Whole-body vibration, or low-level mechanical vibrations often delivered through a small platform, has been shown to increase bone density and muscle strength, not to mention improve circulation and decrease pain.
Greg Maurer, CPT, has used whole-body vibration on a wide variety of patients with positive results, including those with neurological challenges, muscular skeletal injuries and metabolic conditions, such as diabetes and associated problems. He has also used vibration successfully with the elderly, deconditioned population (including significant reduction in fall risk, increased balance and stability; increased strength; and increased ability to perform ADLs), obese patients and athletes.
As in other therapeutic techniques, vibration is not appropriate for all patients. The appropriate frequency and amplitude must be selected depending on the particular patient and exercise/massage being performed, noted Maurer, a business development and training expert for Power Plate Whole Body Vibration, bioDensity Isometric Technology and reACT - Rapid Eccentric Core Training technology.
"So, the PT's job is to select the appropriate exercises done at the correct frequency and amplitude to achieve the treatment goals for the patient's plan of care," he explained.
John R. Martinez, PT, DPT, owner/clinical director of Australian Physio/Therapy Experts in New York City, concurred.
"It is the physical therapy practitioner's role to understand the evidenced-based benefits of this therapy, along with how to apply it safely and to the appropriate patient population," he said.
Understanding Vibration Therapy
Vibration platforms move up and down rapidly (from 20 to 50 times per second), moving one to 15 millimeters each time the plate moves depending on the manufacturer and exact type of vibration unit, maintains Maurer. Some units also produce additional movement side to side and forward and back.
Two key mechanisms of action have been extensively researched: muscle activation and acceleration. Muscle activation occurs due to the muscle spindles sensing a rapid change in length of muscles that are exposed to vibration through the muscular skeletal system when someone stands on a vibration platform.
"Each time the plate moves, the spindles send a signal to the spinal cord via the afferent pathways, and an immediate response is sent via the efferent/motor pathways causing muscles to contract," Maurer explained. "Therefore all strength, balance and stability postures and exercises done on a vibration platform have great muscle activation."
Activating fast twitch muscle fibers is typically challenging with traditional exercise, but not with vibration therapy. For this reason, properly performed exercises on a vibration platform are more productive and efficient than the same exercise done on the floor.
At the same time muscles are being activated, the body is being accelerated each time the plate moves. ("Remember, this is happening 20 to 50 times per second. So, the body is literally in a constant state of being accelerated," noted Maurer.) Increased g-forces are applied to the body depending on the vibration speed and the distance of plate movement.
"The body is in a hyper-gravity environment for short intervals which, along with muscle activation, produces a distinct physiological challenge to many body systems with corresponding adaptation in these systems," Maurer explained.
Benefits of Vibration
Generally, vibration therapy is aimed at achieving systemic bone stimulation to increase density or general strength by fatiguing muscles, said Dr. Martinez. However, it can be used to challenge patients with balance and proprioception issues (e.g., neurologic diseases), conditions of desensitization (e.g., after nerve compromise), bone and soft tissue wound healing (e.g., mechanical bone stimulation and increasing blood flow respectively) and help to bring tonicity back to those who have muscle flaccidity, etc.
Vibration therapy affects many body systems including circulatory, neuromuscular, endocrine, skeleton, and neurotransmitters. The list of benefits verified in scientific literature includes, but is likely not limited to:
· Increased muscular strength, endurance, and power;
· Improved flexibility and range of motion;
· Increased bone density;
· Improved balance and stability;
· Improved core strength and stability;
· Decreased fall risk;
· Reduction of pain through upregulation of proprioceptive input and associated down regulation of nocioreceptors;
· Improved circulation;
· Improved lymphatic flow;
· Increased wound healing and diabetic wound healing;
· Improvement of lymphadema;
· Improved endocrine profile - increased human growth hormone and testosterone, decreased cortisol and increased serotonin;
· Significant Reduction of Visceral Fat; and
· Improvement in Multiple Sclerosis, Parkinson's Disease, ALS, Spinal Cord Injury and arthritis.
'An Amazing Modality'
SallyAnn Davidson, PT, MHS, staff physical therapist at The Spine, Sport and Joint Center at The McConnell Heart Health Center, uses vibration therapy as a modality in her treatment plan for patients. She mentioned that it can be used in conjunction with other strengthening and stretching exercises.
"We have used the vibration platform a lot with patients who have plantar fasciitis. In conjunction with our treatment plan, patients can stand on the platform with both feet on, one on, or do combinations. Typically, three to six repetitions of 30 seconds on and 15 seconds rest are completed," she stated.
Davidson noted that this type of treatment should not be used on patients with joint implants, heart conditions, vertigo and those who are post operative.
Though it is rare that a patient would not benefit from vibration therapy, the known and theoretical contraindications include:
- Recent surgery;
- New implants or joint replacements;
- Acute hernia, discopathy and spondylolysis;
- Recent infections;
- Recently placed IUD's, metal pins or plates;
- Herniated spinal disc;
- Serious cardiovascular illness; and
- Detached or injured retina.
"Whole-body vibration is an amazing modality, but to be effective PT's must go through training and understand the mechanism of action and how to apply this modality for maximum benefit," Maurer concluded.
Detailed course work and certification is available through the National Academy of Sports Medicine: www.nasm.org
Beth Puliti is a frequent contributor to ADVANCE.
Research Pairs Vibration Therapy With SCI
by Beth Puliti
A group of scientists at Toronto Rehab are conducting research that looks at using whole-body vibration therapy as a way to treat low bone density and osteoporosis in people with spinal cord injury.
Who are the researches involved?
Dr Cathy Craven, Dr Milos Popovic, Dr Lora Giangregorio, Dr Kae Masani, Dr Dimitry Sayenko, Dr Masae Miyatani. Milad Alizadeh Meghrazi, Julia Totosy-Zepetnek and Jasper Sidhu of WAVE Manufacturing
How did you come up with the idea for the study?
Patients with spinal cord injury and paralysis of the lower limbs do not have the normal mechanical and physiologic loading of their bones. This contributes to the development of lower limb osteoporosis, muscle atrophy and obesity. We wanted to explore the role of whole body vibration in emulating these mechanical and physiological stimuli among those with spinal cord injury unable to voluntarily use their lower limbs.
What is the goal of the study?
The goal of the study is to stimulate bone formation and muscle contraction in order to maintain bone and muscle mass and reduce fat mass, thereby treating osteoporosis and ideally preventing fracture with long-term treatment. The study involves patients being exposed to intermittent whole-body vibration and passive standing for one hour three times a week for nine months with outcome assessments at baseline, three months, six months and nine months.
What types of patients are involved in this study?
Men with chronic paraplegia between the ages of 18 and 60 years.
What do you hope will happen as a result of this study?
We plan to establish the safety and efficacy of passive standing and whole-body vibration for treatment of osteoporosis (increased bone mass), maintaining or increasing muscle mass and reducing adiposity among male patients with chronic paraplegia. We hope that this technology, should it prove effective, will be widely available in local gyms or purchased for home use by patients with spinal cord injury throughout North America.
Feel free to include anything else about the study.
Whole-body vibration has been safe in appropriately-screened patients with most reporting considerable enjoyment and perceived benefits of the therapy to date.