Does Using Whole-Body Vibration Therapy Following ACL Surgery Improve Recovery?
The inspiration for today’s post was sparked by my personal experimentation after I had ACL surgery 2 weeks ago. I have been going to my local gym, mostly to do some upper body work and use the sauna, but I noticed earlier this week that they had a whole-body vibration (WBV) machine. I’ve used these devices in the past, mostly for fun since they didn’t seem to do much else, but I figured I’d give it a shot. Obviously, I was a little concerned to stand on a vibrating platform 10 days post-surgery – especially since I couldn’t even walk without crutches – but I hung onto the handles for dear life and did 3 sets of 30”. When I stepped off at the end, I was surprised to note that I was able to straighten my leg more and walk with less assistance from the crutches!
This experience got me interested in whether or not there is any research around the use of WBV following knee surgery, and there is! This post will look at that research and see if any of it is applicable to patients following ACL surgery.
What is Whole Body Vibration Training?
WBV training is defined as any training that is performed while standing on or being in contact (think pushups) with a large platform that vibrates at a set frequency. Activities performed on a WBV platform can range from doing squats or pushups to simply standing on the plate for a set amount of time. Athletes like Rafael Nadal have popularized the use of WBV training, and research has found a variety of mechanisms through which WBV training works. Among these are increased release of growth hormones and improved neuromuscular control.
Does WBV Training Improve Outcomes After ACL Surgery?
Initially, I thought I was only going to find research on the effects of WBV on patients following total knee replacements, since the knee is really stable following that surgery and I wasn’t sure that a review board would green light a study looking at WBV following ACL surgery. However, I was wrong.
The best study I found compared one group post-ACL surgery that performed an accelerated rehab protocol with another group that performed the majority of their rehab on a WBV machine. These protocols were intense! The patients performed 80-minute physical therapy sessions an average of 3.5x/week from the 2nd week after surgery through the 10th week; that’s a lot of time to spend in a clinic.
In addition to a basic warm up and cool down performed by both groups, the control group performed standard exercises – 4-way hip strengthening, hamstring strengthening, leg press, calf raises, and balance exercises – starting with 50-60% of their 1RM until 6 weeks post-op and then progressing to 60-80% of their 1RM until 10 weeks post-op.
Instead of performing the strengthening and balance exercise like the control group, the WBV group took a much more interesting route. During weeks 2-4 post-surgery, they simply performed 2-6 sets of standing on the WBV platform for 60 seconds at a time, with the platform vibrating at 10-15 Hz. During weeks 5-7, subjects performed the exact same exercise, but with a progressively higher vibration frequency (Hz) and for 90-120 seconds. During weeks 8-11, they performed squats on the WBV platform for 5-7 sets of 2 minutes each.
The results: the WBV and control group had almost equivalent improvement in knee flexion and extension range of motion, isometric and isokinetic knee flexion and extension strength, and knee laxity at all points throughout the study. In addition, the WBV group did significantly better at performing a dynamic stability test at 8 and 11 weeks compared to the control group.
Now, do I think it’s prudent to only perform WBV training and easy stretching/biking exercises for the first 3 months following ACL surgery? Absolutely not, but this study shows that as little as 5 minutes of balance work on a WBV platform following ACL surgery is not only safe but may be more effective at improving dynamic balance than standard balance exercises. In terms of a risk-reward analysis, WBV appears to have very little risk and moderate-high reward following ACL surgery. I believe WBV should supplement a standard rehab protocol, not replace it.
Let’s quickly look at some other research. One study found that 10 sessions of WBV training performed 3 months after ACL surgery significantly improved postural stability and knee proprioception compared to a control group that performed standard rehab exercises. Another study found that subjects that performed WBV training during months 2 and 3 following ACL surgery, in addition to conventional training, exhibited improved postural stability, isokinetic quadriceps and hamstring strength at 3 and 6 months post-op, and single-hop testing at 6 months post-op compared to a control group.
Summary
WBV training appears to be a safe modality to aid in the rehab program of patients following ACL surgery. The current studies to date have started WBV training as soon as the 2nd week after surgery with no reported injuries, and these studies have found that the WBV group exhibits significant improvements in postural stability, quadriceps and hamstring strength, and functional ability compared to the control groups. WBV training appears to be a low-risk, high-reward modality that can help individuals return to optimal function following ACL surgery.
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