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

Meta-analysis of the dosage of balance training on ankle function and dynamic balance ability in patients with chronic ankle instability

OBJECTIVE

To explore and compare the dosage of balance training on ankle function and dynamic balance ability in patients with chronic ankle instability (CAI).

METHODS

The PubMed, Embase, Web of Science, Medline, and Cochrane databases were searched up to December 2023. Quality assessment was carried out using the risk-of-bias guidelines of the Cochrane Collaboration, and the standardized mean differences (SMD) or mean differences (MD) for each outcome were compute.

RESULTS

Among 20 eligible studies, including 682 participants were analyzed in this meta-analysis. The results of the meta-analysis demonstrated that balance training was effective in enhancing ankle function with self-functional scores (SMD = 1.02; 95% CI, 0.61 to 1.43; p < 0.00001; I2 = 72%) and variables associated with the ability of dynamic balance such as SEBT-A (MD = 5.88; 95% CI, 3.37 to 8.40; p < 0.00001; I2 = 84%), SEBT-PM (MD = 5.47; 95% CI, 3.40 to 7.54; p < 0.00001; I2 = 61%), and SEBT-PL (MD = 6.04; 95% CI, 3.30 to 8.79; p < 0.0001; I2 = 79%) of CAI patients. Meta-regression indicated that the intervention time might be the principal cause of heterogeneity (p = 0.046) in self-functional scores. In subgroup analyses of self-functional score across intervention types, among the intervention time, more than 20 min and less than 30 min had the most favorable effect (MD = 1.21, 95% CI: 0.96 to 1.46, p < 0.00001, I2 = 55%); among the intervention period, 4 weeks (MD = 0.84, 95% CI: 0.50 to 1.19, p < 0.00001, I2 = 78%) and 6 weeks (MD = 1.21, 95% CI: 0.91 to 1.51, p < 0.00001, I2 = 71%) had significant effects; among the intervention frequency, 3 times (MD = 1.14, 95% CI: 0.89 to 1.38), p < 0.00001, I2 = 57%) had significant effects. Secondly, in subgroup analyses of SEBT across intervention types, a 4-week and 6-week intervention with balance training 3 times a week for 20-30 min is the optimal combination of interventions to improve SEBT (dynamic balance) in patients with chronic ankle instability.

CONCLUSION

Balance training proves beneficial for ankle function in patients with CAI. Intervention time constitutes a major factor influencing self-function in patients with CAI. It is recommended that the optimal dosage of balance training for CAI involves intervention three times a week, lasting for 20 to 30 min over a period of 4 to 6 weeks for superior rehabilitation.

Biomechanical and Physiological Variables in Dynamic and Functional Balance Control during Single-Leg Loading in Individuals with Chronic Ankle Instability: A Scoping Review

BACKGROUND

This scoping review summarizes the tasks and outcomes in dynamic and functional balance assessments of individuals with chronic ankle instability, focusing on the physiological and biomechanical characteristics.

METHOD

A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and MEDLINE databases in September 2023 and revised in April 2024. Studies evaluating dynamic and functional balance in chronic ankle instability using clinical tests, as well as biomechanical and physiological outcomes, were included.

RESULTS

Out of 536 publications, 31 met the screening criteria. A history of ankle sprain was the main focus of the inclusion criteria (28 articles, 90%). The star excursion balance test, emphasizing maximum reach distance, was the most common quantitative task (12 articles, 66%). Physiological data mainly came from electromyography studies (7 articles, 23%), while biomechanical variables were often assessed through center of pressure studies using force plates (17 articles, 55%).

CONCLUSIONS

The preferred quantitative clinical assessment was the star excursion balance test, focusing on normalized reach outcomes. Qualitative functional balance assessments emphasize landing activities and center of pressure displacement. Electromyography is commonly used to analyze the tibialis anterior and peroneus longus muscles. However, there is a lack of qualitative data on dynamic balance control, including morphological characteristics and the center of mass adaptation.

Effect of whole-body vibration frequency on objective physical function outcomes in healthy young adults: Randomized clinical trial

INTRODUCTION

Whole-body vibration (WBV) is used to improve muscle function but is important to know if doses can affect the objective function outcomes.

OBJECTIVE

To compare the effect of two frequencies of WBV on objective physical function outcomes in healthy young adults.

METHODS

Forty-two volunteers were randomized into three groups: sham group (SG), and WBV groups with 30 (F30) and 45 Hz (F45). A 6-week WBV intervention protocol was applied by a vibrating platform twice a week, with the platform turn-off for SG and with two frequencies according to group, 30 or 45 Hz. The objective physical functions outcomes assessed were the proprioceptive accuracy, measured by proprioceptive tests, and quasi-static and dynamic balances, measured by Sensory Organization Test (SOT) and Y Balance Test, respectively. The outcomes were assessed before and after the WBV intervention. We used in the results comparisons, by GzLM test, the deltas percentage.

RESULTS

After the intervention, no statistical differences were observed in percentage deltas for any outcomes (proprioceptive accuracy, quasi-static and dynamic balances).

CONCLUSION

Objective physical function outcomes, after the 6-week WBV protocol, did not present statistically significant results in any of the intervention groups (F30 or F45) and SG.

Effects of combination of strength and balance training on postural control and functionality in people with chronic ankle instability: a systematic review and meta analysis

AIM

To identify the effects of strength and balance training on dynamic balance and patient reported outcomes in people with chronic ankle instability(CAI).

METHOD

Five databases(CNKI, WanFang, Web of Science, EBSCO-SPORTD and PubMed were searched in September 2022. The search was conducted on randomized controlled trials(RCTs) that the effects of strength training, balance training and combination of strength and balance training in people with chronic ankle instability compared to a control group. Using Review Manager 5.3 and Stata-SE 15 to conduct Meta-analysis on the included literature. methodological quality and risk of bias were assessed by using the PEDro scale.

RESULTS

A total of 33 Chinese and English RCTs document were screened and 1154 patients with CAI were included in the study. Compared with control group, strength training, balance training and combination of strength and balance training demonstrated to be more effective in terms of improving patient reported outcomes(strength training: SMD = 0.80, 95%CI = 0.39-1.22; balance training: SMD = 0.79, 95%CI = 0.41-1.17; combination of strength and balance training: SMD = 1.28, 95%CI = 0.57, 1.99). Subgroup analysis: Intervention for 6 weeks, more than 3 times a week and more than 30 min each time were the best rehabilitation programs to improve CAI patientreported outcomes. Compared with control group, balance training demonstrated to be more effective in terms of improving Star Excursion Balance Test (SEBT)((anterior: SMD = 0.71, 95%CI = 0.03-1.40; posterolateral: SMD = 0.84, 95%CI = 0.22-1.46; posteromedial: SMD = 0.88, 95%CI = 0.45-1.32). However, strength training and combination of strength and balance training had no improvement effects on SEBT.

CONCLUSIONS

Available evidence showed that, results of the comparison between balance training versus strength training suggest that the combination of strength and balance training achieves greater benefits for patient reported outcomes and balance training could bring greater benefits to dynamic balance. Strength training should be used cautiously in clinic to improve the dynamic balance in individuals with CAI.

TRIAL REGISTRATION

( http://www.crd.york.ac.uk/PROSPERO , Registration No. CRD42022371396).

Effect of whole-body vibration on postural stability in young adults with generalized joint hypermobility: A comparative study

BACKGROUND

Whole-body vibration (WBV) is being used in rehabilitation and sport. Studies confirm its positive impact on muscle strength and power or regulating muscle hypertension. However, there are some uncertainties regarding its influence on postural stability. This issue seems particularly interesting in the case of individuals with generalized joint hypermobility (GJH), for whom proprioceptive training and muscle strengthening exercises are recommended while techniques that decrease muscle tension are not advised.

OBJECTIVE

The aim of the study was to evaluate the acute effect of WBV on postural stability in adults with GJH.

METHODS

60 participants were categorized into the groups: 1) hypermobility with vibration (GJH+WBV), 2) hypermobility without vibration (GJH-WBV), 3) control group with vibration (CTRL+WBV), 4) control group without vibration (CTRL-WBV). The first and the third group completed WBV (frequency: 15 Hz and 30 Hz, amplitude 3 mm, 3 × 3 min). The second and fourth groups participated only in measurement sessions. GJH was assessed using the Beighton test. Postural stability was measured as the overall stability index (OSI) on the Biodex Balance System on the stable and unstable platform with open and closed eyes. Measurements were taken before and after WBV for two weeks.

RESULTS

At a frequency of 15 Hz, a significant time effect was observed for measurements Before and After in CTRL-WBV on the stable platform with open eyes (p= 0.012) and on the unstable platform with closed eyes (p= 0.000) for the GJH+WBV and CTRL+WBV groups. There were no significant interactions (p> 0.05) between factors. At a frequency of 30 Hz, there was a significant time effect Before and After (p= 0.047) on the stable platform with open eyes, but no interaction was found between factors (p= 0.835).

CONCLUSION

There is no positive acute effect of WBV on postural stability in adults with and without GJH.

The impact of whole-body vibration training and proprioceptive neuromuscular facilitation on biomechanical characteristics of lower extremity during cutting movement in individuals with functional ankle instability: A parallel-group study

BACKGROUND

We compared the effects of whole-body vibration training and proprioceptive neuromuscular facilitation on the biomechanical characteristics of the lower limbs in functional ankle instability patients during cutting movement to ascertain the superior rehabilitation method.

METHODS

Twenty-two male College students with unilateral functional ankle instability volunteered for this study and were randomly divided into whole-body vibration training group and proprioceptive neuromuscular facilitation group. Kinematics data and ground reaction forces were collected using infrared motion capture system and 3-D force plates synchronously during cutting. Repeated measures two-way ANOVA was performed to analyze the data.

FINDINGS

Both training methods reduced the maximum hip abduction angle (p = 0.010, effect size: proprioceptive neuromuscular facilitation = 0.69; whole-body vibration training = 0.20), maximum knee flexion angle (p = 0.008, effect size: proprioceptive neuromuscular facilitation = 0.39, whole-body vibration training = 1.26) and angular velocity (p = 0.014, effect size: proprioceptive neuromuscular facilitation = 0.62, whole-body vibration training = 0.55), maximum ankle inversion angular velocity (p = 0.020, effect size: proprioceptive neuromuscular facilitation = 0.52, whole-body vibration training = 0.81), and knee flexion angle at the time of maximum vertical ground reaction forces (p = 0.018, effect size: proprioceptive neuromuscular facilitation = 0.27, whole-body vibration training = 0.76), and increased the maximum ankle dorsiflexion moment (p = 0.049, effect size: proprioceptive neuromuscular facilitation = -0.52, whole-body vibration training = -0.22). Whole-body vibration training reduced the maximum ground reaction forces value in the mediolateral directions (p = 0.010, effect size = 0.82) during cutting movement.

INTERPRETATION

These findings suggested that the two types of training might increase neuromuscular conduction function around the ankle. After these two types of training, functional ankle instability patients showed a similar risk of injury to the lateral ankle ligaments during cutting.

A systematic review and meta-analysis of balance training in patients with chronic ankle instability

BACKGROUND

Chronic ankle instability (CAI) is a common yet serious problem for elder patients. This meta-analysis aimed to evaluate the effects of balance training for CAI, to provide evidence for the clinical treatment, and care of CAI patients.

METHODS

Two investigators searched PubMed, EMBASE, Science Direct, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and Weipu Databases up to May 20, 2023, for randomized controlled trials (RCTs) on the effects of balance training for CAI. The mean difference (MD) with 95% confidence intervals (95%CIs) was calculated for each outcome with a fixed or random effect model. Review Manager 5.3 software was used for meta-analysis.

RESULTS

Nine RCTs involving 341 patients were included. Meta-analysis results showed that compared with blank controls, balanced training treatment of CAI could significantly improve the score of CAI [MD = 3.95, 95% CI (3.26, 4.64), P < 0.00001], SEBT-PM [MD = 4.94, 95% CI (1.88, 8.00), P = 0.002], SEBT-PL [MD = 5.19, 95% CI (1.57, 8.81), P = 0.005], and FAAM Sports [MD = 17.74, 95% CI (14.36, 21.11), P < 0.00001]. Compared with strength training, balance training treatment of CAI improved the score of CAIT [MD = 2.36, 95% CI (0.29, 4.44), P = 0.03], FAAM-ADL [MD = 4.06, 95% CI (1.30, 6.83), P = 0.004].

CONCLUSION

The analysis outcomes indicate that balance training enhances daily activity capability, motor function, and dynamic balance to different extents. Additionally, when comparing the results of balance training and strength training, no significant difference was observed between the two methods in improving the dynamic stability of CAI patients. However, it is noteworthy that balance training exhibits a more pronounced impact on enhancing functional scale scores.

Effects of whole-body vibration training on physical function, activities of daily living, and quality of life in patients with stroke: a systematic review and meta-analysis

Purpose: This systematic review and meta-analysis aimed to evaluate the efficacy of whole-body vibration training (WBVT) in patients with stroke, specifically focusing on its effects on physical function, activities of daily living (ADL), and quality of life (QOL). Additionally, potential moderators influencing WBVT outcomes were explored. Methods: We conducted a systematic search of PubMed, Embase, and Cochrane Library from inception to September 2022. Eligible studies were randomized controlled trials employing WBVT in patients with stroke. Two investigators independently extracted the data and calculated the standardized mean difference (SMD) using random-effect models. Results: Twenty-five studies involving 991 patients were included in this meta-analysis. WBVT demonstrated significant reductions in spasticity (SMD = -0.33, 95% CI = -0.61 to -0.06, p = 0.02), improvements in motor function (SMD = 0.39, 95% CI = 0.16 to 0.61, p < 0.01), and enhancements in balance function (SMD = 0.28, 95% CI = 0.09 to 0.47, p < 0.01) in patients with stroke. However, no significant effects were observed for gait (SMD = -0.23, 95% CI = -0.50 to 0.04, p = 0.10), ADL (SMD = -0.01, 95% CI = -0.46 to 0.44, p = 0.97), or QOL (SMD = 0.12, 95% CI = -0.30 to 0.53, p = 0.59). Subgroup analyses revealed that variable frequency vibration and side-alternating vibration exhibited significant efficacy in reducing spasticity and improving motor and balance functions, while fixed frequency vibration and vertical vibration did not yield significant therapeutic benefits in these domains. Conclusion: Our findings indicate that WBVT may serve as a viable adjunct therapy for stroke patients to alleviate spasticity and enhance motor and balance functions. Variable frequency and side-alternating vibration appear to be crucial factors influencing the therapeutic effects of WBVT on these dysfunctions. Nonetheless, WBVT did not show significant effects on gait, ADL, or QOL in stroke patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42022384319).

What interventions can treat arthrogenic muscle inhibition in patients with chronic ankle instability? A systematic review with meta-analysis

PURPOSE

To identify, critically appraise, and synthesize the existing evidence regarding the effects of therapeutic interventions on arthrogenic muscle inhibition (AMI) in patients with chronic ankle instability (CAI).

MATERIALS AND METHODS

Two reviewers independently performed exhaustive database searches in Web of Science, PubMed, Medline, CINAHL, and SPORTDiscus.

RESULTS

Nine studies were finally included. Five types of disinhibitory interventions were identified: focal ankle joint cooling (FAJC), manual therapy, fibular reposition taping (FRT), whole-body vibration (WBV), and transcranial direct current stimulation (tDCS). There were moderate effects of FAJC on spinal excitability in ankle muscles (g = 0.55, 95% CI = 0.03-1.08, p = 0.040 for the soleus and g = 0.54, 95% CI = 0.01-1.07, p = 0.046 for the fibularis longus). In contrast, manual therapy, FRT, WBV were not effective. Finally, 4 weeks of tDCS combined with eccentric exercise showed large effects on corticospinal excitability in 2 weeks after the intervention (g = 0.99, 95% CI = 0.14-1.85 for the fibularis longus and g = 1.02, 95% CI = 0.16-1.87 for the tibialis anterior).

CONCLUSIONS

FAJC and tDCS may be effective in counteracting AMI. However, the current evidence of mainly short-term studies to support the use of disinhibitory interventions is too limited to draw definitive conclusions.

Effects of whole-body vibration on chronic ankle instability: a systematic review

Background and objective

Chronic ankle instability (CAI) is one of the most common sports injuries, and whole-body vibration (WBV) training has been used lately as a potential rehabilitation modality for these patients. The authors conducted a systematic review and meta-analysis to assess whether WBV training positively affects patients with CAI.

Materials and methods

The authors systematically searched four databases, including MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials, for randomized and non-randomized trials evaluating the effects of WBV on individuals with CAI. The authors used Cochrane RoB2 to assess the risk of bias in randomized trials. A meta-analysis was conducted if three or more studies measured the same outcome. Effect estimates were pooled using a random-effects model.

Results

Results were retrieved from seven articles encompassing 288 participants who had CAI. The reach distance of the Star Excursion Balance Test (SEBT) was regarded as the study's main finding. The authors saw a significant training effect on certain planes of motion on dynamic balance. The findings showed that the post-intervention measurements in the WBV group compared to control groups showed improvements in the posterolateral, posteromedial, and medial directions, respectively. There were also promising results on improvements in muscle activity, strength, and proprioception sense measurements with a great diversity in the reported parameters.

Conclusion

The authors observed a significant WBV training effect on dynamic balance over posterolateral, posteromedial, and medial reach distances. These findings suggest future studies on the effects of WBV on muscle activity, strength, and proprioception in addition to dynamic and static balance.

Comparing the effectiveness of flexi-bar and stability exercises on postural control in chronic nonspecific low back pain: A randomized controlled study

Objectives

This study aimed to compare the effect of flexi-bar and stabilization exercises on static and dynamic postural control in patients with chronic nonspecific low back pain.

Patients and methods

In this randomized controlled study conducted between November 2019 and March 2020, 38 patients (19 males, 19 females; mean age: 33.8±6.2 years; range, 20 to 45 years) were randomly assigned into flexi-bar (n=19) and stabilization (n=19) groups. Both groups received general physiotherapy for three sessions per week, a total of 10 sessions. Besides, the flexi-bar group received flexi-bar exercises, and the stabilization group received stabilization exercises. Postural sway was assessed with a force platform in three difficult conditions, including open eye, close eye, and one-leg standing and dynamic posture with the modified Star Excursion Balance Test.

Results

After the intervention, both groups showed a significant improvement in static and dynamic postural control (p<0.05). However, no significant differences were found between groups after treatment, while only the phase-plane portrait of opened eyes condition was significantly improved (p=0.03), in the flexi-bar group compared to the stabilization group.

Conclusion

Both flexi-bar and stabilization exercises effectively improved static and dynamic postural control, but none of the exercises was superior to the other. Flexi-bar is recommended as an effective tool in low back pain rehabilitation.

Effect of blood flow restriction as a stand-alone treatment on muscle strength, dynamic balance, and physical function in female patients with chronic ankle instability

BACKGROUND

Blood Flow Restriction (BFR) training has gained popularity as a novel training strategy in athletes and rehabilitation settings in recent years.

OBJECTIVE

To investigate whether BFR as a stand-alone treatment would affect muscle strength, dynamic balance, and physical function in female patients with chronic ankle instability (CAI).

METHODS

Thirty-nine patients with CAI were randomly allocated into 1 of 3 groups: BFR as a stand-alone (BFR) group, BFR with rehabilitation (BFR+R) group, and rehabilitation (R) group. All groups trained 3 times per week for 4 weeks. One week before and after the intervention, strength of muscles around ankle joint, 3 dynamic balance indices: Overall Stability Index, Anterior-Posterior Stability Index, and Medial-Lateral Stability Index, and physical function were assessed via an isokinetic dynamometer, the Biodex Balance System, and the Foot and Ankle Disability Index, respectively.

RESULTS

The strength of muscles around ankle and dynamic balance indices improved significantly in BFR + R and R groups (P < .006), but not in BFR group (P > .006). All dynamic balance indices showed improvement in BFR + R and R groups except the Medial-Lateral Stability Index (P > .006). Foot and Ankle Disability Index increased significantly in BFR + R and R groups (P < .006), however; no improvement occurred in BFR group (P > .006).

CONCLUSIONS

The BFR as a stand-alone treatment hasn't the ability to improve the strength of muscles around the ankle, dynamic balance, and physical function in females with CAI compared to the BFR + R or the R program. In addition, the strength of muscles around the ankle correlated significantly with both dynamic balance and physical function in BFR + R and R groups.

Effect of whole-body vibration training on the recovery of lower limb function in people with stroke: a systematic review and meta-analysis

PURPOSE

The purpose of this meta-analysis was to systematically evaluate the effects of whole-body vibration training (WBVT) on the recovery of lower limb function in people with stroke.

METHODS

The literature search was made in the electronic databases PubMed, Web of Science, Scopus and Embase electronic databases. Only randomized controlled trials were included. Data extraction, quality assessment and meta-analysis were performed. The search was conducted on September 01, 2022. The data analysis software was RevMan 5.3.

RESULTS

A total of 13 RCTs were included, including 687 patients. The results showed that compared with the control group, the overall difference in balance function was statistically significant [MD = 4.23, 95% CI 2.21 ∼ 6.26, p < 0.0001]. There was no significant difference in the evaluation indexes of lower limb motor function, including the TUG, 10MWT, 6MWT, and FMA - LE. The overall difference in lower limb muscle spasticity was statistically significant [MD = -0.53, 95% CI -0.81 ∼ 0.26, p = 0.0001].

CONCLUSIONS

Compared with the control group, using WBVT treatment has a more obvious effect on the recovery of lower limb function and muscle spasticity, and there is no obvious advantage in motor function recovery.IMPLICATIONS FOR REHABILITATIONThis Systematic Review and meta-analysis of evidence suggest that whole-body vibration training is effective in the rehabilitation of lower limb function in patients with stroke.Whole body vibration training may be a better choice for improving balance and spasm in people with stroke.Currently it is not known which whole-body vibration training model with vibration intensity, stimulus type and duration is most effective and to design more targeted interventions.

Effects of Ankle Stabilization Exercises Using Sonic Balance Pad on Proprioception and Balance in Subjects with Ankle Instability

Sound waves generate acoustic resonance energy that penetrates deeply and safely into body areas normal mechanical vibrations cannot reach. The sonic balance pad utilizes these sound waves to create an optimal musculoskeletal response. The purpose of this study was to investigate the effects of a 4-week ankle stabilization exercise program using a sonic balance pad on proprioceptive sense and balance ability in individuals with ankle instability. This study was conducted as a randomized control-group pre-and post-test design in 30 participants (21 females and 9 males) who had experienced an ankle fracture or sprain within the last 5 years or who scored 11 points or more on The Identification of Functional Ankle Instability. The ankle stabilization exercise program was conducted for 4 weeks in the experimental group (n = 15), to which sonic pads were applied, and the control group (n = 15), to which balance pads were applied. All participants were assessed for their intrinsic proprioceptive sense of dorsiflexion and plantarflexion, static balance test, dynamic balance test, and long jump test were measured before and after 4 weeks as dependent variables. After 4 weeks of training, a significant difference was shown in the right dorsiflexion error (Balance pad = PRE: 2.47 ± 0.92; POST: 2.33 ± 1.40, Sonic pad = PRE: 3.27 ± 1.39; POST: 1.20 ± 0.77) and the left plantar flexion error (Balance pad = PRE: 2.00 ± 1.36; POST: 2.73 ± 1.22, Sonic pad = PRE: 3.53 ± 1.25; POST: 2.20 ± 1.01) (p < 0.05) between the experimental and control groups in the proprioception test. In the static balance test, there was no significant difference between the experimental and control groups during the pre, post, and variation stages. However, in the Y-Balance test, which is one of the dynamic balance tests, there was a significant difference between the experimental and control groups at various points, including anterior left (Balance pad = PRE: 72.85 ± 19.95; POST: 63.41 ± 8.66, Sonic pad = PRE: 68.16 ± 6.38; POST: 76.17 ± 3.67), posteromedial right (Balance pad = PRE: 78.59 ± 15.34; POST: 81.41 ± 10.37, Sonic pad = PRE: 86.33 ± 16.44; POST: 102.23 ± 11.53), posteromedial left (Balance pad = PRE: 78.00 ± 16.99; POST: 83.36 ± 10.15, Sonic pad = PRE: 88.96 ± 19.92; POST: 102.45 ± 12.98), posterolateral right (Balance pad = PRE: 78.16 ± 14.33; POST: 82.61 ± 10.73, Sonic pad = PRE: 87.95 ± 17.51; POST: 101.34 ± 15.37), and posterolateral left (Balance pad = PRE: 80.86 ± 14.96; POST: 81.31 ± 7.16, Sonic pad = PRE: 91.23 ± 17.35; POST: 104.18 ± 11.78) (p < 0.05). Moreover, in the single-leg long jump test, which is another dynamic balance test, the experimental group (Sonic pad = PRE: 100.27 ± 29.00; POST: 116.80 ± 28.86) also demonstrated a significant difference in the right single-leg long jump compared to the control group (Balance pad = PRE: 91.87 ± 17.74; POST: 97.67 ± 17.70) (p < 0.05). When a sonic balance pad using sound waves was applied in addition to a 4-week ankle stabilization exercise program for participants with ankle stability, it helped to improve proprioception and dynamic balance ability.

Risk factors for chronic ankle instability after first episode of lateral ankle sprain: A retrospective analysis of 362 cases

BACKGROUND

Chronic ankle instability (CAI) is a common sequela following an acute lateral ankle sprain (LAS). To treat an acute LAS more effectively and efficiently, it is important to identify patients at substantial risk for developing CAI. This study identifies magnetic resonance imaging (MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients.

METHODS

All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1, 2017 to December 1, 2019 were identified. Data were collected using the Cumberland Ankle Instability Tool at final follow-up. Demographic and other related clinical variables, including age, sex, body mass index, and treatment were also recorded. Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS.

RESULTS

A total 131 out of 362 patients with a mean follow-up of 3.0 ± 0.6 years (mean ± SD; 2.0-4.1 years) developed CAI after first-episode LAS. According to multivariable regression, development of CAI after first-episode LAS was associated with 5 prognostic factors: age (odds ratio (OR) = 0.96, 95% confidence interval (95%CI): 0.93-1.00, p = 0.032); body mass index (OR = 1.09, 95%CI: 1.02-1.17, p = 0.009); posterior talofibular ligament injury (OR = 2.17, 95%CI: 1.05-4.48, p = 0.035); large bone marrow lesion of the talus (OR = 2.69, 95%CI: 1.30-5.58, p = 0.008), and Grade 2 effusion of the tibiotalar joint (OR = 2.61, 95%CI: 1.39-4.89, p = 0.003). When patients had at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, or inversion tilt test, they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI.

CONCLUSION

MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, and inversion tilt test. Further prospective and large-scale studies are necessary for validation.

Adding mechanical vibration to a half squat with different ballasts and rhythms increases movement variability

The aim of this study was to determine whether whole body vibration increases movement variability while performing a half squat with different ballasts and rhythms through entropy. A total of 12 male athletes (age: 21.24 ± 2.35 years, height: 176.83 ± 5.80 cm, body mass: 70.63 ± 8.58 kg) performed a half squat with weighted vest, dumbbells and bar with weights suspended with elastic bands, with and without vibration at the squat rhythm of 40 and 60 bpm. Each ballast corresponded to 15% of the body mass. The movement variability was analysed by calculating the sample entropy of the acceleration signal, recorded at the waist using an accelerometer. With vibration, differences were found between weighted vest and dumbbells (t(121) = -8.81, p < 0.001 at 40 bpm; t(121) = -8.18, p < 0.001 at 60 bpm) and between weighted vest and bar at both rhythms (t(121) = -8.96, p < 0.001 at 40 bpm; t(121) = -8.83, p < 0.001 at 60 bpm). Furthermore, a higher sample entropy was obtained at 40 bpm with all ballasts (t(121) = 5.65, p < 0.001 with weighted vest; t(121) = 6.27, p < 0.001 with dumbbells; t(121) = 5.78, p < 0.001 with bar). No differences were found without vibration. These findings reveal that adding mechanical vibration to a half squat produces a non-proportional increase in movement variability, being larger when the ballast is placed on the upper limbs and when performed at a slow rhythm.

Effects of whole-body vibration on sensorimotor deficits and brain plasticity among people with chronic ankle instability: a study protocol for a single-blind randomized controlled trial

BACKGROUND

Chronic ankle instability (CAI) is a form of musculoskeletal disease that can occur after a lateral ankle sprain, and it is characterized by pain, recurrent ankle sprains, a feeling of "giving way" at the ankle joint, and sensorimotor deficits. There has been increasing evidence to suggest that plastic changes in the brain after the initial injury play an important role in CAI. As one modality to treat CAI, whole-body vibration (WBV) has been found to be beneficial for treating the sensorimotor deficits accompanying CAI, but whether these benefits are associated with brain plasticity remains unknown. Therefore, the current study aims to investigate the effect of WBV on sensorimotor deficits and determine its correlation with plastic changes in the brain.

METHODS

The present study is a single-blind randomized controlled trial. A total of 80 participants with CAI recruited from the university and local communities will be divided into 4 groups: whole-body vibration and balance training (WBVBT), balance training (BT), whole-body vibration (WBV), and control group. Participants will be given the WBV intervention (25-38 Hz, 1.3-2 mm, 3-time per week, 6-week) supervised by a professional therapist. Primary outcome measures are sensorimotor function including strength, balance, proprioception and functional performance. Brain plasticity will be evaluated by corticomotor excitability, inhibition, and representation of muscles, as measured by transcranial magnetic stimulation. Activation of brain areas will be assessed through functional near-infrared spectroscopy. Secondary outcome measures are self-reported functional outcomes involving the Cumberland Ankle Instability Tool and the Foot and Ankle Ability Measure. All tests will be conducted before and after the WBV intervention, and at 2-week follow-up. Per‑protocol and intention-to-treat analysis will be applied if any participants withdraw.

DISCUSSION

This is the first trial to investigate the role of brain plasticity in sensorimotor changes brought by WBV for individuals with CAI. As plastic changes in the brain have been an increasingly important aspect in CAI, the results of the current study can provide insight into the treatment of CAI from the perspective of brain plasticity.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2300068972); registered on 02 March 2023.

Effects of plantar-sensory treatments on postural control in chronic ankle instability: A systematic review and meta-analysis

OBJECTIVE

This study aimed to examine the effects of plantar-sensory treatments on postural control in individuals with chronic ankle instability (CAI).

METHODS

This study was registered in PROSPERO (registration number CRD42022329985) on May 14, 2022. An extensive search was performed in Pubmed, Embase, Cochrane, Web of Science, and Scopus to identify the potential studies on plantar-sensory treatments affecting postural control before May 2022. The methodological quality of involved studies was assessed using the scale of Physiotherapy Evidence Database (PEDro). The Cochrane Tool and the Risk of Bias in Non-randomized Studies of Interventions assessment tool were used to evaluate the risk of bias in randomised controlled trials (RCTs) and non-RCTs respectively. RevMan 5.4 was utilised to calculate the standardised mean difference (SMD), with 95% confidence interval (CI).

RESULTS

Eight RCTs with a mean PEDro rating of 6 and four non-RCTs with a mean PEDro rating of 4.75 were included in the quantitative analysis. The types of plantar-sensory treatments included plantar massage, whole-body vibration and textured surface-stimulation treatment. A significant effect of static balance with eyes open (SMD = -0.54; 95% CI: -0.81 to -0.27; p < 0.001) was found and subgroup analysis showed that plantar massage (SMD = -0.49; 95% CI: -0.84 to -0.14; p = 0.006) and whole-body vibration (SMD = -0.66; 95% CI: -1.12 to -0.19; p = 0.005) had positive effects. In the subgroup analysis of anterior dynamic balance, whole-body vibration revealed a significant increase (SMD = 0.60; 95% CI: 0.06-1.14; p = 0.03). The pooled results or subgroup analysis including eyes-closed static balance and other directions of dynamic balance indicated no significant difference (p > 0.05).

CONCLUSIONS

This meta-analysis indicated that plantar-sensory treatments could improve postural control in CAI, especially the treatments of plantar massage and long-term whole-body vibration.

Therapeutic Approach of Whole-Body Vibration Exercise on Wound Healing in Animal Models: A Systematic Review

Human skin wounds pose a gathering threat to the public health, carrying an immense epidemiologic and financial burden. Pharmacological and non-pharmacological (NP) treatments have been proposed to the management of wound healing. Physical exercise is a strong NP intervention considered for patients in wound healing. Particularly, a type of exercise intervention known as whole-body vibration (WBV) exercise has gained increasing interest. WBV exercise is generated due to the transmission of mechanical vibrations, produced by a vibrating platform, to the body. The aim of this review was to summarize studies in experimental animal models using WBV exercise in wound healing. Searches were performed in EMBASE, PubMed, Scopus and Web of Science including publications on 21 November 2022 using the string "whole body vibration" AND "wound healing" (animal or mice or mouse or rat or rodent). The SYRCLE tool was used to assess the risk of bias (RoB). From 48 studies, five studies met the inclusion criteria. RoB indicated that none of the studies fulfilled all methodological analyzed criteria, resulting in possible biases. The studies were homogeneous, and results suggest beneficial effects of WBV exercise in wound healing, mainly related to enhancing angiogenesis, granulation tissue formation, reducing the blood glucose level and enhancing blood microcirculation, by increasing myofiber growth and rapid re-epithelialization. In conclusion, the various biological effects of the response to the WBV exercise indicate the relevance of this intervention in wound healing in animals. Moreover, considering the translation approach, it is possible to speculate that the beneficial effects of this non-pharmacological therapy might justify clinical trials for wound healing also in humans, after criterion evaluation.

Effects of Whole-Body Vibration Exercise on Athletes with Ankle Instability: A Systematic Review

OBJECTIVE

Chronic Ankle Instability (CAI) or Functional Ankle Instability (FAI) is a condition characterized by laxity and mechanical instability in the ankle joint. This instability interferes with the activities and physical-functional parameters of athletes, which leads to repetitive ankle sprains. The current systematic review was carried out to identify the effects of whole-body vibration exercise (WBVE) in athletes with CAI.

METHODS

We conducted electronic searches in Pubmed, the Cochrane Library, Embase, Web of Science, Scopus, Science Direct, Allied Health Literature (CINAHL) and Academic Search Premier (ASP) (EBSCO) databases on 26 February 2022. Registers were identified, and studies were selected for inclusion according to the eligibility criteria. The methodological quality was assessed by the Physiotherapy Evidence Database (PEDro) scale.

RESULTS

Seven studies were included with a mean methodological quality score of 5.85, considered 'regular' quality on the PEDro scale. WBVE interventions in athletes with CAI showed that this exercise contributes to a better response on parameters of neuromuscular performance, muscle strength and consequently in balance and postural control, variables that are for the management of CAI.

CONCLUSION

WBVE interventions in sports modalities promote physiological responses that may lead to positive effects in several parameters. The protocols proposed in each modality can be carried out in practice and are considered effective additional exercise and training methods beyond traditional types of training for athletes. However, more studies are needed on athletes with this condition, with specific protocols, to highlight the possible physiological and physical-functional responses. Protocol study registration: PROSPERO (CRD42020204434).

Does whole-body vibration training have a positive effect on balance and walking function in patients with stroke? A meta-analysis

Objective

After a stroke, patients usually suffer from dysfunction, such as decreased balance ability, and abnormal walking function. Whole-body vibration training can promote muscle contraction, stimulate the proprioceptive system, enhance the muscle strength of low limbs and improve motor control ability. The study aims to evaluate the effectiveness of whole-body vibration training on the balance and walking function of patients with stroke.

Methods

PubMed, CNKI, VIP, CBM, EBSCO, Embase and Web of Science were searched. According to the inclusion and exclusion criteria, randomized controlled trials on the effectiveness of whole-body vibration training on the balance and walking function of patients with stroke were collected. The search time ranged from the date of database construction to November 2022. The included trials were evaluated by the Cochrane risk-of-bias tool. The meta-analysis was performed using two software packages, consisting of RevMan 5.4 and Stata 12.2. If the results included in the literature were continuous variables, use the mean difference (MD) and 95% confidence interval (CI) for statistics.

Results

(1) A total of 22 randomized controlled trials (RCTs) with a total of 1089 patients were included. (2) The results of meta-analysis showed that: compared with the controls, step length (MD = 6.12, 95%CI [5.63, 6.62], p < 0.001), step speed (MD = 0.14, 95%CI [0.09, 0.20], p < 0.001), cadence (MD = 9.03, 95%CI [2.23, 15.83], p = 0.009), stride length (MD = 6.74, 95%CI [-3.47, 10.01], p < 0.001), Berg Balance Scale (BBS) (MD = 4.08, 95%CI [2.39, 5.76], p < 0.001), Timed Up-and-Go test (TUGT) (MD = -2.88, 95%CI [-4.94, 0.81], p = 0.006), 10-meter Walk Test (10MWT) (MD = -2.69, 95%CI [-3.35, -2.03], p < 0.001), functional ambulation category scale (FAC) (MD = 0.78, 95%CI [0.65, 0.91], p < 0.001), Fugl-Meyer motor assessment of lower extremity (FMA-LE) (MD = 4.10, 95%CI [2.01, 6.20], p = 0.0001). (3) The results of subgroup analysis showed that, compared with other vibration frequencies, at 20-30 Hz frequency, WBV training had an obvious improvement effect only in TUGT. (4) The safety analysis showed that WBV training may be safe.

Conclusion

Whole-body vibration training has a positive effect on the balance and walking function of patients with stroke. Thus, whole-body vibration training is a safe treatment method to improve the motor dysfunction of patients with stroke.

Systematic review registration

[http://www.crd.york.ac.uk/PROSPERO], identifier [CRD4202348263].

Superimposed vibration on suspended push-ups

Background

Superimposition of vibration has been proposed in sports training using several devices and methods to enhance muscle activation and strength adaptations. Due to the popularity of suspension training, vibration systems have recently been developed to increase the effects of this training method. The present cross-sectional study aims to examine the effects of superimposing vibration on one of the most popular exercises in strength and conditioning programs: push-ups.

Methods

Twenty-eight physically active men and women executed push-ups in three suspended conditions (non-vibration, vibration at 25 Hz, and vibration at 40 Hz). OMNI-Res scale was registered, and surface electromyographic signals were measured for the activity of the right and left external oblique, anterior deltoid, triceps brachii, sternal, and clavicular heads of the pectoralis major.

Results

A linear mixed model indicated a significant fixed effect for vibration at 25 Hz and 40 Hz on muscle activity. Suspended push-ups with superimposed vibration (25 Hz and 40 Hz) showed a significant higher activity on left (25 Hz: p = 0.036, d = 0.34; 40 Hz: p = 0.003, d = 0.48) and right external oblique (25 Hz: p = 0.004, d = 0.36; 40 Hz: p = 0.000, d = 0.59), anterior deltoid (25 Hz: p = 0.032, d = 0.44; 40 Hz: p = 0.003, d = 0.64), and global activity (25 Hz: p = 0.000, d = 0.55; 40 Hz: p = 0.000, d = 0.83) compared to non-vibration condition. Moreover, OMNI-Res significant differences were found at 25 Hz (6.04 ± 0.32, p = 0.000 d = 4.03 CI = 3.27, 4.79) and 40 Hz (6.21 ± 0.36 p = 0.00 d = 4.29 CI = 3.49, 5.08) compared to the non-vibration condition (4.75 ± 0.32).

Conclusion

Superimposing vibration is a feasible strategy to enhance the muscle activity of suspended push-ups.

The Influence of Surgical Mask on Heart Rate, Muscle Saturation of Oxygen, and Hemoglobin during Whole-Body Vibration Exercise

Background. Whole-body vibration (WBV) is a safe and effective exercise system that affects muscle oxygen through several physiological processes, although its effects on different protocols are still unclear. Unfortunately, the COVID-19 pandemic has generated various health problems and controversy or confusion on its possible adverse consequences and impact on performance when wearing a mask during the practice of physical exercise. Aim. To analyze the acute effects of WBV exercise in muscle oxygen variables during different intervention phases with or without a surgical mask and compare protocols that differ in the order of vibration frequencies. Methods. Forty-seven healthy students participated in WBV training. They were randomly assigned to use or not use a mask between the three intervention groups: group A (8, 12.6, and 20 Hz), group B (12.6, 20, and 8 Hz), and group C (20, 8, and 12.6 Hz). Besides the 3 WBV moments, the intervention had a baseline moment, two rest time and a recovery moment. During the whole intervention, the heart rate (HR), muscle oxygen saturation (SatO2), oxyhemoglobin (O2Hb), and deoxyhemoglobin (HHb) were registered. Results. There were no significant differences between the mask use and not use groups. Significant differences were found between the variables during the seven intervention moments and between intervention groups (A, B, or C). Conclusion. HR, SatO2, and Hb were not influenced by the use of a surgical mask, but they reacted differently through the different moments and were sensitive to vibration frequencies and respective order.

Effects of Conservative Interventions on Static and Dynamic Balance in Individuals With Chronic Ankle Instability: A Systematic Review and Meta-analysis

OBJECTIVE

To determine which conservative interventions are effective for static and dynamic balance in patients with chronic ankle instability (CAI).

DATA SOURCES

PubMed, Cochrane Library, Web of Sciences, and CINAHL databases were searched up to March 20, 2022.

STUDY SELECTION

Randomized controlled trials investigating the effects of conservative interventions on static and/or dynamic balance in patients with CAI compared with those of different conservative interventions or controls were included.

DATA EXTRACTION

Two independent reviewers extracted the data. Certainty of the evidence was assessed using the GRADE approach.

DATA SYNTHESIS

Forty-eight studies (1906 participants) were included. Whole-body vibration training (WBVT) was significantly more effective than controls for both static (standardized mean difference, 1.13; 95% confidence interval [CI], 0.58-1.68; moderate-certainty evidence) and dynamic balance (0.56; CI, 0.24-0.88; low-certainty evidence). Balance training (BT) and joint mobilization were significantly more effective than controls for dynamic balance (0.77; CI, 0.41-1.14; and 0.75; CI, 0.35-1.14, respectively), but not for static balance (very low to low-certainty evidence). Adding other interventions to BT had no significant effect on either type of balance compared with that of BT alone (moderate to low-certainty evidence). Strength training (ST) and taping had no significant effect on either type of balance (very low- to low-certainty evidence). Multimodal interventions were significantly effective in improving dynamic balance (0.76; CI, 0.32-1.20; low-certainty evidence). Adding transcranial direct current stimulation to ST was significantly more effective for dynamic balance than ST (0.81; CI, 0.08-1.53; moderate-certainty evidence). The effects on balance were not significantly different among BT, ST, and WBVT (very low- to low-certainty evidence).

CONCLUSIONS

The significantly effective interventions reviewed may be treatment options for balance impairments associated with CAI. However, interventions should be chosen carefully, as much of the certainty of evidence is very low to low.

Whole Body Vibration: A Valid Alternative Strategy to Exercise?

Several studies agree that mechanical vibration can induce physiological changes at different levels, improving neuromuscular function through postural control strategies, muscle tuning mechanisms and tonic vibration reflexes. Whole-body vibration has also been reported to increase bone mineral density and muscle mass and strength, as well as to relieve pain and modulate proprioceptive function in patients with osteoarthritis or lower back pain. Furthermore, vibratory training was found to be an effective strategy for improving the physical performance of healthy athletes in terms of muscle strength, agility, flexibility, and vertical jump height. Notably, several benefits have also been observed at the brain level, proving to be an important factor in protecting and/or preventing the development of age-related cognitive disorders. Although research in this field is still debated, certain molecular mechanisms responsible for the response to whole-body vibration also appear to be involved in physiological adaptations to exercise, suggesting the possibility of using it as an alternative or reinforcing strategy to canonical training. Understanding these mechanisms is crucial for the development of whole body vibration protocols appropriately designed based on individual needs to optimize these effects. Therefore, we performed a narrative review of the literature, consulting the bibliographic databases MEDLINE and Google Scholar, to i) summarize the most recent scientific evidence on the effects of whole-body vibration and the molecular mechanisms proposed so far to provide a useful state of the art and ii) assess the potential of whole-body vibration as a form of passive training in place of or in association with exercise.

Beneficial effects of whole-body vibration exercise for brain disorders in experimental studies with animal models: a systematic review

Brain disorders have been a health challenge and is increasing over the years. Early diagnosis and interventions are considered essential strategies to treat patients at risk of brain disease. Physical exercise has shown to be beneficial for patients with brain diseases. A type of exercise intervention known as whole-body vibration (WBV) exercise gained increasing interest. During WBV, mechanical vibrations, produced by a vibrating platform are transmitted, to the body. The purpose of the current review was to summarize the effects of WBV exercise on brain function and behavior in experimental studies with animal models. Searches were performed in EMBASE, PubMed, Scopus and Web of Science including publications from 1960 to July 2021, using the keywords "whole body vibration" AND (animal or mice or mouse or rat or rodent). From 1284 hits, 20 papers were selected. Rats were the main animal model used (75%) followed by mice (20%) and porcine model (5%), 16 studies used males species and 4 females. The risk of bias, accessed with the SYRCLE Risk of Bias tool, indicated that none of the studies fulfilled all methodological criteria, resulting in possible bias. Despite heterogeneity, the results suggest beneficial effects of WBV exercise on brain functioning, mainly related to motor performance, coordination, behavioral control, neuronal plasticity and synapse function. In conclusion, the findings observed in animal studies justifies continued clinical research regarding the effectiveness and potential of WBV for the treatment of various types of brain disorders such as trauma, developmental disorders, neurogenetic diseases and other neurological diseases.

The effect of whole body vibration on sensorimotor deficits in people with chronic ankle instability: A systematic review and meta-analysis

OBJECTIVE

To investigate the effects of whole body vibration on chronic ankle instability-associated sensorimotor deficits in balance, strength, joint position sense and muscle activity.

DATA SOURCES

Electronic databases including Cochrane Library, PubMed, Embase, Web of Science, EBSCO, China National Knowledge Infrastructure and WanFang were searched from database inception up to 31 March 2022.

METHODS

The risk of bias and methodological quality of included studies were assessed using the Cochrane tool and Physiotherapy Evidence Database (PEDro) scale respectively. Standardized mean difference (SMD) and mean differences (MD) with 95% confidence interval (CI) were calculated using the RevMan 5.3 software. Meta-regression was conducted with Stata 16.

RESULTS

Eight studies, with 315 subjects were eventually included in this review with an average PEDro score of 6.1/10. Significant effects of whole body vibration on balance (SMD = 0.61, 95% CI: 0.12 to 1.09, P = 0.01), and on the posterolateral direction (MD = 5.52, 95% CI: 1.02 to 10.01, P = 0.02) and medial direction (MD = 3.90, 95% CI: 0.87 to 6.94, P = 0.01) of the star excursion balance test were found. Whole body vibration significantly improved the peak torque (SMD = 0.36, 95% CI: 0.04 to 0.69, P = 0.03), joint position sense (SMD = 0.60, 95% CI: 0.10 to 1.11, P = 0.02), and muscle activity in tibialis anterior (SMD = 0.46, 95% CI: 0.04 to 0.88, P = 0.03) and gastrocnemius (SMD = 0.68, 95% CI: 0.14 to 1.23, P = 0.01).

CONCLUSIONS

The current evidence supports the use of whole body vibration to improve sensorimotor deficits involving balance, strength, joint position sense, and muscle activity in people with chronic ankle instability.

Whole body vibration remodels skeletal muscle via autophagy and energy metabolism in diabetic mice

Hyperglycemia occurs due to a defect in insulin secretion or impaired biological functions, or both. The long-term hyperglycemia during diabetes causes chronic damage and dysfunction of various tissues. Whole body vibration (WBV) has significant effects on lipid and glucose metabolism and endocrine and motor systems. In order to explore the effects of WBV on skeletal muscle, mice trained for 12 weeks with WBV (15 Hz, 30 min) were used as experimental subjects and their skeletal muscle morphology under the pathological state of diabetes was observed. In addition, the blood lipids, blood glucose, gastrocnemius muscle glycogen and mRNA and protein levels of autophagy and glucose metabolism biomarkers were compared among the three groups of mice via western blot and RT-qPCR. The results showed that WBV can significantly reshape skeletal muscle morphology and upregulate high density lipoprotein. The expression of glucose-6-phosphatase (G6P), Beclin1 and Atg7 in the gastrocnemius muscle of the WBV group was significantly increased. Therefore, it can be concluded that WBV promotes skeletal muscle remodeling in diabetic mice. The present study confirmed that WBV can attenuate the development of diabetes melitus (DM) and lead to lower level low density lipoprotein in the blood. In addition, G6P level plays an important role in WBV-treated DM model and may be used to monitor the effect of WBV in patients. The findings of the present study may provide a new molecular basis for WBV to play a therapeutic role in the treatment of diabetes and may have potential clinical applications in the future.

The effect of combining vibratory platform and unstable footwear on static balance in active young people

Vibratory platforms (VPs) and unstable footwear (UF) have both shown benefits on balance in some populations. However, there is no evidence about the combined effects of using UF while training on an VP in healthy and physically active young people. We aimed to evaluate the effects of wearing unstable footwear (UF) while training on a whole-body VP on balance in healthy, physically active young people. 23 participants were randomized into groups assigned UF (n = 11) or stable footwear (SF; n = 12). Both groups followed the same training program on an VP with the assigned footwear type twice a week for 12 weeks. The training consisted of performing 8 isometric exercises for progressively longer periods and higher oscillation amplitudes (15-60 s, 1-3 mm), at a fixed vibration frequency (20 Hz). The main outcomes were the antero-posterior and medio-lateral velocities of the center of pressure (COP) recorded using a plantar pressure corridor at baseline, post-treatment and 1-month follow-up. We found a statistically significant difference in the antero-posterior velocity during the monopodal test in the UF group between the different time-points (χ²(2) = 13.282, p = 0.001). Mediolateral COP velocity ranking during the bipodal test was lower for UF than for SF group (U = 19.50, z = - 2.86, p = 0.003) at follow-up. The traditional vibratory platform training does not seem to be effective to improve static balance in physically active young people, however, adding UF provided slightly greater effect.

Effectiveness of balance training in patients with chronic ankle instability: protocol for a systematic review and meta-analysis

INTRODUCTION

Lateral ankle sprains are one of the most common musculoskeletal injuries. Up to 70% of individuals who sustain lateral ankle sprains develop chronic ankle instability (CAI). Balance training has been used in patients with CAI, but the evidence for its efficacy is inconsistent. This systematic review and meta-analysis aims to determine the short-term (end of the treatment period) and long-term (6 months after treatment) effectiveness of balance training for patients with CAI.

METHODS AND ANALYSIS

We will search PubMed, EMBASE, the Cochrane Library, Ovid, EBSCO-host, Pedro, ClinicalKey, ScienceDirect, Springer, China National Knowledge Infrastructure, Technology Periodical Database (VIP), WanFang Data and China Biology Medicine for reports of randomised trials of balance training in patients with CAI, from inception to 1 October 2021. The language will be restricted to English and Chinese, and articles will be screened and collected by two reviewers independently. Dynamic balance and functional ankle instability are the primary outcomes of this study. Secondary outcomes include pain, ankle range of motion, ankle strength and health-related quality of life. Review Manager V.5.3 software will be used for meta-analysis, and stratification analysis will be conducted for study quality according to the Jadad score. Subgroup and sensitivity analyses will be conducted. Grading of Recommendations, Assessment, Development and Evaluation will be used to assess confidence in the cumulative evidence. The protocol follows the Cochrane Handbook for Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines.

ETHICS AND DISSEMINATION

Ethical approval is not required for literature-based studies. The results will be disseminated through peer-reviewed publications.

Effect of Functional Rehabilitation on Performance of the Star Excursion Balance Test Among Recreational Athletes With Chronic Ankle Instability: A Systematic Review

OBJECTIVE

To determine (1) the effectiveness of rehabilitation for chronic ankle instability as measured by the Star Excursion Balance Test (SEBT) and (2) the relative efficacy and the long-term effects of these rehabilitation interventions.

DATA SOURCES

Ten electronic databases were searched (2009-2019).

STUDY SELECTION

Included articles were randomized controlled trials in English investigating recreational athletes aged ≥18 years with chronic ankle instability. At least 1 functional rehabilitation intervention had to be included and the SEBT test (or the modified version) used as an outcome measure.

DATA EXTRACTION

Two researchers (L.A., O.N.) extracted data regarding participant demographics; intervention characteristics; trial size; and results at baseline, postintervention, and at follow-up, where appropriate.

DATA SYNTHESIS

A systematic review and narrative synthesis was conducted. Methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool and the van Tulder scale. The review was registered with PROSPERO (ID: 164468). Ten studies (n=368), 2 high-quality, 1 moderate-quality, and 7 low-quality, were included in the review. Interventions included balance training, strength training, vibration training, and mixed training. Results suggest that rehabilitation of chronic ankle instability that includes wobble board exercises (average percentage change: 14.3%) and hip strengthening exercises (average percentage change: 12.8%) are most effective. Few studies compared different types of rehabilitation for chronic ankle instability. However, improvements on the SEBT suggest that a rehabilitation program focusing on wobble board training and hip strengthening performed 3 times weekly for 4-6 weeks is the optimal rehabilitation program to improve dynamic postural control in recreational athletes with chronic ankle instability.

CONCLUSIONS

Few studies directly compared different rehabilitation interventions, and there was limited long-term follow-up; therefore, the relative efficacy of different rehabilitation programs remains unclear. However, it seems that rehabilitation of chronic ankle instability should include proprioceptive and strengthening exercises of relatively short duration.

sEMG Activity in Superimposed Vibration on Suspended Supine Bridge and Hamstring Curl

Traditionally in strength and conditioning environments, vibration has been transmitted using platforms, barbells, dumbbells, or cables but not suspension devices. This study aimed to examine the effects on the lower limb of applying superimposed vibration on a suspension device. Twenty-one physically active men and women performed supine bridge and hamstring curl exercises in three suspended conditions (non-vibration, vibration at 25 Hz, and vibration at 40 Hz). In each exercise condition, the perceived exertion scale for resistance exercise (OMNI-Res) was registered, and the electromyographic signal was assessed for gastrocnemius (medialis and lateralis), biceps femoris, semitendinosus, gluteus maximus, and rectus femoris. A linear mixed model indicated a significant fixed effect for vibration at 25 Hz and 40 Hz on muscle activity in suspended supine bridge (p < 0.05), but no effect for suspended hamstring curl (p > 0.05). Likewise, the Friedman test showed a significant main effect for vibration at 25 Hz and 40 Hz in suspended supine bridge (p < 0.05) but not for suspended hamstring curl (p > 0.05) on OMNI-Res. Post hoc analysis for suspended supine bridge with vibration at 25 Hz showed a significant activation increase in gastrocnemius lateralis (p = 0.008), gastrocnemius medialis (p = 0.000), semitendinosus (p = 0.003) activity, and for semitendinosus under 40 Hz condition (p = 0.001) compared to the non-vibration condition. Furthermore, OMNI-Res was significantly higher for the suspended supine bridge at 25 Hz (p = 0.003) and 40 Hz (p = 0.000) than for the non-vibration condition. Superimposed vibration at 25 Hz elicits a higher neuromuscular response during the suspended supine bridge, and the increase in vibration frequency also raises the OMNI-Res value.

The Effects of Acute and Long-Term Whole-Body Vibration Training on the Postural Control During Cognitive Task in Patients With Chronic Ankle Instability

CONTEXT

Chronic ankle instability (CAI) is a common problem associated with impaired postural stability. Whole-body vibration (WBV) has been developed to improve muscle function and reportedly improves postural stability. The aim of this study was to evaluate the effect of 12 sessions of WBV on postural control during standing postural task in participants with CAI.

DESIGN

A controlled clinical trial study.

METHODS

Sixteen participants with CAI and 16 healthy participants aged between 20 and 40 years included in this study. They received WBV (30-Hz frequency, 3 series of four 45-s exercises with a 45-s rest) for a total of 12 sessions, 2 session per week for 6 weeks. Postural control was assessed by center of pressure (COP) parameters, including mean and SD in the anterior-posterior and medial-lateral displacement during single-leg standing. Assessments were done before and immediately after the first session and after the 12th session of WBV, with opened and closed eyes associated with easy and difficult cognitive tasks.

RESULTS

The results showed that the SD of COP displacement in the x-axis was significant in eyes opened and SD of COP displacement in the x- and y-axes were significant between groups in the eyes-opened, and eyes-closed conditions (P < .05). Analysis of variance indicated that the effect of WBV training was significant for the mean of COP displacement in the y-axis. Post hoc indicated that the effect of 12 sessions of WBV on the mean of COP displacement was significant in the CAI group (P < .05). However, the acute effect of WBV was not significant on the COP displacement in all axes (P > .05).

CONCLUSION

Higher postural sway associated with postural cognitive interactions might be considered in the rehabilitation of CAI. Twelve sessions of WBV might induce some improvement in postural control with the method of WBV used in this study.

The Effects of Whole Body Vibration on the Limits of Stability in Adults With Subacute Ankle Injury

BACKGROUND

Limited research exists on the effects of both high and low frequency whole body vibration (WBV) on individuals with subacute lateral ankle sprains.

HYPOTHESIS/PURPOSE

To examine the difference in the effects of high and low frequency WBV on limits of stability (LOS) in adults with a subacute ankle sprain. It was hypothesized that WBV would improve effects on outcome variables for LOS as a component of dynamic balance.

STUDY DESIGN

Quasi-experimental, pretest-posttest design.

METHODS

Fifteen participants ages 19-27 years (Mean age 22±2.36) with either a Grade I or Grade II lateral ankle sprain received WBV in bilateral stance under three randomized conditions (high frequency-25 Hz, low frequency-6 Hz, and control, which consisted of bilateral stance with machine off) for six minutes over three sessions (one time per week). The LOS test, consisting of 5 variables, were assessed using the NeuroCom® Balance Manager-SMART EquiTest® (Natus Medical Incorporated, Pleasanton, CA) at baseline and after the intervention period. The participants completed a practice LOS test and then had a six-minute standing rest break. After the rest break, they completed the pre-LOS (baseline) test. Intervention was administered using the Galileo® Med L Chip Research (Novotec Medical GmbH, Pforzheim, Germany) for six minutes for the appropriate condition of either high or low frequency WBV or control. Data analysis was performed using 2-Way (2x3) Repeated Measures ANOVAs with additional post hoc testing as needed.

RESULTS

Significant interactions were found for reaction time (RT), movement velocity (MVL), and maximal excursion (MXE) composite scores with a decrease in RT of 0.117 seconds (p=0.022) between control and high frequency conditions during the post LOS. For composite MVL, an increase of 0.547 degrees/second (p=0.002) between pre- and post-high frequency WBV occurred. For composite MXE, an increase of 2.13% p=0.031 (when comparing pre- and post-high frequency WBV.

CONCLUSION

Findings suggest that a single session of high frequency WBV in individuals with a subacute lateral ankle sprain may result in improvement in several components of postural stability. WBV is a quick intervention that could be implemented in physical therapy clinics, athletic training rooms, and workout facilities to improve an individual's LOS as a component of dynamic balance one to eight weeks post lateral ankle sprain.

LEVEL OF EVIDENCE

2b.

Effects of Whole-Body Vibration and Balance Training on Female Athletes with Chronic Ankle Instability

We explored the effects of 6-week whole-body vibration (WBV) and balance training programs on female athletes with chronic ankle instability (CAI). This randomized controlled study involved female athletes with dominant-leg CAI. The participants were randomly divided into three groups: WBV training (Group A), balance training (Group B), and nontraining (control group; Group C). Groups A and B performed three exercise movements (double-leg stance, one-legged stance, and tandem stance) in 6-week training programs by using a vibration platform and balance ball, respectively. The Star Excursion Balance Test (SEBT), a joint position sense test, and an isokinetic strength test were conducted. In total, 63 female athletes with dominant-leg CAI were divided into three study groups (all n = 21). All of them completed the study. We observed time-by-group interactions in the SEBT (p = 0.001) and isokinetic strength test at 30°/s of concentric contraction (CON) of ankle inversion (p = 0.04). Compared with the control group, participants of the two exercise training programs improved in dynamic balance, active repositioning, and 30°/s of CON and eccentric contraction of the ankle invertor in the SEBT, joint position sense test, and isokinetic strength test, respectively. Furthermore, the effect sizes for the assessed outcomes in Groups A and B ranged from very small to small. Female athletes who participated in 6-week training programs incorporating a vibration platform or balance ball exhibited very small or small effect sizes for CAI in the SEBT, joint position sense test, and isokinetic strength test. No differences were observed in the variables between the two exercise training programs.

The effect of the combination of whole body vibration and shoe with an unstable surface in chronic ankle instability treatment: a randomized clinical trial

Background

Chronic ankle instability (CAI) is a common condition following an ankle sprain. This study investigated the effects of whole body vibration (WBV) and shoe with an unstable surface training on balance, functional performance, strength, joint position sense in people with CAI.

Method

Thirty- four peoples with unilateral CAI were randomly assigned to three groups: WBV group, WBV with shoe with an unstable surface (WBV-S), and no treatment control group (CON). The WBV group received 4 weeks progressive WBV training and the WBV-S group received progressive WBV training with shoe with an unstable surface. Modified star excursion balance test (mSEBT)reach distance, Hop-Test, muscle strength, and joint position sense were measured at baseline and after the 4 weeks; Moreover, the mSEBT and Hop-Test were reassessed again 2 weeks post intervention.

Results

The result showed a significant group-by-time interaction for anterior and posterolateral directions of mSEBT. The reach distance of these directions at post-intervention and follow-up increased significantly compare to pre-intervention in the WBV and WBV-S groups but not significantly change in the CON group. The Hop test in the WBV-S group was significantly more at post-intervention and follow-up compared to pre-intervention. However, no significant changes were observed in WBV and CON groups. No significant changes were observed for mSEBT posteromedial direction, muscles strength, and joint position sense errors.

Conclusion

The 4 weeks WBV and WBV-S interventions could improve balance in peoples with CAI. Improvement in Hop test was only observed in the WBV-S group suggesting the added value of combining WBV and shoe with an unstable surface as an effective therapy compared to WBV training alone. The use of WBV and WBV-S were not associated with significant changes in strength and joint position sense variables over a four-week period.

Trial registration

This work registered in the Iranian Registry of Clinical Trials (IRCT20151118025105N4).

Effect of Novel Remodeled Bicycle Pedal Training on Balance Performance in Athletes With Functional Ankle Instability

Context

Appropriate training without risk of injury is a critical concern for athletes. Remodeled bicycle pedal training with multi-directional challenges may be effective in improving the balance performance of athletes with functional ankle instability (FAI).

Objective

To evaluate the effects of 6-week modified bicycle pedal training on the balance ability and proprioception of athletes with FAI.

Design

Randomized controlled trial.

Setting

University motion analysis laboratory.

Participants

Fourteen healthy athletes (healthy group) and twenty-six athletes with FAI and an age of 18 to 30 years old. The participants with FAI were randomly distributed to two groups, designated as the training group (AI-T group) and non-training group (AI-NT group), respectively. The athletes in the AI-T group received 6-week remodeled bicycle pedal training, while those in the AI-NT group received no intervention at all.

Intervention

A 6-week training using modified bicycle pedal capable of moving freely during loading cycle vs no intervention.

Main Outcome Measures

The passive ankle joint position sense (JPS) in four angles and the center of pressure (COP) parameters were analyzed during single-leg standing with and without vision, respectively.

Results

A 6-week remodeled pedal training: (1) significantly improved the passive JPS of ankle in all directions (P < 0.05); (2) reduced the excursion of the COP in the medial-lateral (ML) direction (p < 0.05), the velocity of the COP in the ML direction (p < 0.05), and the RMS of the COP in the ML direction (P < 0.05) during single-leg standing both with and without vision.

Conclusion

The remodeled bicycle pedal training improved the passive JPS and reduced the postural sway in single-leg standing both with and without vision. Therefore, remodeled bicycle pedal training can be considered for inclusion in rehabilitation programs for athletes with FAI to restore the proprioception and balance ability.

Investigating the Prevalence and Predictors of Injury Occurrence in Competitive Hip Hop Dancers: Prospective Analysis

Hip hop is a popular form of competitive and recreational sport worldwide, but studies rarely investigate injury prevalence and factors associated with injury occurrence in this sport. This study aimed to prospectively examine injury occurrence in hip hop dancers in a three-month period and to evaluate potential predictors of injury occurrence in hip hop dancers. The participants were 129 competitive hip hop dancers (114 females, 17.95 ± 4.15 years of age). Study predictors were obtained at study baseline and included sociodemographic factors, sport-related factors, previous injury status, anthropometric and body build indices (body height, mass, body mass index, and body composition variables), and dynamic balance performance (obtained by the Star Excursion Balance Test—SEBT). The outcome was injury occurrence, which was prospectively observed once a week by the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC). During the course of the study, 101 injuries occurred, equating to an annual injury incidence of 312%. On average, each dancer suffered 0.78 injuries (95% Confidence Interval (95% CI): 0.61–0.97) across a study period of three months (0.76 (95% CI: 0.60–0.95) and 0.93 (95% CI: 0.75–1.13), in females and males, respectively; Mann Whitney Z-value: 0.68, p = 0.52). Seventeen percent of dancers suffered multiple injuries, and 49% of all injuries were time-loss injuries. The knee was the most frequently injured body location (42% of all reported injuries), followed by the back region (32%) and the ankle (15%). Previous injury was a strong predictor of injury occurrence (Odds Ratio: 3.76, 95% CI: 1.87–4.59). Lower injury risk was evidenced among those participants who achieved better scores on several SEBT variables, irrespective of gender and previous injury status; with no significant influence of anthropometric and body build variables on injury occurrence. This study highlighted a high injury rate in hip hop dancers. Dancers and coaches should be informed about the certain protective effects of dynamic balance on the prevention of musculoskeletal injury in hip hop in order to assure safe and effective practices. The usage of SEBT as a convenient and cheap testing procedure is encouraged in other dance disciplines.

Effects of therapeutic exercise on sea sand on pain, fatigue, and balance in patients with chronic ankle instability: a feasibility study

BACKGROUND

Chronic ankle instability (CAI) is a common disease following ankle sprain and appears balance and gait problems, pain, and fatigue. This study aimed to examine the effect of therapeutic exercise performed on sea sand on pain, fatigue, and balance ability in patients with CAI.

METHODS

This study was designed as a randomized controlled trial. Subjects with a Cumberland Ankle Instability Tool (CAIT) score of less than 27 were selected. 22 subjects were randomly assigned to the sea sand (SS) group (N.=11) or the self-management (SM) group (N.=11). The SS group performed the therapeutic exercise on sea sand and the SM group conducted the exercises on a firm surface at home 5 times over the course of a week. To measure static balance, center of pressure (COP) of one-leg standing on the force plate was assessed. Visual Analog Scale (VAS) was used to measure pain and fatigue.

RESULTS

The SS group showed statistically significant improvements in all static balance outcomes (COP-area, COP-average velocity, minor-axis, major-axis) after the intervention (P<0.05), while the SM group did not show a significant change in all static balance parameters (P>0.05). Also, the SS group showed statistically significant improvements in pain and fatigue (P<0.05). All outcomes except major axis showed statistically significant differences between SS group and SM group at change value (P<0.05).

CONCLUSIONS

Therapeutic exercise on sea sand effectively improved balance and decreased pain and fatigue. Thus, it can be considered a rehabilitation method for CAI patients.