Vibration Therapy

Original Editor - Sehriban Ozmen

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Description[edit | edit source]

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). [1]

Beneficial Effects[edit | edit source]

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. [2]
  • It promotes proprioceptive function, reducing the intensity and perception of pain. [2]
  • It increases muscle mass and strength, as well as motor performance while reducing muscle atrophy. [1]
  • It increases bone mineral density and promotes fracture healing and joint stability. [2]
  • It improves balance and mobility. [2]
  • It improves the physical performance of healthy athletes in terms of muscle strength, agility, flexibility, and vertical jump height. [2]

Evidence[edit | edit source]

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. [3]
  • Sarcopenia: Both local vibration and whole-body vibration improved muscle strength and physical performance in older adults. [4]
  • Stroke: WBV improves walking performance following stroke. [5] WBV and FV appear to play a considerable role in reducing spasticity and improving gait, balance, and motor function in stroke patients. [6]
  • Multiple Sclerosis: A meta-analysis [7] 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 [6] 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. [8] Vibration therapy seems to be unable to reduce spasticity in cerebral palsy. [6]
  • Osteoporosis: Meta-analysis of 30 studies [9] revealed bone density improvement after WBV in both healthy and postmenopausal women. [10] 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. [5] 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). [11]
  • Fibromyalgia: There is limited evidence to support WBV application in clinical practice in patients with fibromyalgia. [12]
  • Myofascial Pain [13]
  • Autogenic Muscle Inhibition [13]

Clinical Application[edit | edit source]

Application Principles[edit | edit source]

The standardized protocols including vibration parameters (frequency, amplitude, acceleration) and training durations are non-existent. [1] However most studies agree that the main benefits are associated with low-intensity WBV protocols. [2] 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) [14][15]
  • a decrease in maximal voluntary strength via presynaptic autogenic inhibition when applied for prolonged periods (30+ seconds). [16][17][18]

Thus, a study [13] 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. [13]

Safety and Contraindications[edit | edit source]

There are no direct contraindications for the use of vibration therapy. However, the conditions that require caution are listed below [13]:

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. [19]

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. [20]

Resources[edit | edit source]

Vibration and Pain Management

References[edit | edit source]

  1. 1.0 1.1 1.2 Ghazi M, Rippetoe J, Chandrashekhar R, Wang H. Focal vibration therapy: Vibration parameters of effective wearable devices. Applied Sciences. 2021 Mar 26;11(7):2969.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Bonanni R, Cariati I, Romagnoli C, D’Arcangelo G, Annino G, Tancredi V. Whole body vibration: a valid alternative strategy to exercise?. Journal of functional morphology and kinesiology. 2022 Nov 3;7(4):99.
  3. Wang W, Wang S, Lin W, Li X, Andersen LL, Wang Y. Efficacy of whole body vibration therapy on pain and functional ability in people with non-specific low back pain: a systematic review. BMC Complementary Medicine and Therapies. 2020 Dec;20:1-2.
  4. Wu S, Ning HT, Xiao SM, Hu MY, Wu XY, Deng HW, Feng H. Effects of vibration therapy on muscle mass, muscle strength and physical function in older adults with sarcopenia: a systematic review and meta-analysis. European Review of Aging and Physical Activity. 2020 Dec;17:1-2.
  5. 5.0 5.1 Fischer M, Vialleron T, Fourcade P, Yiou E, Delafontaine A. Long-term effects of whole-body vibration on human gait: a systematic review and meta-analysis. Frontiers in neurology. 2019 Jun 19;10:449173.
  6. 6.0 6.1 6.2 Moggio L, de Sire A, Marotta N, Demeco A, Ammendolia A. Vibration therapy role in neurological diseases rehabilitation: an umbrella review of systematic reviews. Disability and Rehabilitation. 2022 Sep 25;44(20):5741-9.
  7. Zhang Y, Xu P, Deng Y, Duan W, Cui J, Ni C, Wu M. Effects of vibration training on motor and non-motor symptoms for patients with multiple sclerosis: A systematic review and meta-analysis. Frontiers in aging neuroscience. 2022 Aug 5;14:960328.
  8. Hussain SA, Hassan Z, Rasanani MR, Afzal R, Khan N, Zaib HM. Effect of Whole Body Vibration Therapy on Spasticity, Balance, Fine and Gross Motor Functions in Patients with Spastic Cerebral Palsy: A Systematic Review of RCTs. Pakistan Journal of Medical & Health Sciences. 2023 Jun 17;17(04):617-.
  9. de Oliveira RD, de Oliveira RG, de Oliveira LC, Santos-Filho SD, Sa-Caputo DC, Bernardo-Filho M. Effectiveness of whole-body vibration on bone mineral density in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Osteoporosis International. 2023 Jan;34(1):29-52.
  10. DadeMatthews OO, Agostinelli PJ, Neal FK, Oladipupo SO, Hirschhorn RM, Wilson AE, Sefton JM. Systematic review and meta-analyses on the effects of whole-body vibration on bone health. Complementary Therapies in Medicine. 2022 May 1;65:102811.
  11. Qiu CG, Chui CS, Chow SK, Cheung WH, Wong RM. Effects of whole-body vibration therapy on knee Osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Journal of rehabilitation medicine. 2022;54.
  12. dos Santos JM, Mendonça VA, Ribeiro VG, Oliveira VC, da Fonseca SF, Leite HR, de Oliveira AC, Figueiredo PH, Bernardo-Filho M, Lima VP, Lacerda AC. Effects of Whole-Body Vibration on Fibromyalgia: Is There Any Evidence to Support Clinical Practice?. Journal of Rehabilitation Therapy. 2019 Sep 11;1(1).
  13. 13.0 13.1 13.2 13.3 13.4 Lupowitz L. Vibration Therapy–A Clinical Commentary. International journal of sports physical therapy. 2022;17(6):984.
  14. Bongiovanni LG, Hagbarth KE. Tonic vibration reflexes elicited during fatigue from maximal voluntary contractions in man. The Journal of physiology. 1990 Apr 1;423(1):1-4.
  15. Grande G, Cafarelli E. Ia afferent input alters the recruitment thresholds and firing rates of single human motor units. Experimental brain research. 2003 Jun;150:449-57.
  16. Barrera-Curiel A, Colquhoun RJ, Hernandez-Sarabia JA, DeFreitas JM. The effects of vibration-induced altered stretch reflex sensitivity on maximal motor unit firing properties. Journal of neurophysiology. 2019 Jun 1;121(6):2215-21.
  17. Girard O, Billaut F, Christian RJ, Bradley PS, Bishop DJ. Exercise-related sensations contribute to decrease power during repeated cycle sprints with limited influence on neural drive. European Journal of Applied Physiology. 2017 Nov;117:2171-9.
  18. Shinohara M. Effects of prolonged vibration on motor unit activity and motor performance. Medicine and science in sports and exercise. 2005 Dec 1;37(12):2120-5.
  19. Riley, D.A., Rittweger, J. (2020). Safety and Contraindications. In: Rittweger, J. (eds) Manual of Vibration Exercise and Vibration Therapy. Springer, Cham.
  20. Oroszi T, van Heuvelen MJ, Nyakas C, van der Zee EA. Vibration detection: its function and recent advances in medical applications. F1000Research. 2020;9.