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Megan N. Houston, Victoria E. Hodson, Kelda K.E. Adams and Johanna M. Hoch

Clinical Scenario:

Hamstring tightness is common among physically active individuals. In addition to limiting range of motion and increasing the risk of muscle strain, hamstring tightness contributes to a variety of orthopedic conditions. Therefore, clinicians continue to identify effective methods to increase flexibility. Although hamstring tightness is typically treated with common stretching techniques such as static stretching and proprioceptive neuromuscular facilitation, it has been suggested that whole-body-vibration (WBV) training may improve hamstring flexibility.

Clinical Question:

Can WBV training, used in isolation or in combination with common stretching protocols or exercise, improve hamstring flexibility in physically active young adults?

Summary of Key Findings:

Of the included studies, 4 demonstrated statistically significant improvements in hamstring flexibility in the intervention group, and 1 study found minor improvements over time in the intervention group after treatment.

Clinical Bottom Line:

There is moderate evidence to support the use of WBV training to improve hamstring flexibility in physically active young adults.

Strength of Recommendation:

There is grade B evidence that WBV training improves hamstring flexibility in physically active adults. The Centre of Evidence Based Medicine recommends a grade of B for level 2 evidence with consistent findings.

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D. Clark Dickin and Jacqueline E. Heath

Whole body vibration (WBV) has been shown to improve force and power output as well as flexibility and speed, with improvements suggested to result from reduced electromechanical delays, improved rate of force development, and sensitivity of muscle spindles. Fixed frequency studies on postural control have been somewhat equivocal; however, individualized frequency protocols have shown promising results in other motor tasks. To assess this, 18 healthy young adults experienced three 4-minute WBV sessions with postural control assessed before vibration, after multiple exposures, and during recovery, with altered levels of sensory information available to the participants. Sway velocity, sway path length, and sway area were assessed in each environment. Study findings revealed that stability was impacted following WBV, with more challenging environments eliciting improvements persisting for 20 minutes. When the environment was less challenging, postural stability was impaired; however, the effects dissipated quickly (10-20 min). It was determined that exposure to individualized frequency WBV served to impair postural control when the challenge was low, but resulted in heightened stability when the overall challenge was high and vestibular information was needed for stability.

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Noureddin Nakhostin Ansari, Soofia Naghdi, Hadi Karimi-Zarchi, Zahra Fakhari and Scott Hasson

Context:

Whole-body vibration (WBV) is a type of weight-bearing exercise used in the field of sport and rehabilitation. There is no study on the effects of WBV on muscle recovery after a fatiguing activity.

Objective:

To determine the effects of a single WBV session on lower-extremity fatigue.

Design:

Randomized controlled pilot study.

Setting:

University Physiotherapy Clinic.

Subjects:

A total of 13 healthy young men volunteered to participate in this study. Subjects were randomly assigned into the WBV group (n = 7, mean age: 21 y) or control group (CG; n = 6, mean age: 20 y).

Intervention:

Subjects in the WBV group participated in a single-session WBV (30 Hz, amplitude 4 mm, 2 min) after lower-extremity fatigue.

Main Outcome Measures:

Peak force of quadriceps muscle, single leg hop test, and Y-test were measured before inducing muscle fatigue (T0), immediately after completing the fatigue protocol (T1), after WBV (T2), and 15 min following the application of WBV (T3). The same method was applied in the CG while the WBV machine was turned off.

Results:

Repeated-measure ANOVA revealed no significant differences between groups in any of the outcomes.

Conclusions:

The findings indicated that WBV was not effective in the recovery of lower-extremity fatigue in healthy young men.

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Derek T. Smith, Stacey Judge, Ashley Malone, Rebecca C. Moynes, Jason Conviser and James S. Skinner

Reduced strength, balance, and functional independence diminish quality of life and increase health care costs. Sixty adults (82.2 ± 4.9 years) were randomized to a control or three 12-week intervention groups: bioDensity (bD); Power Plate (PP) whole-body vibration (WBV); or bD+PP. bD involved one weekly 5-s maximal contraction of four muscle groups. PP involved two 5-min WBV sessions. Primary outcomes were strength, balance, and Functional Independence Measure (FIM). No groups differed initially. Strength significantly increased 22–51% for three muscle groups in bD and bD+PP (P < .001), with no changes in control and PP. Balance significantly improved in PP and bD+PP but not in control or bD. bD, PP, and bD+PP differentially improved FIM self-care and mobility. Strength improvements from weekly 5-min sessions of bD may impart health/clinical benefits. Balance and leg strength improvements suggest WBV beneficially impacts fall risk and incidence. Improved FIM scores are encouraging and justify larger controlled trials on bD and bD+PP efficacy.

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Seong-won Han, Dae-yeon Lee, Dong-Sung Choi, Boram Han, Jin-Sun Kim and Hae-Dong Lee

This study aimed to examine whether muscle force and tendon stiffness in a muscle-tendon complex alter synchronously following 8-week whole-body vibration (WBV) training in older people. Forty older women aged 65 years and older were randomly assigned into control (CON, n = 15) and whole-body vibration (WBV) training groups (exposure time, n = 13; vibration intensity, n = 12). For the training groups, a 4-week detraining period was completed following the training period. Throughout the training/detraining period, force of the medial gastrocnemius (MG) muscle and stiffness of the Achilles tendon were assessed four times (0, 4, 8, and 12 weeks) using a combined system of dynamometer and ultrasonography. While muscle force gradually increased throughout the training period (p < .05), a significant increase in tendon stiffness was observed after 8 weeks (p < .05). These findings indicated that, during the early phase of WBV training, muscle force and tendon stiffness changed asynchronously, which might be a factor in possible musculotendinous injuries.

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Ronald Davis, Charlotte Sanborn, David Nichols, David M. Bazett-Jones and Eric L. Dugan

Bone mineral density (BMD) loss is a medical concern for individuals with spinal cord injury (SCI). Concerns related to osteoporosis have lead researchers to use various interventions to address BMD loss within this population. Whole body vibration (WBV) has been reported to improve BMD for postmenopausal women and suggested for SCI. The purpose of this case study was to identify the effects of WBV on BMD for an individual with SCI. There were three progressive phases (standing only, partial standing, and combined stand with vibration), each lasting 10 weeks. Using the least significant change calculation, significant positive changes in BMD were reported at the trunk (0.46 g/cm2) and spine (.093 g/cm2) for phase 3 only. Increases in leg lean tissue mass and reduction in total body fat were noted in all three phases.

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Morteza Ahmadi, Giti Torkaman, Sedigheh Kahrizi, Mojdeh Ghabaee and Leila Dadashi Arani

Context:

Despite the widespread use of whole-body vibration (WBV), especially in recent years, its neurophysiological mechanism is still unclear and it is yet to be determined whether acute and short-term WBV exposure produce neurogenic enhancement for agility.

Objective:

To compare the acute and short-term effects of WBV on the H-reflex-recruitment curve and agility.

Design:

Cross-over study.

Setting:

Clinical electrophysiology laboratory.

Participants:

20 nonathlete male volunteers (mean age 24.85 ± 3.03 y).

Main Outcome Measures:

Subjects were randomly divided into 2 groups, H-reflex and agility. In the sham protocol, subjects stood on the turned-off vibration plate while maintaining the semisquat position, and then, after a 2-wk washout, vibration-training sessions were performed in the same position with a frequency of 30 Hz and an amplitude of 3 mm. H-reflex-recruitment curve was recorded and the agility test of a shuttle run was performed before and after the first session and also 48 h after the 11th session in both sham and vibration-training protocols.

Results:

Acute effects of WBV training caused a significant decrease of threshold amplitude and H-max/M-max (P = .01 and P = .04, respectively). Short-term WBV training significantly decreased the threshold intensity of the soleus H-reflex-recruitment curve (P = .01) and caused a decrease and increase respectively, in the threshold intensity and the area under the recruitment curve.

Conclusions:

The results suggest an inhibitory effect of acute WBV training on the H-reflex response.

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Noriaki Maeda, Yukio Urabe, Junpei Sasadai, Akira Miyamoto, Masahito Murakami and Junichi Kato

Context:

Whole-body-vibration (WBV) stimulus equipment has been used as a new training method for health promotion. Its use in the clinic has expanded to the field of sports and rehabilitation for disabled patients. WBV training is rapidly gaining popularity in health and fitness centers as an alternative method for improving muscle performance. Acute positive effects of WBV have been shown on lower-extremity muscle power and vertical-jump ability; however, there have not been any studies focusing on the long-term effects of WBV for trunk muscle and dynamic balance.

Objective:

To investigate the effects of an 8-wk program of WBV in combination with trunk-muscle training on muscle performance in healthy, untrained adults.

Design:

Laboratory-based, repeated-measures study.

Setting:

University laboratory.

Participants:

20 healthy university men.

Intervention:

Participants were randomly assigned to a WBV or non-WBV group. The WBV group performed a trunk-muscle-training program in combination with WBV; the non-WBV group performed the same muscle-training program without WBV for 8 wk.

Main Outcome Measures:

In the pre- and posttraining period, the participants were evaluated using the Functional Movement Screen (FMS), Y Balance Test (Y-test) (anterior, posteromedial, and posterolateral reach), trunk-muscle isometric strength (flexor, extensor, and flexor:extensor ratio), squat jump, and countermovement jump.

Results:

The WBV group had greater improvement than the non-WBV group in both trunk-flexor muscle strength (P = .02) and the Y-test (anterior reach) (P = .004) between pre- and posttraining.

Conclusion:

Adding WBV to a trunk-muscle-strengthening program may improve trunk-flexor isometric strength and anterior reach during the Y-test more than training without WBV. The WBV protocol used in this study had no significant impact on FMS scores, squat jumping, countermovement jumping, trunk-extensor isometric strength, or trunk flexor:extensor ratio.

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Sven Rees, Aron Murphy and Mark Watsford

This study was designed to investigate the effects of vibration on muscle performance and mobility in a healthy, untrained, older population. Forty-three participants (23 men, 20 women, 66–85 y old) performed tests of sit-to-stand (STS), 5- and 10-m fast walk, timed up-and-go test, stair mobility, and strength. Participants were randomly assigned to a vibration group, an exercise-without-vibration group, or a control group. Training consisted of 3 sessions/wk for 2 mo. After training, the vibration and exercise groups showed improved STS (12.4%, 10.2%), 5-m fast walk (3.0%, 3.7%), and knee-extension strength (8.1%, 7.2%) compared with the control (p < 0.05). Even though vibration training improved lower limb strength, it did not appear to have a facilitatory effect on functional-performance tasks compared with the exercise-without-vibration group. Comparable mobility and performance changes between the experimental groups suggest that improvements are linked with greater knee-extension strength and largely attributed to the unloaded squats performed by both exercise groups.

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W. Steven Tucker and Stephen W. Slone

Context:

Clinicians use various stretching techniques to prevent the onset of and treat glenohumeral internal-rotation deficit (GIRD). It is unknown which stretching technique is the most effective.

Objective:

To investigate the acute effects of hold–relax proprioceptive neuromuscular facilitation (PNF) with and without vibration therapy on internal rotation in individuals with GIRD.

Design:

2-within (stretch × time) comparison with repeated measures.

Setting:

Controlled laboratory.

Participants:

11 male current and former overhead athletes (19.8 ± 1.4 y, 184.5 ± 4.5 cm, 91.8 ± 11.6 kg) who presented with GIRD.

Interventions:

At 3 separate sessions, participants performed 1 of 3 randomly assigned stretches: hold–relax PNF (PNF), hold–relax PNF in combination with a whole-body-vibration unit set at 30 Hz (PNF-V), and static stretch (SS). Pretest and posttest maximum passive glenohumeral internal-rotation measurements were taken with a digital protractor.

Main Outcome Measures:

The dependent variables were the mean glenohumeral internal-rotation measurements taken at the pretest and posttest. The influence of stretch (PNF, PNF-V, and SS) and time (pretest and posttest) on mean glenohumeral internal rotation was compared using a 3 × 2 factorial ANOVA with repeated measures on both variables (P ≤ .05).

Results:

There was a stretch-by-time interaction (F 2,20 = 34.697, P < .001). Post hoc testing revealed that the PNF posttest (73.0° ± 10.4°) was greater than the PNF pretest (60.0° ± 11.8°), the PNF-V posttest (74.7° ± 10.0°) was greater than the PNF-V pretest (57.4° ± 10.4°), and the SS posttest (67.0° ± 10.7°) was greater than the SS pretest (60.1° ± 9.4°). When comparing the posttest values, the PNF-V posttest was greater than the SS posttest.

Conclusions:

All 3 stretches (PNF, PNF-V, and SS) resulted in acute increases in glenohumeral internal rotation in individuals presenting with GIRD. The PNF-V stretch resulted in the greatest increase and would be the most clinically beneficial for patients with GIRD.