Effects of Passive Whole-Body Vibration

and Auriculotherapy on the Surface

Electromyographic Pattern of the Vastus
Lateralis Right Muscle in Individuals
with Knee Osteoarthritis

Eloa Moreira Marconi1,2, Adriana Lírio1(&),

Marcia Cristina Moura Fernandes1,2, Alexandre Meireles1,3,
Tania Lemos Santos1, Luis Felipe Souza1,
Maria Eduarda M. Oliveira1,3, Renata Marchon1,3,
Ygor Teixeira Silva1,4, Patricia Lopes Souza1,4,
Arlete Francisca-Santos1,5, Aline Reis-Silva1,3,8,
Eliane Guedes-Aguiar1,5, Laisa Paineiras-Domingos1,4,5,
Danubia da Cunha de Sá-Caputo1,4,5, Aderito Seixas6,
Francisco Borja Sanudo7, and Mario Bernardo-Filho1
1
Laboratório de Vibrações Mecânicas e Práticas Integrativas,
Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara
Gomes e Policlínica Américo Piquet Carneiro,
Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
eloamarconi@gmail.com, adrianaliriolavimpi@gmail.com
2
Pós-Graduação em Fisiopatologia Clínica e Experimental,
Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
3
Mestrado Profissional em Saúde, Medicina Laboratorial e Tecnologia Forense,
Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado
do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
4
Programa de Pós-Graduação em Ciências Médicas,
Faculdade de Ciências Médicas,
Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
5
Faculdade Bezerra de Araújo, Rio de Janeiro, RJ, Brazil
6
Escola Superior de Saúde, Universidade Fernando Pessoa, Porto, Portugal
7
Departamento de Educación Física y Deporte,
Universidad de Sevilla, Seville, Spain
8
Hospital de Força Aérea do Galeão (HFAG), Rio de Janeiro, Brazil

Abstract. Knee osteoarthritis (KOA) is a cause of public disability, mainly in

elderly. The management of KOA symptoms requires a combination of conser-
vative interventions for the joint, including both pharmacological and non-
pharmacological strategies. The analysis of the surface electromyographic pattern
(sEMG) of the Vastus lateralis right(VLR) muscle may increase the under-
standing of some functions that are impaired by KOA and investigate if passive
whole-body vibration (pWBV) or auriculotherapy (AT) increases the neuro-
muscular activity in these individuals. This study aimed to evaluate the effect
(immediate and cumulative effects of a 5-week intervention). The immediate and

© Springer Nature Switzerland AG 2020

T. Ahram et al. (Eds.): IHIET 2019, AISC 1018, pp. 665–671, 2020.
https://doi.org/10.1007/978-3-030-25629-6_104
666 E. M. Marconi et al.

cumulative effects of the interventions on the sEMG behavior of the VLR muscle
were evaluated in all participants. AT, alone or combined with pWBV, signifi-
cantly increased the recruitment of muscle fibers after 5 weeks of intervention in
KOA patients.

Keywords: Knee osteoarthritis
passive Whole Body Vibration

Auriculotherapy
Electromyographic

1 Introduction

Knee osteoarthritis (KOA) is the most prevalent form of arthritis [1]. Cartilage
degradation with joint space narrowing, bone remodeling, formation of new bone at the
joints margins (osteophytes), reduced muscle strength, swelling, stiffness, joint
inflammation and loss of normal joint function may be present in patients with KOA
[2–6]. Neuromuscular function is highly relevant in the development and/or progres-
sion of KOA [7] and as it was reviewed by Mills et al. [8] neuromuscular alterations in
muscle amplitude and muscle activity have been reported Therefore, the analysis of the
surface electromyography (sEMG) plays an important role to understand changes in
neuromuscular function that are impaired in the KOA individuals [9]. Whole body
vibration (WBV) [10] or other alternative therapeutic techniques related to the Tradi-
tional Chinese Medicine, including acupuncture [11] and auriculotherapy (AT)
[12–14], have been used to induce clinical benefits in KOA individuals (i.e., auricu-
lotherapy). Therefore, the aim of this study was to determine the effectiveness (Vastus
lateralis right muscle activation) of these non-pharmacological interventions (WBV
and AT) on different functional tests.

2 Materials and Methods

This study was approved by local Ethics Committee in Research and clinical trial
registration (CAAE - 19826413.8.0000.5259 and RBR-7dfwct, respectively).
As inclusion criteria the subjects should be 40 years old or more, with clinical
diagnosis of KOA according to the criteria established by Ahlback and should sign the
declared informed consent [15]. Exclusion criteria included the presence of other
musculoskeletal disorders, neurological diseases and uncontrolled hypertension. Par-
ticipants who declined to sign the were also excluded.
One hundred thirteen participants with KOA diagnosis were allocated in six groups:
(a) pWBV group, (b) AT group, (c) WBV + AT and respective control groups,
(d) pWBV_CG, (e) AT_CG and pWBV + AT_CG. The individuals performed a pro-
tocol 2 days/week during 5 weeks (Fig. 1). To record sEMG activity of the VLR muscle,
the individuals were instructed to sit on a chair, back straight, feet approximately
shoulder-width apart, and placed on the floor, and the arms crossed over the chest. From
the sitting position, participants’ were instructed to stand up completely and then back
down, the test measures the actual time subjects needed to perform five rises as fast as
possible without using the upper limbs (5CST) [16]. The electromyographic activity of
 Effects of Passive Whole-Body Vibration and Auriculotherapy 667

the VLR during the 5CST was assessed before and after the first session, and before and
after the last session (5 weeks). The RMS values recorded after the first, and before and
after the last intervention session were normalized using the RMS values recorded
before the first intervention session.

Fig. 1. Protocols of the interventions

3 Statistical Analysis

The statistical analyses were performed using BioEstat for Windows (version 5.3). The
Shapiro-Wilk test was used to assess the data distribution of each variable. As it was
significant (p < 0.05), the nonparametric Wilcoxon test was used to compare RMS
values recorded during the intervention period and the Mann-Whitney test was used to
compare the RMS between groups.

3.1 Results
Table 1 shows the results of the VLR activation (RMS) after the first session (imme-
diate effect). There were no significant difference in the RMS of the participants
subjected to all the interventions, when compared to the participants of the control
groups.
Table 2 shows the results of the VLR activation (RMS) after the last session
(immediate effect). It was verified that there were no significant differences in the RMS
of the participants of the intervention groups, when compared to the participants of the
control groups.
668 E. M. Marconi et al.

Table 1. Immediate effect of the vastus lateralis right electromyography in the first session
Control (RMS%) Intervention (RMS%) p value
pWBV 98.95 ± 9.05 102.10 ± 14.35 0.97
AT 92.64 ± 9.25 96.86 ± 11.90 0.74
pWBV + AT 102.00 ± 13.83 95.89 ± 10.06 0.27
pWBV - group submitted to passive whole-body vibration, AT -
auriculotherapy group, pWBV + AT - group submitted to combined
intervention, RMS - root mean square.

Table 2. Immediate effect of the vastus lateralis right electromyography in the last session
Control (RMS%) Intervention (RMS%) P value
pWBV 95.25 ± 27.60 97.08 ± 21.50 0.80
AT 93.66 ± 10.95 103.6 ± 15.86 0.07
pWBV + AT 86.14 ± 20.53 100.40 ± 7.41 0.06
pWBV - group submitted to passive whole-body vibration, AT -
auriculotherapy group, pWBV + AT - group submitted to combined
intervention, RMS - root mean square.

Table 3 shows the results of the VLR activation (RMS) before and after the pro-
tocol (cumulative effect). A significant difference can be observed in the groups sub-
mitted to auriculotherapy (AT) and in the group undergoing the associated treatment
(pWBV + AT). In the group submitted to pWBV, there was no significant difference in
this percentage of RMS in relation to the participants in the control groups.

Table 3. Cumulative effect of the vastus lateralis right electromyography

Control (RMS%) Intervention (RMS%) P value
pWBV 91.51 ± 18.71 100.50 ± 28.47 0.67
AT 84.29 ± 16.07 100.40 ± 19.06 0.05*
pWBV + AT 79.15 ± 17.00 97.93 ± 15.27 0.03*
pWBV - group submitted to passive whole-body vibration, AT -
auriculotherapy group, pWBV + AT - group submitted to combined
intervention, RMS - root mean square.
*
p < 0.05.

Statistical analysis was considered with the Mann Whitney test.

4 Discussion

The effect of non-pharmacological interventions (AT, pWBV and combined AT and

pWBV) on the electromyographic profile (immediate and cumulative effects) of the
vastus lateralis muscle (right lower limb) of KOA individuals was assessed. The
electromyographic profile of the VLR was not altered due to immediate effect on the
 Effects of Passive Whole-Body Vibration and Auriculotherapy 669

first intervention session. However, a significant cumulative effect (p < 0.05) was
verified to the interventions involving AT alone or combined with pWBV.
Previous research reported that AT would induce this effect by activating the
descending pain inhibitory pathways of the brainstem, thereby inhibiting the ascending
pain pathway. The effects of AT on the functional capacity of patients with KOA, the
clinical responses, seem to be associated with mechanisms related to a close rela-
tionship with the autonomic nervous system, the neuroendocrine system, neuroim-
munological factors, neuroinflammation, and neural reflex, as well as antioxidation.
Previous research has used sEMG as an outcome to quantify the effectiveness of AT. It
was reported that the acupressure at a specific point with a somatopic relation to the
biceps brachial muscle can modify the electromyographic activity. Furthermore, the
response of the acupressure of a sham point has different responses. The maximum
voluntary isometric contractions parameters were higher in acupressure treatment than
those of control and sham treatments. Moreover, it was also reported significant
changes in the pattern of temporal muscle activity after stimulation of the Shenmen,
kidney, sympathetic, brain stem and temporomandibular points with mustard seeds.
Although there is no consensus about the mechanisms by which the vibratory
stimulus affects the neuromuscular system, it has been suggested that the cause of the
increase in motor unit recruitment is an excitatory response of the muscle spindles, due
to the stretch reflex mechanism [17–19]. Moreover, It is suggested that neurophysio-
logical factors involved in the response to vibratory stimulus have an important con-
tribution of the oscillation frequency at which body structures are exposed [18, 20].
Considering the cumulative effect (Table 3), a significant improvement on the VLR
activation due to the AT alone or combined with pWBV, before the first (with 5 Hz)
and after the last session (14 Hz). Trans et al. (2009) [21] have reported that muscle
strength and knee-extension range of motion were significantly increased due to the
WBV with frequencies from 25 to 30 Hz in individuals with KOA. Fattorini et al. [22],
vibration with frequencies pWBV alone has not EMG increased the VLR activation.
The improvement of the recruitment of muscular fibers (Table 3) due to the AT alone
or combine with pWBV could be associated with analgesic effects of the AT that would
be induced by activating the descending pain inhibitory pathway of the brainstem,
thereby inhibiting the ascending pain pathway [12, 14]. This would aid patients with
KOA to perform tasks that would otherwise increase pain.

5 Conclusion

AT, alone or combined with pWBV, significantly increased the recruitment of muscle
fibers after 5 weeks of intervention in KOA patients. However, no immediate effects
were observed. Further studies are needed to better understand the effects of WBV and
AT in the sEMG of the VL considering also the Vastus Lateralis Left.
670 E. M. Marconi et al.

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