Vibration Exercise Therapy

Overview of rationale, efficacy and safety considerations.

Dr. Sidhu and patient performing flexibility training, with the goal of decreasing spasticity.

With its many benefits for the patient population, it’s no surprise that vibration exercise therapy is one of the fastest growing modalities in the chiropractic and physiotherapy profession. And, with the increasing popularity of new types of technologies comes the choice of different units from various manufacturers. However, not all equipment should be compared on equal grounds. This article will discuss the benefits that vibration exercise therapy can provide for your patient population, as well as for your practice, and provide you with a checklist of what to look for in a vibration platform when you decide to purchase one.

Vibration exercise technology was originally used within the Russian space program and continues to be used for Olympic athletes. The initial area of focus and research and focus, for the technology, was sports enhancement. 1,2,3,4 However, its therapeutic benefits have quickly been discovered, and are now being implemented in hospitals, physiotherapy clinics, and chiropractic clinics across North America. The physiological basis behind the therapy is simple: the vibration platform vibrates up and down over a distance of a few millimetres, up to 50 times per second, thereby naturally stimulating the stretch reflex to, in turn, create an involuntary muscle contraction.5 Within one minute, a patient can undergo up to 3,000 muscle contractions. This involuntary stretch reflex leads to the many benefits – described in the paragraphs that follow – that vibration exercise therapy can provide for the patient population.

Faster strength gains through neurological adaptation
We know that the initial strength gain seen from any exercise program is through recruiting more muscle fibres rather than through hypertrophy. Since vibration exercise therapy works through an involuntary muscle contraction, more muscles are initially recruited through vibration than conventional strength training.6 This allows a de-conditioned patient with, for instance,  chronic knee pain to undergo a safe and effective strength training program in less time, thereby giving the chiropractor more time to spend on increasing ADLs and function.

Shorter training times per session
With the ability to produce up to 3,000 muscle contractions in one minute, exercise time during a single session can be reduced. Research has already shown similar strength gains from 20 minutes of vibration exercise as compared to an hour of conventional training.7 This allows any chiropractor to effectively incorporate a time-efficient rehabilitation program within their practice.

Address the concerns of a wider variety of patient populations
Vibration exercise therapy is well suited as an effective exercise solution for those having difficulty engaging in a conventional exercise program due to physical limitations. Strength and flexibility training can initially be done in static, pain free range of motions. Patient populations that have benefited from this include those with multiple sclerosis, fibromyalgia, spinal cord injury, osteoporosis, and Parkinson’s Disease, to name a few. 8, 9,10,11,12

Expanding practice opportunities
Vibration exercise therapy is not only available to be utilized as a modality in chiropractic offices. Since a strength training program can take as little as 15 minutes a day, some patients opt to continue with vibration exercise after being discharged from their chiropractic care. These people not only want to maintain the gains they have made with their chronic conditions, but also want to look good. It’s no surprise that small vibration studios are starting to pop up and will continue to increase in popularity. A chiropractor is in a prime position to be able to utilize this as an enhancement to his/her practice.

CHOOSING THE RIGHT TYPE OF VIBRATION PLATFORM
Prior to purchasing a vibration platform, it’s always advisable to do your research. With all the choices in the marketplace, it’s sometimes confusing to understand what the key features are that separate the quality products from imitations. In addition, it’s important to understand the features that are essential to address the needs of a particular patient population, as opposed to the fitness or sports performance population. The following paragraphs outline some key features that should be present in a vibration platform. 

1) Consistent dosimetry
When it comes to such devices as lasers or ultrasound, every clinician knows the importance of having devices that provide a consistent dose. A laser that changes the wavelength from one patient to the next is unacceptable, in health-care standards. Vibration exercise therapy is no different. The frequencies and amplitudes that are being generated are very specific. Regardless of the weight of the patient, the dose should be identical.
With vibration exercise, this can sometimes be an issue. The vibration platform needs to be consistent with the various weight loads. This is especially important considering certain frequencies are optimal for muscle contraction. If the platform is not able to provide this consistent frequency, the patient may be subjected to a dose of exercise that may be ineffective.

2) Ability to handle heavy loads
Some clinicians argue that they are not dealing with very heavy people. However, one should note that the heavier the load a vibration platform can take, the less chance there is of it being worn down and breaking. The reason for heavy loads is simple; I’ve seen two therapists standing on the platform with a spinal cord injury patient; I’ve also seen a 300-pound linebacker doing full squats with an additional 200-pound barbell. In order to ensure safety for the user, ability to handle heavier loads is mandatory.

3) Large platform size
A larger platform size allows for a greater variety of uses. Not only can you use vibration exercise therapy for strengthening, you can also use it for flexibility, mobilization, and massage. Large platform sizes allow a clinician to integrate various forms of functional training for the athlete, in addition to balance and gait training for an elderly patient.

4) Vertical vibrations
Regardless of the type of platform, maximizing the amount of vertical displacement and minimizing lateral movements is crucial. One of the main reasons for this is safety.  Some state that three-dimensional vibrations allow for increased proprioceptive and balance training. However, one needs to look at this in a different light. Wobble boards and gym balls are referenced as effective unstable surfaces that increase proprioception and stability. However, vibration platforms can provide up to six Gs of force. Any translation of this force will lead to shearing forces on the joints. Platform manufacturers that work towards minimizing lateral movements understand the importance of applying this technology to the patient population. 

5) Support and training
Most platform manufacturers can provide exercise pictures, and even a training manual. However, this is generic for anyone that purchases a vibration platform. Seek out companies that have experience in the medical rehabilitation field and can produce protocols when requested.
There should also be potential to get further training in addition to ongoing support.•

References:

1. Issurin VB, Kuksa SV, Temnov PN. Effect of different vibratory stimulation regimens in exercises for maximal strength and strength endurance. In: Dolnik JA, Issurin V, Morzevikov NV, editors. Modern state of athletes’ preparation in paddling and rowing. Leningrad: LNI-IFK; 1988. Pp. 154-8.
2. Bosk C, Cardinale M, Colli R, Tihanyi J, von Duvillard SP, Viru A. The influence of whole body vibration on jumping ability. Biol Sport 1998; 15: 157-64.
3. Mester J, Spitzenfeil P, Schwarzer J, Seifriz F. Biological reaction to vibration-implications for sport. J Sci Med Sport 1999; 2: 211-26.
4. Liebermann DG, Issurin VB. Effort perception during isotonic muscle contraction with superimposed mechanical vibratory stimulation. J Hum Mov Studies 1997; 32: 171-86
5. Eklund G, Hagbarth KE. Normal variability of tonic vibration reflex. Exp Neurol 1966; 16:80-92.
6. Hazell TJ, Jakobi, JM, Kenno KA. The effects of whole-body vibration on upper- and lower-body EMG during static and dynamic contractions. Appl. Physiol. Nutr. Metab. 2007; 32: 1156-1163.
7. Delecluse C, Machteld R, Verschueren S. Strength Increase after Whole-Body Vibration compared with Resistance Training. Medicine & Science in Sports & Exercise 2003; 1033 – 1041.
8. Schuhfried O, Mittermaier TJ, Pieber K, Tatjana PS. Effects of whole-body vibration in patients with multiple sclerosis: a pilot study. Clinical Rehabilitation 2005; 19: 834-842.
9. Verschueren S, Roelants M, Delecluse C, Swinnen S, Vanderschueren D, Boonen S. Journal of Bone and Mineral Research 2004; 19: 352- 359.
10. Melchiorri G, Andreoli A, Padua E, Sorge R & De Lorenzo. The use of vibration exercise in spinal cord injury patients who regularly practice sports. Functional Neurology 2008; 22: 151 154.
11. Ebersback G, Edler D, KAufhold O, Wissel J. Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson’s disease. Archives of Physical Medicine and Rehabilitation 2008; 89: 399-403.
12. Van Nes IJ, Latour H, Schils F, Meijer R, van Kujik A, Geurts AC. Long-term effects of 6 week whole body vibration on balance recovery and activities of daily living in the postacute phase of stroke: a randomized, controlled trial. Stroke 2006; 37: 2331-2335.