Reference: Wang XQ, Zheng JJ, Yu ZW, et al. A metaanalysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 2012;7(12):e52082.Clinical Questions: Is core stability exercise more effective than general exercise in the treatment of patients with nonspecific low back pain (LBP)?Data Sources: The authors searched the following databases: China Biological Medicine disc, Cochrane Library, Embase, and PubMed from 1970 through 2011. The key medical subject headings searched were chronic pain, exercise, LBP, lumbosacral region, and sciatica.Study Selection: Randomized controlled trials comparing core stability exercise with general exercise in the treatment of chronic LBP were investigated. Participants were male and female adults with LBP for at least 3 months that was not caused by a specific known condition. A control group receiving general exercise and an experimental group receiving core stability exercise were required for inclusion in the meta-analysis. Core stability was defined as the ability to ensure a stable neutral spine position, but the type of exercise was not specified. Outcome measures of pain intensity, back-specific functional status, quality of life, and work absenteeism were recorded at 3-, 6-, and 12-month intervals.Data Extraction: The study design, participant information, description of interventions in the control and experimental groups, outcome measures, and follow-up period were extracted. The mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate statistical significance. Risk of bias was assessed using the Cochrane Collaboration Recommendations, and all articles were rated as high risk for other bias with no further explanation given.Main Results: Five studies involving 414 patients were included. Four studies assessed pain intensity using the visual analog scale or numeric rating scale. In the core stability exercise group, the reduction in pain was significant at 3 months (MD ¼ À1.29, 95% CI ¼ À2.47, À0.11; P ¼ .003) but not at 6 months (MD ¼À0.50, 95% CI ¼À1.36, 0.35; P ¼ .26). Functional status was improved at 3 months (MD ¼ À7.14, 95% CI ¼ À11.64, À2.65; P ¼ .002) but not at 6 months (MD ¼À0.50, 95% CI ¼ 0.36, 0.35; P ¼ .26) or 12 months (MD ¼ À0.32, 95% CI ¼ À0.87, 0.23; P ¼ .25). All of the included studies assessed backspecific functional status: 4 used the Oswestry Disability Index and 1 used the Roland-Morris Disability Questionnaire. Patients in the core stability exercise groups experienced improved functional status versus the general exercise group at 3 months (MD ¼À7.14, 95% CI ¼À11.64, À2.65; P ¼ .002); no results were recorded at 6 or 12 months.Conclusions: In the short term, core stability exercise was more effective than general exercise for decreasing pain and increasing back-specific functional status in patients with LBP.

Context:The use and popularity of whole-body vibration (WBV) has increased in recent years, but there is a lack of consensus in the literature about the effectiveness of the treatment.Objective: To quantitatively examine the effects of WBV on muscle oxygenation and peripheral blood flow in healthy adults.Data Sources: We searched Web of Science and PubMed databases and reference lists from relevant articles using the key terms whole body vibration, whole-body vibration, WBV, blood flow, peripheral blood flow, oxygenation, muscle oxygenation, circulation, circulatory, near infrared spectroscopy, NIRS, and power Doppler. Key terms were searched using single word and combination searches. No date range was specified.Study Selection: Criteria for inclusion were (1) use of a commercially available WBV device, (2) a human research model, (3) a pre-WBV condition and at least 1 WBV experimental condition, and (4) reporting of unstandardized means and standard deviations of muscle oxygenation or peripheral blood flow.Data Extraction: Means, standard deviations, and sample sizes were extracted from the text, tables, and figures of included studies. A total of 35 and 90 data points were extracted for the muscle-oxygenation and blood-flow meta-analyses, respectively. Data for each meta-analysis were combined and analyzed using meta-analysis software. Weighted, randomeffects meta-analyses using the Hedges g metric were completed for muscle oxygenation and blood flow. We then conducted follow-up analyses using the moderator variables of vibration type, vibration time, vibration frequency, measurement location, and sample type.Data Synthesis: We found 18 potential articles. Further examination yielded 10 studies meeting the inclusion criteria. Whole-body vibration was shown to positively influence peripheral blood flow. Additionally, the moderators of vibration type and frequency altered the influence of WBV on blood flow. Overall, WBV did not alter muscle oxygenation; however, when the measurement site was considered, muscle oxygenation increased or decreased depending on the location.Conclusions: Acute bouts of WBV increase peripheral blood flow but do not alter skeletal muscle oxygenation. Vibration type appears to be the most important factor influencing both muscle oxygenation and peripheral blood flow. Key Words: interventions, modalities, circulatory system Key PointsAn acute bout of therapeutic whole-body vibration (WBV) increases peripheral blood flow but does not alter muscleoxygenation levels. Vibration type and frequency affect peripheral blood flow and muscle oxygenation during an acute bout of WBV. Additional work examining the effects of WBV on circulatory measures in injured populations is needed. Although WBV is promising when used in healthy people, clinicians should be cautious in applying WBV as a therapeutic modality to improve vascular measures after injury or illness.O ver the past decade, the incorporation of wholebody vibration (WBV) into fitness and injury treatment programs has expanded rapidly.1,2 R...

Stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high load-bearing activities such as running, military and aerobic exercise and therefore require practitioner expertise in diagnosis and management. Accurate diagnosis for stress fractures is dependent on the anatomical area. Anatomical regions such as the pelvis, sacrum, and metatarsals offer challenges due to difficulty differentiating pathologies with common symptoms. Special tests and treatment regimes, however, are similar among most stress fractures with resolution between 4 weeks to a year. The most difficult aspect of stress fracture treatment entails mitigating internal and external risk factors. Practitioners should address ongoing risk factors to minimize recurrence.

Whole-body vibration (WBV) is currently used to enhance performance and treat injuries even though we lack an understanding of how WBV influences physiological processes. An improved understanding of the physiological effects of WBV could lead to protocols to speed healing or treat pathologies. This study examined the acute effects of WBV on peripheral blood perfusion, muscle oxygenation, motoneuron pool excitability, and sensory nerve conduction velocity. Fourteen healthy participants [9 women (21.7 ± 2.4 years); 5 men (20.8 ± 1.1 years)] completed a 5 min bout of WBV (50 Hz, 2 mm amplitude). Measures were assessed pre-treatment and at 0, 5, 10, 15, and 20 min post-treatment. WBV significantly increased superficial skin temperature (P < 0.0005) and total hemoglobin (P = 0.009), had no effect of oxyhemoglobin (P = 0.186), increased deoxyhemoglobin (P < 0.0005), inhibited the soleus Hoffmann reflex (P = 0.007), and had no effect on sural sensory nerve conduction velocity (P = 0.695). These results suggest that an acute bout of WBV influences physiological processes in both the circulatory and the nervous systems.

Proprioceptive training programs were effective in reducing the incidence rates of ankle sprains in the athletic population, including those with and those without a history of ankle sprains.