Khanmohammadi Roya, Zare Sahar, Musavi Ali, Ahmadi Morteza
Physical Therapy Department, Rehabilitation Faculty, Tehran University of Medical Sciences, P. O. Box 16535-188, Tehran, Iran.
Amir A'alam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Sci Rep. 2025 Apr 23;15(1):14063. doi: 10.1038/s41598-025-98134-5.
Previous studies have shown that athletes recovering from anterior cruciate ligament (ACL) reconstruction experience a decline in motor cortex excitability and injury-related cortical reorganization, potentially leading to ongoing complications and a higher risk of subsequent injuries. Therefore, incorporating an intervention that consistently delivers sensory inputs to the central nervous system and enhances excitability at both spinal and supra-spinal levels, in addition to exercise therapy, may offer greater benefits. The purpose of this study was to explore whether combining whole body vibration (WBV) with exercise therapy enhances motor cortical excitability in athletes undergoing ACL reconstruction more effectively than exercise therapy alone. Additionally, it aimed to assess whether this combination improves quadriceps strength and reduces functional limitations in daily activities. This study is a randomized, single-blinded, controlled trial. Twenty-six participants were assigned to either the WBV plus exercise therapy group (intervention group) or the exercise therapy-only group (control group). Outcome measures, assessed before and after treatment, included motor cortex excitability [active motor threshold (AMT) and motor-evoked potential amplitude of the quadriceps], isometric peak torque of the quadriceps, and daily functional disabilities using the knee outcome survey activities of daily living scale (KOS-ADL scale). The treatment period consisted of 12 sessions (4 weeks, with 3 sessions per week). A two-way mixed ANOVA was conducted to examine the main effects of group, time and their interactions. The results showed that in the intervention group (WBV plus exercise therapy), AMT significantly decreased (F(1, 12) = 11.35, P = 0.006, η = 0.486), while the control group (exercise therapy only) showed no significant change (F(1, 12) = 0.252, P = 0.625, η = 0.021). In the intervention group, AMT decreased by 19.47% post-treatment. Both groups showed significant improvements in isometric peak torque and KOS-ADL scores (P < 0.001), with large effect sizes for these parameters. The study concluded that adding WBV to exercise therapy is more effective in increasing motor cortex excitability compared to exercise therapy alone. However, since both groups showed significant improvements in quadriceps peak torque and KOS-ADL scores, it suggests that the addition of WBV did not provide substantial added benefits in enhancing quadriceps strength and improving daily functional abilities. The observed improvements may primarily be attributed to exercise therapy. Nonetheless, it is important to consider the small sample size and low statistical power when interpreting these results.RCT registration: On the Iranian Registry of Clinical Trials (IRCT20220220054078N1).
先前的研究表明，前交叉韧带（ACL）重建术后正在恢复的运动员运动皮层兴奋性会下降，且会出现与损伤相关的皮层重组，这可能会导致持续的并发症以及后续受伤风险增加。因此，除了运动疗法之外，采用一种能持续向中枢神经系统传递感觉输入并增强脊髓和脊髓上水平兴奋性的干预措施，可能会带来更大益处。本研究的目的是探讨全身振动（WBV）与运动疗法相结合，是否比单纯运动疗法更有效地提高ACL重建运动员的运动皮层兴奋性。此外，该研究旨在评估这种联合疗法是否能改善股四头肌力量并减少日常活动中的功能限制。本研究是一项随机、单盲、对照试验。26名参与者被分配到WBV加运动疗法组（干预组）或仅运动疗法组（对照组）。在治疗前后评估的结果指标包括运动皮层兴奋性[主动运动阈值（AMT）和股四头肌的运动诱发电位幅度]、股四头肌的等长峰值扭矩，以及使用膝关节日常生活活动量表（KOS - ADL量表）评估的日常功能障碍。治疗期包括12次疗程（4周，每周3次）。进行了双向混合方差分析以检验组、时间及其交互作用的主要影响。结果显示，在干预组（WBV加运动疗法）中，AMT显著降低（F(1, 12) = 11.35，P = 0.006，η = 0.486），而对照组（仅运动疗法）无显著变化（F(1, 12) = 0.252，P = 0.625，η = 0.021）。在干预组中，治疗后AMT下降了19.47%。两组在等长峰值扭矩和KOS - ADL评分方面均有显著改善（P < 0.001），这些参数的效应量较大。该研究得出结论，与单纯运动疗法相比，在运动疗法中加入WBV能更有效地提高运动皮层兴奋性。然而，由于两组在股四头肌峰值扭矩和KOS - ADL评分方面均有显著改善，这表明加入WBV在增强股四头肌力量和改善日常功能能力方面并未提供实质性的额外益处。观察到的改善可能主要归因于运动疗法。尽管如此，在解释这些结果时，考虑到样本量小和统计效力低是很重要的。随机对照试验注册：在伊朗临床试验注册中心（IRCT20220220054078N1）。
