in Clinical Rehabilitation

CONTEXT

Arthrogenic muscle inhibition (AMI) impedes the recovery of muscle function following joint injury, and in a broader sense, acts as a limiting factor in rehabilitation if left untreated. Despite a call to treat the underlying pathophysiology of muscle dysfunction more than three decades ago, the continued widespread observations of post-traumatic muscular impairments are concerning, and suggest that interventions for AMI are not being successfully integrated into clinical practice.

OBJECTIVES

To highlight the clinical relevance of AMI, provide updated evidence for the use of clinically accessible therapeutic adjuncts to treat AMI, and discuss the known or theoretical mechanisms for these interventions.

EVIDENCE ACQUISITION

PubMed and Web of Science electronic databases were searched for articles that investigated the effectiveness or efficacy of interventions to treat outcomes relevant to AMI.

EVIDENCE SYNTHESIS

122 articles that investigated an intervention used to treat AMI among individuals with pathology or simulated pathology were retrieved from 1986 to 2021. Additional articles among uninjured individuals were considered when discussing mechanisms of effect.

CONCLUSION

AMI contributes to the characteristic muscular impairments observed in patients recovering from joint injuries. If left unresolved, AMI impedes short-term recovery and threatens patients' long-term joint health and well-being. Growing evidence supports the use of neuromodulatory strategies to facilitate muscle recovery over the course of rehabilitation. Interventions should be individualized to meet the needs of the patient through shared clinician-patient decision-making. At a minimum, we propose to keep the treatment approach simple by attempting to resolve inflammation, pain, and effusion early following injury.

Effect of Whole-Body Vibration Training on Muscle Activation for Individuals with Knee Osteoarthritis

Whole-body vibration (WBV) training may improve the strength of lower extremity muscles in patients with knee osteoarthritis (KOA), but the inconsistency in vibration parameters leads to differences in findings. This cross-sectional study is aimed at observing the effects of different vibration frequencies and knee flexion angles on the activation of lower extremity muscles in patients with KOA. Enrolled participants received WBV training at 0, 30, and 60° knee flexion angles with vibration frequencies of 0, 5, 10, and 20 Hz. Activation rates for vastus medialis, vastus lateralis, rectus femoris, biceps femoris, and semitendinosus in different combinations were collected through surface electromyography. The effects of frequency and angle on muscle activation rate were quantified by repeated measures ANOVA. Individual and synergistic effects of frequency and angle were also analysed. Twenty-six participants with KOA were included. Muscle activation increased with the vibration frequency in 0–20 Hz range and with knee flexion angle in 0–60° range. WBV training at 20 Hz was the most effective for knee muscle activation, and static squatting at 60° was the most suitable for WBV training. Therefore, WBV training can increase the activation rate of knee flexor and extensor muscles in patients with KOA, and the most efficient combination was 20 Hz vibration frequency and 60° knee flexion. When applying WBV to patients with KOA, individual differences and rehabilitation purposes should be considered in selecting vibration parameters and knee angle to effectively increase neuromuscular activity.

Comparison of whole-body vibration training and quadriceps strength training on physical function and neuromuscular function of individuals with knee osteoarthritis: A randomised clinical trial

Background

Knee osteoarthritis (KOA) is one of the leading causes of global disability, which causes knee pain, stiffness and swelling. Impaired neuromuscular function may cause joint instability, alignment changes and knee stress, which leads to the progression of KOA. Whole-body vibration (WBV) training is considered to improve pain and functional mobility effectively. However, few studies have investigated the therapeutic effect of WBV on neuromuscular function in KOA.

Material and methods

A single-blinded, randomised, controlled trial was performed on 81 participants diagnosed with KOA. The participants were randomised into three groups: (1) WBV group, in which participants performed strength training (ST) with vibration exposure for 8 weeks; (2) ST group, in which participants performed ST without vibration for 8 weeks; and (3) health education (HE) group, in which participants received a HE for 8 weeks. The visual analogue scale for knee pain, isokinetic muscle strength test, proprioception test, Timed Up and Go test (TUG) and 6-min Walk Distance test (6MWD) were performed before and after the interventions.

Results

No significant difference was found on pain, proprioception, TUG and 6MWD. A significant interaction effect was found in isokinetic muscle strength between groups. Further analysis showed that compared with the HE group, the WBV group exhibited significantly greater improvement in isokinetic muscle strength (peak torque [PT] of extensors, p < 0.01, 95% CI = 0.11-0.33 Nm/kg; PT of flexors, p = 0.01, 95% CI = 0.02-0.19 Nm/kg; peak work [PW] of extensors, p < 0.01, 95% CI = 0.12-0.75 W/kg). In addition, compared with the ST group, the muscle strength of the WBV group (PT of extensors, p < 0.01, 95% CI = 0.10-0.32 Nm/kg; PW of extensors, p < 0.01, 95% CI = 0.09-0.71 W/kg) improved significantly.

Conclusion

Our findings suggested that adding WBV training to ST might benefit muscle strength around the knee joint in patients with KOA.

Effect of adding whole-body vibration training to squat training on physical function and muscle strength in individuals with knee osteoarthritis

OBJECTIVES

This study aims to investigate the effects of adding whole-body vibration (WBV) exercise to squat training (ST) on the physical function and muscle strength of patients with knee osteoarthritis (KOA).

METHODS

41 participants completed the intervention and measurements (ST group; n=21, age=65.00±4.39 years, BMI=23.01±2.95 kg/m²; WBV+ST group; n=20, age=64.10±4.95 years, BMI=24.79±3.12 kg/m²). The supervised eight-week intervention was performed three times per week with the intensity and duration increased gradually. Visual analog scale, Timed Up and Go test (TUG), 6-min Walk Distance test, and isokinetic measurements were performed at baseline and post-intervention.

RESULTS

The peak torque (PT) of the extensors at 180°/s increased significantly in the WBV+ST group compared with the ST group (p = 0.046). The peak work of the extensors and the PT of the flexors at 180°/s improved only in the WBV+ST group (p<0.0125). However, no significant changes in these variables were found between groups (p>0.05).

CONCLUSIONS

Adding 8 weeks of WBV training to ST can more effectively improve the muscular strength of knee extensors compared with ST in patients with KOA.

Effects of whole body vibration exercise on neuromuscular function for individuals with knee osteoarthritis: study protocol for a randomized controlled trial

Background

Knee osteoarthritis (KOA) is a leading cause of public disability. Neuromuscular function contributes to the development and/or progression of KOA. Whole body vibration (WBV) exercise improve the neuromuscular function of patients with neurological disorders and even that of older patients with limited exercise options. Therefore, WBV exercise may offer an efficient and alternative treatment for individuals with KOA. However, the effects of WBV training on the neuromuscular function of individuals with KOA remain unclear. Therefore, this study attempts to investigate the effect of a 12-week WBV exercise on the neuromuscular function of individuals with KOA.

Methods/design

We will conduct a prospective, single-blind randomized controlled trial on 180 KOA patients. Participants will be randomly assigned to the WBV exercise, lower extremity resistance training, and health education groups. The WBV exercise group will participate in a 12-week WBV training. The lower extremity resistance training group will undergo a 12-week lower extremity resistance training of both lower limbs. The control group will receive health education for 12 weeks. After the intervention, the participants will be followed up for 3 months with no active intervention. Primary outcome measures will include anthropometric measurements, gait analysis during walking and stair climbing, muscle strength test of the knee and ankle, proprioception test of the knee and ankle, and neuromuscular response of the leg muscles. Secondary outcome measures will include self-reported pain and physical functional capacity, and physical performance measures. Furthermore, adverse events will be recorded and analyzed. If any participant withdraws from the trial, intention-to-treat analysis will be performed.

Discussion

Important features of this trial mainly include intervention setting, outcome measure selection, and study duration. This study is intended for estimating the effect of WBV intervention on neuromuscular control outcomes. Study results may provide evidence to support the beneficial effects of WBV exercise on the physical performance and neuromuscular control of individuals with KOA to fill the research gap on the efficacy of WBV.

Trial registration

Chinese Clinical Trial Registry, ID: ChiCTR-IOR-16009234. Registered on 21 September 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2170-6) contains supplementary material, which is available to authorized users.

Whole-body vibration of mice induces articular cartilage degeneration with minimal changes in subchondral bone

OBJECTIVE

Low-amplitude, high-frequency whole-body vibration (WBV) has been adopted for the treatment of musculoskeletal diseases including osteoarthritis (OA); however, there is limited knowledge of the direct effects of vibration on joint tissues. Our recent studies revealed striking damage to the knee joint following exposure of mice to WBV. The current study examined the effects of WBV on specific compartments of the murine tibiofemoral joint over 8 weeks, including microarchitecture of the tibia, to understand the mechanisms associated with WBV-induced joint damage.

DESIGN

Ten-week-old male CD-1 mice were exposed to WBV (45 Hz, 0.3 g peak acceleration; 30 min/day, 5 days/week) for 4 weeks, 8 weeks, or 4 weeks WBV followed by 4 weeks recovery. The knee joint was evaluated histologically for tissue damage. Architecture of the subchondral bone plate, subchondral trabecular bone, primary and secondary spongiosa of the tibia was assessed using micro-CT.

RESULTS

Meniscal tears and focal articular cartilage damage were induced by WBV; the extent of damage increased between 4 and 8-week exposures to WBV. WBV did not alter the subchondral bone plate, or trabecular bone of the tibial spongiosa; however, a transient increase was detected in the subchondral trabecular bone volume and density.

CONCLUSIONS

The lack of WBV-induced changes in the underlying subchondral bone suggests that damage to the articular cartilage may be secondary to the meniscal injury we detected. Our findings underscore the need for further studies to assess the safety of WBV in the human population to avoid long-term joint damage.

Effects of Whole Body Vibration Exercise associated with Quadriceps Resistance Exercise on functioning and quality of life in patients with knee osteoarthritis: a randomized controlled trial

OBJECTIVE

To determine effects of Whole Body Vibration Exercise (WBVE) associated with quadriceps resistance exercises (QRE) versus QRE only on pain, physical function, biomarkers in serum and urine, activities of daily living (ADL), and quality of life in patients with knee osteoarthitis (OA).

DESIGN

Randomized-controlled trial .

SETTING

Rehabilitation medicine outpatient department of West China Hospital, Chengdu, Sichuan, People's Republic of China.

SUBJECTS

Forty-nine patients were assigned to WBVE+QRE and 50 to QRE .

MAIN OUTCOME MEASURES

Primary outcomes included pain assessed with visual analogue scale (VAS), Timed up & go test (TUG), 6-min walk distance test (6MWD), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes comprised range of motion, muscular strength, serum COMP and urinary CTX-II, Lequesne Index (LI), and SF-36. All outcomes were analyzed with mixed effects regression.

RESULTS

Compared with QRE, WBVE+QRE showed significantly greater improvement in VAS at 4weeks ( p=0.03), in VAS ( p<0.01), 6MWD ( p=0.01), WOMAC pain ( p=0.01), and WOMAC physical function ( p=0.02) at 16 weeks, and in all primary outcomes at 24 weeks (all p<0.01).

CONCLUSION

Over a six months period, WBVE in combination with QRE was superior to QRE in most outcomes.

Clinical applications of vibration therapy in orthopaedic practice

BACKGROUND

Vibration therapy (VT) has been proposed as an option to improve physical performance and reduce the negative effects of ageing on bone, muscles and tendons. Several discrepancies exist on the type of applications, frequency and magnitude. These differences reflex on the contradictory clinical results in literature. Aim of the present study is to carry on an exhaustive review to focus on technical options on the market, clinical applications in orthopaedic practice and expected outcomes.

METHODS

a literature review using the key words "vibration therapy" and "whole-body vibration" and "orthopaedics" was performed. After checking the available abstracts 71 full text articles were evaluated.

RESULTS

fifty-one articles focused on the effects of VT on muscles and tendons reporting ways of action and clinical outcomes. In a similar way 20 studies focused on the influence of VT on bone tissue with regard on ways of action and clinical trials.

CONCLUSIONS

VT provides anabolic mechanical signals to bone and musculo-tendinous system. The best effects seem to be achieved with devices that deliver low-intensity stimuli at high frequencies providing linear horizontal displacement.

Effect of whole body vibration training on quadriceps muscle strength in individuals with knee osteoarthritis: a systematic review and meta-analysis

BACKGROUND

Several studies have reported the effects of whole body vibration (WBV) training on muscle strength. This systematic review investigates the current evidence regarding the effects of WBV training on quadriceps muscle strength in individuals with knee osteoarthritis (OA).

DATA SOURCES

We searched PubMed, CINAHL, Embase, Scopus, PEDro, and Science citation index for research articles published prior to March 2015 using the keywords whole body vibration, vibration training, strength and vibratory exercise in combination with the Medical Subject Heading 'Osteoarthritis knee'.

STUDY SELECTION

This meta-analysis was limited to randomized controlled trials published in the English language.

DATA EXTRACTION

The quality of the selected studies was assessed by two independent evaluators using the PEDro scale and criteria given by the International Society of Musculoskeletal and Neuronal Interactions (ISMNI) for reporting WBV intervention studies. The risk of bias was assessed using the Cochrane collaboration's tool for domain-based evaluation. Isokinetic quadriceps muscle strength was calculated for each intervention.

RESULTS

Eighteen studies were identified in the search. Of these, four studies met the inclusion criteria. Three of these four studies reached high methodological quality on the PEDro scale. Out of the four studies, only one study found significantly greater quadriceps muscle strength gains following WBV compared to the control group.

CONCLUSIONS

In three of the four studies that compared a control group performing the same exercise as the WBV groups, no additional effect of WBV on quadriceps muscle strength in individuals with knee OA was indicated.

The effect of adding whole body vibration training to strengthening training in the treatment of knee osteoarthritis: A randomized clinical trial

Strengthening training (ST) and whole body vibration training (WBV) alone may improve symptoms of osteoarthritis of the knee. In this study, we investigated the effect of adding WBV training to quadriceps and hamstring muscles strengthening training on functional activity, pain, quality of life and muscle strength in patients with knee osteoarthritis. 28 volunteers were randomly allocated to two groups; 1) quadriceps and hamstring muscles strengthening training (ST group, 13 patients) and 2) quadriceps and hamstring muscles strengthening training along with WBV training (ST + WBV group, 15 patients). The treatment protocol for both groups involved 3 sessions per week for 8 weeks. All measurements were performed before and after intervention. The measurements included: pain by means of a visual analogue scale (VAS), quality of life by means of the WOMAC scale, functional activity by the 2 min walking test (2MWT), time up & go test (TUGT) and 50-foot walking test (50FWT) and the muscle peak torque (MPT), total work (TW) and muscle power (MP) as muscle performance of quadriceps and hamstring muscles by an Isokinetic Biodex machine. After intervention, the comparison of mean changes between two groups showed improvement in the WBV + ST group in terms of 2MWT, MPT, TW and MP variables (P < 0.05). However, no significant difference was found between the experimental groups in term of pain, quality of life, TUGT and 50FWT. These results suggest that adding whole body vibration training to strengthening training may provide better treatment effects for patients with knee osteoarthritis.

Therapeutic effects of whole-body vibration training in knee osteoarthritis: a systematic review and meta-analysis

OBJECTIVE

To examine the current evidence regarding the effects of whole-body vibration (WBV) training in individuals with knee osteoarthritis (OA).

DATA SOURCES

We searched PubMed, CINAHL, Embase, Scopus, Physiotherapy Evidence Database (PEDro), and Science Citation Index for research articles published prior to January 2015 using the keywords whole body vibration, vibration training, and vibratory exercise in combination with the Medical Subject Heading osteoarthritis knee.

STUDY SELECTION

This meta-analysis was restricted to randomized controlled trials published in the English language. The quality of the selected studies was assessed by the PEDro Scale. The risk of bias was assessed using the Cochrane collaboration's tool in the domain-based evaluation. We also evaluated the quality of each study based on the criteria given by the International Society of Musculoskeletal and Neuronal Interactions for reporting WBV intervention studies, consisting of 13 factors.

DATA EXTRACTION

Descriptive data regarding subjects, design, intervention, WBV parameters, outcomes, and conclusions were collected from each study by 2 independent evaluators. The mean and SD of the baseline and final endpoint scores for pain, stiffness, and function were extracted from the included studies.

DATA SYNTHESIS

A total of 83 studies were found in the search. Of these, 5 studies met the inclusion criteria and were further analyzed. Four of these 5 studies reached high methodologic quality on the PEDro Scale. Overall, studies demonstrated mixed results in favor of additive effects of WBV for reducing pain and improving function in knee OA. There was considerable variation in the parameters of the WBV included in this systematic review.

CONCLUSIONS

WBV training reduces pain and improves function in individuals with knee OA.

Effects of whole body vibration on pain, stiffness and physical functions in patients with knee osteoarthritis: a systematic review and meta-analysis

Objective:

To assess the effects of whole body vibration for pain, stiffness and physical functions in patients with knee osteoarthritis.

Data sources:

We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Physiotherapy Evidence Database (PEDro) and EMBASE (up to October 2014) to identify relevant randomized controlled trials. The outcome measures were pain, stiffness and physical functions.

Review methods:

Two investigators identified eligible studies and extracted data independently. The PEDro score was used to evaluate the methodological quality of the selected studies. Standard mean differences (SMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test.

Results:

A total of five randomized controlled trials involving 170 patients with knee osteoarthritis met the inclusion criteria. Only four studies involving 144 patients were deemed to be good quality trials (PEDro score = 6–7). Meta-analysis revealed that whole body vibration has a significant treatment effect in Western Ontario and McMaster Universities index physical function score (SMD = −0.72 points, 95% CI = −1.14 to −0.30, P = 0.0008), 12 weeks whole body vibration improved the 6-minute walk test (SMD 1.15 m, 95% CI 0.50 to 1.80, P = 0.0006) and balance (SMD = −0.78 points, 95% CI −1.40 to −0.16, P = 0.01). Whole body vibration was not associated with a significant reduction in Western Ontario and McMaster Universities index pain and stiffness score.

Conclusion:

Eight-week and 12-week whole body vibration is beneficial for improving physical functions in patients with knee osteoarthritis and could be included in rehabilitation programs.

Whole body and local muscle vibration reduce artificially induced quadriceps arthrogenic inhibition

OBJECTIVE

To evaluate the effects of whole body vibration (WBV) and local muscle vibration (LMV) on quadriceps function after experimental knee effusion (ie, simulated pathology).

DESIGN

Randomized controlled trial.

SETTING

Research laboratory.

PARTICIPANTS

Healthy volunteers (N=43) were randomized to WBV (n=14), LMV (n=16), or control (n=13) groups.

INTERVENTIONS

Saline was injected into the knee to induce quadriceps arthrogenic muscle inhibition (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 after effusion, and immediately and 5 minutes after each intervention (WBV, LMV, control) via voluntary peak torque (VPT) and the central activation ratio (CAR) during maximal isometric knee extension on a multifunction dynamometer.

RESULTS

The CAR improved in the WBV (11.4%, P=.021) and LMV (7.3%, P<.001) groups immediately postintervention, but they did not improve in the control group. Similarly, VPT increased by 16.5% (P=.021) in the WBV group and 23% (P=.078) in the LMV group immediately postintervention, but it did not increase in the control group. The magnitudes of improvements in the CAR and VPT did not differ between the WBV and LMV groups.

CONCLUSIONS

Quadriceps AMI is a common complication following knee pathology that produces quadriceps dysfunction and increases the risk of posttraumatic osteoarthritis. Quadriceps strengthening after knee pathology is often ineffective because of AMI. WBV and LMV improve quadriceps function equivocally after simulated knee pathology, effectively minimizing quadriceps AMI. Therefore, these stimuli may be used to enhance quadriceps strengthening, therefore improving the efficacy of rehabilitation and reducing the risk of osteoarthritis.