Vibration Therapy

Original Editor - Sehriban Ozmen

Top Contributors - Sehriban Ozmen, Admin, Rachael Lowe and Kirenga Bamurange Liliane  

Description

Vibration therapy can take two forms: Whole-Body Vibration (WBV) or Focal Vibration (FV). Vibration is either delivered through a vibration platform on which a patient can sit or stand (WBV), or a hand-held or wearable vibrating device applied to muscles and tendons (FV).

Beneficial Effects

The WBV shown to have beneficial effects on the nervous and musculoskeletal systems:

• It causes an increase in neuronal activity, cognitive function, and synaptic plasticity.
• It promotes proprioceptive function, reducing the intensity and perception of pain.
• It increases muscle mass and strength, as well as motor performance while reducing muscle atrophy.
• It increases bone mineral density and promotes fracture healing and joint stability.
• It improves balance and mobility.
• It improves the physical performance of healthy athletes in terms of muscle strength, agility, flexibility, and vertical jump height.

Evidence

Evidence for the efficacy of vibration therapy in different patient populations is as follows.

• Low Back Pain: WBV showed a beneficial effect on pain and functional ability in people with non-specific low back pain.
• Sarcopenia: Both local vibration and whole-body vibration improved muscle strength and physical performance in older adults.
• Stroke: WBV improves walking performance following stroke. WBV and FV appear to play a considerable role in reducing spasticity and improving gait, balance, and motor function in stroke patients.
• Multiple Sclerosis: A meta-analysis concluded that vibration therapy had a significant advantage over the control intervention in improving balance function and walking endurance, however, the degree of disability and duration of intervention may affect outcomes and the effects of the vibration therapy on functional mobility, gait speed, fatigue, and quality of life remains unclear. Another study stated that vibration therapy seems to be unable to reduce spasticity in multiple sclerosis.

• Cerebral Palsy (CP): WBV can produce positive therapeutic effects on spasticity, static and dynamic balance, fine and gross motor function, muscle strength and range of motion in patients with spastic CP. Vibration therapy seems to be unable to reduce spasticity in cerebral palsy.

• Osteoporosis: Meta-analysis of 30 studies revealed bone density improvement after WBV in both healthy and postmenopausal women. The study recommended to use of WBV with high frequency (≈ 30 Hz), low magnitude (≈ 0.3 g), and high cumulative dose (≈ 7000 min) to improve lumbar spine area of bone mineral density (aBMD) in postmenopausal women.
• Osteoarthritis: Vibration therapy improves walking performance in patients with knee osteoarthrosis. When combined with exercise, WBW is superior to exercise alone in improving pain, physical function (Timed Up and Go test and Western Ontario and McMaster Universities Osteoarthritis Index), and knee extensor strength (isokinetic and isometric).
• Fibromyalgia: There is limited evidence to support WBV application in clinical practice in patients with fibromyalgia.
• Myofascial Pain
• Autogenic Muscle Inhibition

Clinical Application

Application Principles

The standardized protocols including vibration parameters (frequency, amplitude, acceleration) and training durations are non-existent. However most studies agree that the main benefits are associated with low-intensity WBV protocols. For example, WBV at frequencies below 20 Hz has been suggested to reduce LBP by relaxing muscle spasm.

It is known that vibration therapy causes;

• additional excitation of the motor neuron pool which increases initial firing rates and ultimately enhances force production when applied briefly (2-25 seconds)
• a decrease in maximal voluntary strength via presynaptic autogenic inhibition when applied for prolonged periods (30+ seconds).

Thus, a study recommended to choose;

• lower frequency and amplitude coupled with longer duration (30+ seconds) to alleviate pain, improve tissue extensibility, and reduce the potential for delayed onset muscle soreness which can be beneficial in post-operative patients, dealing with chronic pain or just finished performing strenuous eccentric exercises
• higher frequency and amplitude with short duration usage (< 30 seconds) to assist with motor unit recruitment and tissue preparedness which can be beneficial before or during exercise activity.

The general recommendation is to provide gentle pressure with continuous motion into the affected tissue. If the response from the tissue is more pronounced (‘bouncy’) or louder, then the therapist will know that they have found an area that requires more attention.

Safety and Contraindications

There are no direct contraindications for the use of vibration therapy. However, the conditions that require caution are listed below :

• Stress fractures/reactions
• Neuropathy
• Fibromyalgia
• Epilepsy
• Pregnancy
• Recent surgery or joint replacement
• Metal pins or plates
• Pacemakers
• Areas with skin rash or open wounds
• Hypertension or risk for clotting.

Even though adverse events emerging from using vibration machines in medicine and exercise are rare, caution is still warranted when applying vibration therapy. This is because of very well-known whole-body and hand-arm vibration injuries (neural, vascular, and musculoskeletal) from industrial tools in the workplace as well as the possibility of an unknown number of unreported adverse events cases.

It is also helpful to note that vibrations can be dangerous for humans when the amplitude is high (>1 millimetre), the duration is long (> ~30 minutes), and the vibrations have an erratic, random waveform.

Resources

Vibration and Pain Management