title: Response to Tendon Vibration Questions the Underlying Rationale of Proprioceptive Training.
abstract: BACKGROUND
  Proprioceptive training on compliant surfaces is used to rehabilitate and prevent ankle sprains. The ability to improve proprioceptive function via such training has been questioned. Achilles tendon vibration is used in motor-control research as a form of proprioceptive stimulus. Using measures of postural steadiness with nonlinear measures to elucidate control mechanisms, tendon vibration can be applied to investigate the underlying rationale of proprioceptive training.
  
  
  OBJECTIVE
  To test whether the effect of vibration on young adults' postural control depended on the support surface.
  
  
  METHODS
  Descriptive laboratory study.
  
  
  METHODS
  Research laboratory.
  
  
  METHODS
  Thirty healthy adults and 10 adults with chronic ankle instability (CAI; age range = 18-40 years).
  
  
  METHODS
  With eyes open, participants stood in bilateral stance on a rigid plate (floor), memory foam, and a Both Sides Up (BOSU) ball covering a force platform. We applied bilateral Achilles tendon vibration for the middle 20 seconds in a series of 60-second trials and analyzed participants' responses from previbration to vibration (pre-vib) and from vibration to postvibration (vib-post).
  
  
  METHODS
  We calculated anterior-posterior excursion of the center of pressure and complexity index derived from the area under multiscale entropy curves.
  
  
  RESULTS
  The excursion response to vibration differed by surface, as indicated by a significant interaction of P < .001 for the healthy group at both time points and for the CAI group vib-post. Although both groups demonstrated increased excursion from pre-vib and from vib-post, a decrease was observed on the BOSU. The complexity response to vibration differed by surface for the healthy group (pre-vib, P < .001). The pattern for the CAI group was similar but not significant. Complexity changes vib-post were the same on all surfaces for both groups.
  
  
  CONCLUSIONS
  Participants reacted less to ankle vibration when standing on the BOSU as compared with the floor, suggesting that proprioceptive training may not be occurring. Different balance-training paradigms to target proprioception, including tendon vibration, should be explored.
authors.affiliation: Department of Physical Therapy, Steinhardt School of Culture Education and Human Performance, New York University.
authors.forename: Anat Vilnai
authors.initials: AV
authors.lastname: Lubetzky
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle.
authors.forename: Sarah Westcott
authors.initials: SW
authors.lastname: McCoy
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle.
authors.forename: Robert
authors.initials: R
authors.lastname: Price
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle.
authors.forename: Deborah
authors.initials: D
authors.lastname: Kartin
mesh_terms: D000125:Achilles Tendon; D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000628:therapy; D008297:Male; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology; D011312:Pressure; D011434:Proprioception / Q000502:physiology*; D014732:Vibration; D055815:Young Adult
keywords: BOSU; ankle sprain; balance; chronic ankle instability; foam; postural control