Vibration therapy increases knee strength after arthroplasty

A study was done at Brigham Young University on vibration strengthening compared to traditional strengthening during physical therapy for those with total knee arthroplasty. The study found that knee extensor strength improved 84.3% with vibration while the traditional resistance program increased by 77.3%. Timed Up and Go scores also improved 31 and 32 % with vibration and traditional exercise, respectively. No adverse effects were noted.

Study shows vibration therapy to be safe for knee replacement

The study used 8 subjects for each group. One of the most important findings apart from the strength gains and TUG results is the fact that there were no adverse effects noted. This is important because most physical therapists and health professionals may initially be we weary to place their more compromised patients on a vibration platform. Originally, the contraindications list dictated that people place those with knee replacements on after 1 year post surgery. However, this rarely takes into consideration the stage of healing, the ability of the patient to begin a strengthening program, and other ways to utilize vibration other than strengthening. We have seen therapists use vibration much earlier than the 1 year. However, applications are modified based on clinical presentation and treatment goals.

Vibration therapy is based on treatment goals

Therapists wonder when vibration therapy should be initiated. The real questions are ‘what are your treatment goals?’ ‘Is the patient ready for strength training?’ ‘Can we initiate other treatment techniques such as massage, strengthening of opposite extremities to initiate cross over effect’? Once a clinician understands what they are looking to achieve, the use of vibration exercise becomes much more effective. Calf massage and circulation can assist in keeping blood flow going once the patient has been cleared of any risks of thrombosis. Strengthening of the other leg can be easily begun at an earlier stage than traditional exercise. Placing the patient in a static posture is easier with vibration exercise in order to begin initiating involuntary muscle contractions. The cross over effect is well known and we’ve seen improved outcomes in patients that have begun their exercise program earlier on.

Vibration does increase muscle activation

The study pointed to the fact that it was unclear that vibration initiated muscle activation. Recent studies do indeed show greater muscle activation. However, adding muscle facilitation techniques like the ones we’ve been utilizing over the last 8 years are highly effective. Muscle facilitation is a technique used by therapists to help a patient recruit more muscle fibers. It’s no different with vibration. Utilizing these techniques can be very helpful in generating activation, particularly the gluteals and the vastus medialis. We hope to see further studies that look into this and compare to conventional training. This is only the beginning for studies like this. We expect to see more post surgical studies that truly lead to the justification of utilizing vibration therapy for knee arthroplasty.

This article is in response to a conversation I had with a wonderful lady that bought a vertical type of platform. She immediately voiced some concern that the machine did not let her do a full continuous 15 minute workout. I tried to explain why you do not need to stand on a machine for 15 minutes, but its hard to explain something when emotions are running high. At that moment in time, she felt cheated and was adamant on standing on a machine for 15 minutes. This article provides the key points to my side of the argument, with the hopes that it can educate you prior to purchasing a vibration exercise machine, or let you think differently about the way you use your vibration platform.

Where did they get the 15 minutes equals an hour at the gym anyways?

The 15 minute finding actually came from a research study done in 2003 by Dr. Christophe Delecluse entitled Strength Increase After Whole Body vibration compared to resistance training. The study was done on a vertical vibration platform. It started with about 3 minutes of vibration and ended with a 20 minute vibration session. The longest time for one exercise was 1 minute with the most rest between exercises being 1 minute. Notice that there is actually rest in between each exercise. The resistance group actually performed 20 minutes of warm up and then strengthening of the legs. At the end of the study, they found that strength gains of the knee muscles were equal among both groups. This is where the claim ’15 minutes of vibration equals 1 hour at the gym’.

Vibration exercise is not about 15 minutes of NONSTOP exercise

Eventually, marketers got a hold of this study and platforms began marketing it as such. Pivotal machines started offering an easy 10 to 15 minute program whereby you simply stand on a vibration platform and get the wonderful results shown in research. This led to late night infomercials showing the effortless exercises that one can do. This also led to a lot of misinformation about vibration training. Yes, you can get a good workout in a very short period of time on a vibration platform compared to regular resistance training. However, you shouldn’t be doing this by simply standing on a vibration platform.

Fitness goals versus wellness goals

How you use a vibration platform is dependent on what you want to achieve. If you are looking for fitness or toning effects, standing on a vibration platform will not be the best way to achieve this. Can you see results? Sure, in the beginning stages. Any form of movement or activity will get you some initial results. Just look at people starting a weight loss program. They get results in the short term but it becomes a struggle long term. If you are looking at fitness effects, you actually need to position yourself in exercise postures so that your muscles are challenged. This isn’t anything new. This is common sense. Your body needs to be constantly challenged to have any chance of staying toned and fit. That’s why vertical machines have various exercise poses to be in. Surprisingly, pivotal machines also have the same exercises, although they tend to want to only promote the ‘stand on for 10 minutes and see instant results’ angle. If you are only looking to get some form of exercise to keep your body limber, maintain circulation and mobility, then standing on a vibration machine for a few minutes a day may be suitable. However, you’d be surprised to learn that over 86% of the people that originally wanted to do very little, craved more after a few weeks. They started feeling better and moving better. Hence, they wanted to be challenged because now they were motivated. Just a thought next time you feel that all you have to do is stand on a vibration machine. Embrace your new found mobility and well being and crave more.

Vibration therapy limits stress on the joints

Vibration exercise allows a person to get a significant amount of muscle strengthening exercises without impact on the joints. Exactly how does this work? Let’s take knee arthritis as an example. Have you tried doing some form of strength training? If so, did you feel pain as you tried bending your knees more? With vibration exercise, you can simply place yourself on the platform in a semi squat position where YOU feel comfortable. The platform will then go up and down instead of you. This elicits over 3000 muscle contractions in 1 minute. Now, you are getting that strength training program while putting yourself in a position that’s comfortable. You can increase the ‘difficulty’ of the exercise simply by increasing the intensity on the machine rather than doing more difficult and painful exercises.

With any form of arthritis, strengthening the muscles around the joints is the common sense approach. However, as we can see in the previous example, one can be limited by mobility or pain. Vibration exercise can generate these muscle contractions without putting as much stress on your body. Not only do you need to strengthen your muscles, there can also be stiffness of the joints and eventually the muscles around the joint. Therefore, engaging in some form of gentle stretching is also beneficial. This too can be done with the vibration effect. Last thing is to increase blood flow around the joint. This can be done in the form of deep massage exercises with a vibration exercise platform.

Vibration therapy involves more than just standing on a machine

As you can see, arthritis management is not just about standing on a vibration machine. Incorporating flexibility, deep massage work, and eventually functional training can go a long way in ensuring that your arthritic joint is protected by strong and flexible muscles. When looking to begin a workout, first ask yourself what your goals are. Is it to get less pain? Or is it to be able to move better?  What if its to just get looser so you aren’t as tight? First find out what your goal is. Then work towards a specific exercise that will help you with your goal. That’s why doing an vibration exercise program is not cookie cutter. It has to take into consideration what your needs are. Next thing to look at is how you will progress yourself with your program. How fast should you proceed? Do you increase the settings on the machine or do a harder exercise? All too often, people tend to just do the same thing and add more time. That’s not the way to go. We’ve seen people do the same type of easy exercise, yet increase the intensity settings on the vibration platform. They also then increase the level of difficulty of the exercise. After that, you can decrease your rest time to make it more difficult. Most important point to remember is to increase everything but the time. With respect to time, settle for about 2 minutes of vibration per body part. So if you do a 30 second squat exercise, do it 4 times. That’s it! Don’t think for a second that you need to do more. Remember, make the exercise harder and you will see that time is the last thing to increase.

Review of Vibration Therapy and Multiple Sclerosis Research

Studies have been fairly mixed with respect to positive outcomes, with frequency and amplitude parameters varying between studies. A single subject experimental design was replicated for 3 subjects in a study by Wunderer K et al (2010). They looked at ankle plantar flexor and knee extensor strength with the Nicholas Manual Muscle tester and assessed functional mobility with the Timed Up and Go test. All subjects improved significantly with plantar flexor strength. One subject improved in knee extensor strength bilaterally and another improved in strength in their weak leg. Two subjects improved significantly in functional mobility. The research study was done on a vertical vibration platform. However, a randomized controlled trial by Broekmans T et al (2010) found no increase in leg muscle performance and functional capacity. This study involved an exercise program of 5 training sessions over a 2 week cycle for a total of 20 weeks. A pilot study by Schyns F et al. (2009) compared vibration and exercise to exercise alone. Groups did not differ in terms of function or strength. However, the vibration and exercise group showed reduced muscle spasms. Another double blind, randomized controlled trial by Schuhfried O et al. (2005) looked at postural control, mobility and balance by providing vibration in comparison to placebo. This study showed vibration having positive influence on postural control and mobility. With all the studies out there, why the difference in results?

Clinical experience with vibration therapy

Vibration therapy has shown some promise and warrants further research. However, as every clinician will know, each patient will present differently and each rehabilitation program will be customized for each individual. Not every patient with MS presents in similar manners. There are varying degrees of functional loss. There are varying degrees of muscle spasm. These things, in addition to patient goals, motivation, and ability to engage in an exercise program, all require specific treatment protocols. We’ve had experience in placing patients on relatively low intensity levels for a couple of minutes, to engaging patients in high intensity programs lasting well over 20 minutes. Results through  vibration training varied dramatically with each patient.

With vibration exercise, many different techniques can be integrated. The goal of any rehabilitation program is not to rely solely on a therapeutic modality to provide the ‘cure’. The goal of rehabilitation is to provide a form of therapy that enhances or assists in the final goal of rehabilitation, which is usually increase function and ADL’s. We’ve found patients getting significant reduction in muscle spasms through PNF techniques while undergoing vibration stimulation. This can take 1 to 2 minutes only. If we are able to decrease the muscle spasms, the patient is able to quickly progress into a walking or functional gait training program. The initial stretching technique helped facilitate this. In other cases, two patients may present the same way, with the same functional losses. One patient is placed on a higher intensity setting with their quad strengthening program. During the first two to three sessions, the patient had to sit for at least 45 minutes prior to feeling comfortable enough to drive home. However, the high intensity allows for decreased spasticity and increased mobility for a 2 day period. The other patient was put through the same program and reports increased muscle spasms for 2 days. However, modifying the program into a low intensity setting increased mobility for this second patient.

As you can see, each patient will respond differently to not only different frequencies and intensities, but to different number of sets, total vibration time and type of treatment approach (stretching, mobilization, functional gait training, strengthening, etc.). It’s only when a clinician’s competency level and sense of comfort level with vibration training and therapy increases, can they be more confident in prescribing an individualized vibration exercise program that will provide the best possible outcomes.

Is the concept of whole body vibration exercise safe?

Yes, vibration training platforms are safe. The question really comes down to HOW you use vibration exercise. I always reference pilates, yoga and weight training to provide similarities. Have you lately seen how popular Yoga and Pilates have become? Many studios have opened up and classes are offered in fitness club all over the world. Yoga and Pilates have shown to help a lot of people and there are success stories that I’ve personally seen that brings a tear to my eye. People in chronic pain have all of a sudden got their life back. When this happens, you know you have a good thing. Weight training is also getting more popular and rehabilitation services incorporate it into their programs. Weight training is great for everyone, regardless of age.

An exercise program is only as safe as the guidance and training that goes behind it

You may say to yourself ‘yeah, I know Yoga, Pilates, and weight training are effective.’ But what if I asked the same question on if you feel that it is safe? Did you know that there is an increase in injuries from Yoga over the past several years? Did you know doctors are seeing more injuries from it? Does that mean Yoga is not safe? Not at all. It goes back to the real answer to any physical activity: safety of any physical activity is dependent on having the right training and information available to ensure you do each exercise in a safe manner. That’s the bottom line. If any of these exercise activities are used incorrectly, there is a greater chance of harm. If you are looking to begin vibration training, it’s imperative that you are comfortable with the after sales support you are going to be getting. Vibration training, exercise or therapy is not about simply standing on a machine. It does require a certain amount of education to do it right, just as it requires similar education to learn how to use weights, Pilates or Yoga. If you get the right guidance and support, you won’t be having any issues with whether whole body vibration exercise is safe or not.

Contraindications are ‘precautions’ only

I had a cardiologist that sent me patients that were either deconditioned or came out of surgery and needed some form of strength training. He understood the value of vibration therapy and how it could help with strengthening without putting a lot of stress on the heart. One day, he sent me a patient with a pacemaker. My new therapist had told the patient they would not be allowed to work with a vibration platform because a pacemaker was a contraindication. We cleared things up and the patient was able to use the vibration plate. My therapist got caught up in the whole ‘contraindication’ list and assumed that these people were not allowed to use the vibration exercise machines. He didnt realise that these contraindications are actually ‘precautions’. That means a person should take them into consideration, see a health professional prior to starting an exercise program, and be a bit more careful not to over do it.

Origin of Contraindications

Vibration training originated from Russia, similar to electrical muscle stimulation. The contraindications for vibration exercise were conveniently taken from electrical stimulation and placed on vibration. However, once you go through each contraindication, you’ll realize that most of them are just precautions. A health professional that places a patient on a vibration platform knows that the reason to use the vibration technology depends on the patient goals, stage of healing, and feedback and close monitoring of their therapy.

Vibration is just like any other form of exercise

Although we’ve seen some great results with vibration therapy, the decision to place someone on the vibration platform is no different than the decision to know when to place someone on a strengthening program. Of course there are subtle differences, but the rationale is the same. For someone coming off a surgery to the knee, has the patient healed enough to warrant strength training? Is there potential to provide a deep tissue massage distal to the surgery so we can begin with increasing circulation? How about starting the patient on a full body workout with vibration, but avoiding the surgical area? This will help with increasing fitness and eventually lead to better results from what we call the ‘cross over effect.’ We’ve seen some great results doing this with athletes that have come off ACL knee surgery. They started vibration training immediately for the rest of their body, which helped maintain their conditioning and strength.

Absolute contraindications

Although most of the contraindications are precautions, there are some ‘absolute’ ones. Pregnancy, active cancer, recent fracture, acute inflammation, current blood clots, and recent surgery are some that you want to avoid vibration with. Pacemaker used to be an absolute contraindication. However, there are no ‘electrical’ impulses from a vibration platform. Hence, there is no need to deny someone with a pacemaker the benefits of strength and flexibility through vibration therapy. Best thing to do is discuss with the patient’s doctor or specialist on what you are looking to achieve. We’ve also had some women that became pregnant while they were undergoing vibration training. This will not cause any adverse effects. We simply will stop vibration training until they have their baby.

I hope this provides a simple overview of the contraindications for vibration therapy. At the end of the day, most of these are no different than any other form of exercise. With any type of exercise, consulting a health or fitness professional is always a good idea before you begin something new.

Chronic Fatigue Syndrome is based on ‘reduced effort tolerance’

Chronic fatigue is characterized by low effort capacity. It’s difficult to initiate any form of exercise. Hence a person becomes deconditioned. This continues on in a vicious cycle until the deconditioning continues to make one more and more unable to engage in any activity. This is a peripheral thing. You can’t use your muscles because for some reason your body can’t handle the load. You avoid it. The muscles get weak. Your ability to do anything goes down and down. However, there’s another factor also present. This is what we call the reduced effort tolerance. Most people with chronic fatigue just can’t do something because their tolerance to the activity is quite low. A study found that those with chronic fatigue syndrome had altered cerebral oxygenation and blood volume. This led to a significant exercise intolerance. So it’s not just that the muscles can’t handle the exercise. By having altered oxygenation in the brain, a simple exertion through an easy exercise program can be ‘perceived’ as harder than it actually is. Then of course one doesn’t do the exercise and then the muscles get deconditioned and the vicious cycle continues.

Vibration therapy is an effective ‘early adoption’ of exercise

So now we know that someone with chronic fatigue syndrome is unable to engage fully in an exercise program. However, exercise is exactly what they need. That’s where vibration exercise has some significant benefits. A person can get a high enough intensity workout in a fraction of the time as conventional training. What this means is that you can easily start with a few seconds and work your way up to a couple of minutes. By having a high number of muscle contractions in a short period of time, there is less chance of quitting because you are unable to exert yourself. Also, vibration exercise can be done in gentle static positions, thereby making the ability to actually complete an exercise session more plausible. Not only is there strengthening involved, but also flexibility and deep massage and circulation.

Do your research when you purchase a vibration platform

All these effects makes it clear that vibration training is an ideal choice for exercise. However, just like any other exercise program, you will need to have a program designed for you by a competent professional or trainer. Don’t just follow a standard poster or exercise dvd. What is your limitation? What aspects do you need to work on? Is it flexibility? Massage? Strengthening? Also, what kind of vibration unit will be the best fit for you? All these things need to come into consideration when you are looking at vibration exercise.

Does vibration exercise really burn 300 calories in 10 minutes of just standing on a machine?

After I finished with the vibration machine, I ran into a personal trainer I’ve known for awhile. She’s probably one of the best trainers I’ve ever met. I have never met anyone that keeps more up to date with the latest research findings than she does. While others read the latest fitness magazines, she spends her time proving the latest techniques with her clients. She’s all about action, and not just talk. However, that day she was rolling her eyes. She looked at me and said “Do you really believe standing on something for 10 minutes is going to burn 300 calories?” The answer was simple. Here are the key points that we discussed. I’ve had these types of discussions with a lot of trainers and health professionals and I can say they’ve always started off as being highly skeptical. That usually goes away after we discuss the key points:

Burning calories with vibration. The real facts:

For those of you that want to burn ’300 calories’ by doing nothing, the real truth is that you can’t. I have actually measured this and will look to see if i can locate my findings and post in a future article.

Vibration training should fit you, not you fitting the machine

What vibration exercise DOES do is attempt to activate as many of your muscles as it can. The more muscles you use, the more they contract. That’s why it’s not about just standing. You actually have to be in ‘exercise positions’ when you are on a vibration platform. The amount of effort you put into it will depend on your fitness level. Are you not able to do a lot? That’s ok. Just keep it on a lower intensity level and do an easier exercise. If you are more fit, you can go to a higher intensity and do more. It’s that simple.

Vibration exercise increases metabolism over time

What I’ve found with a lot of my patients is not that you will burn more calories, but that over time, the amount of calories you burn at rest will increase. If I had to choose between burning more calories while I exercise, or burning calories all day without doing anything, I’d take the second option. That’s exactly what weight lifting does. Therefore, vibration training is very similar to weight training in the effects it produces. Except for the fact that it can be easily done for the less fit and made harder for those that want a challenge.

Vibration training can increase heart rate

If you want to increase your heart rate on a vibration plate, you CAN do it. Remember, its about what YOU want to achieve. Once you know what your goals are, you can use a vibration plate and fit a program to your needs.

In summary, don’t pay attention to all the over promises of burning a lot of calories by standing on a vibration machine. That’s false advertising and misleading to the consumer. That takes away from how effective vibration exercise really can be for someone that is looking to get fit or lose weight. Does the technology work? Yes. Remember that personal trainer I told you about? She’s been using vibration exercise for over 3 years and she believes it to work, if you have the right program that fits the right person. Vibration training is effective for weight loss, but make sure you work with a reputable company that can provide you with the right vibration exercise programs to fit your needs.

From fitness clubs to personal training studios to vibration studios: evolution of fitness

First there were the large fitness chains. After that, personal training studios began popping up. Some wondered whether they would work. The big chains all have personal training so why would someone go to a smaller place and sometimes pay more? The thing is, personal training studios offer certain things that the larger chains can’t. Perhaps a person likes the small areas and enjoys developing closer relationships with a select trainer. Whatever the reason, there is a niche for personal training studios. Vibration studios that have opened up are no different. However, their niche is surprisingly different than a personal training studio. We’ve seen facilities open up right across from a fitness club (some that even have vibration!) and have these facilities do extremely well. The reason is, the technology lends itself to attracting a slightly different clientele than that goes into a gym. The following are some of the characteristics of a typical person that goes to a vibration studio.

Five top characteristics of a vibration studio customer

People that are intimidated by the young, muscled people in a gym.
People that may have physical limitations or disabilities that prevent them from going into a gym
People that enjoy a more personal exercise experience and enjoy the attention they get in a smaller environment
The baby boomer and elderly population that feels that interaction on a quieter and smaller scale is better
Those that lack time to exercise. These usually show up at a studio with their regular street clothes on and begin to do their exercise program.

Vibration studios need to market specific niches

As you can see, a vibration studio that markets to these type of people will do well. Always attract the baby boomers, the elderly, or the typical woman or man that wants to lose weight and start a program but may have physical limitations to do conventional training. We’ve seen studios with 80 percent of their members being 40 years of age or older. This is also one the most lucrative markets for fitness clubs. However, vibration studios can hit this market right away with the right message and right marketing. There is some initial marketing costs but after that, 80 % of your new members should be coming from referrals. This has not only to do with the unique features of vibration training, but also due to the personality and ambience of the vibration studio owner and trainers. Successful customer service is one that caters to each customer’s own unique needs. You have to realize that you need to be a hands-on owner in the initial stages. Since this is a customer service driven business, don’t expect anyone else do to the job as good as you. With the right support and training, more people are becoming successful with their own vibration exercise studios.

Vibration training is a ‘tool in the toolbox’

What we need to take away from this is that whole body vibration training is another ‘tool in the toolbox’ for the strength and conditioning coach. All strength coaches know that a certain technology or piece of equipment is not magic. It’s the ability of a strength coach to integrate certain technologies at the right time within an athlete’s training program that will give that athlete an edge. If it was only the technology, then you can pretty much just hire a high school kid to run your sports performance division! If you have a bad strength and conditioning coach, and you give him or her a vibration platform, you will now have a bad strength and conditioning coach with a vibration platform. It’s HOW one applies vibration technology into their program that makes it successful.

Now that we know that it’s a tool, we can then set out how we want to integrate it. Vibration exercise has shown to be as effective, if not more effective than conventional stretching. Also, research is showing that the effects of vibration last even up to 2 weeks after one finishes, whereas the flexibility of those in a traditional program regresses after being stopped. The benefit is that the stretching takes only 30 seconds to a minute. Being able to stretch in a shorter period of time works well when you want to spend more time training the more difficult tasks and activities and less on stretching. Also, vibration has shown to increase body temperature in a similar fashion to an upper body ergometer. Therefore, we can quickly warm up an athlete in a shorter period of time. This may also be beneficial during competition. Some major professional teams have vibration platforms on the sideline for this purpose.

Vibration training is based on proper physiological principles and program design

For strength training, results have been mixed. Again, that’s because coaches are tweaking the proper settings, parameters and dosage to get the best result. We often hear some coaches say they will wait to integrate vibration training once someone finds the optimal parameters. Do you have optimal parameters for strength training? Or do you have a physiological basis of what to do, but have to tweak it for each athlete? Most coaches we talk to will admit there is no ‘cookbook’ and relies on various skills of the coach to tweak the program. We know that vibration training recruits more muscle fibers than conventional training. We know we can get strength gains from neurological adaptation. Applying it within a program and tweaking it through feedback will allow you to utilize it in the right way.

Vibration training and adding additional weight loads

Some coaches utilize vibration with additional weight loads applied. You may see the platforms under a squat rack. This basically creates a greater physiological load to the body than they can get with weights alone. This has been used with a lot of success. The key thing to point out here is this: This has been used with a lot of success BY THOSE THAT KNOW WHAT THEY ARE DOING!! If you don’t have much experience in power training or proper lifting techniques, doing it on a vibration platform will only lead to more harm than good. A key point is that this training is INTEGRATED within a whole program based on screening out the athlete’s deficiencies, capabilities and performance objectives.

Vibration training for postactivation potentiation

Other coaches utilize vibration as an added stimulation during rest periods in between exercise. Vibration has the ability to produce postactivation potentiation. Simply doing 10 seconds of vibration during the rest periods may continue to maintain optimal muscle function. If an athlete is lifting heavy weights and usually fatigues after the third or fourth set, utilizing vibration exercise platforms in between sets may provide enough stimulation to prevent this fatigue. Again, frequency and intensity settings have to be modified for each athlete and feedback given to know exactly what the right dose will be for this athlete. The goal here is to prevent fatigue as an athlete performs a high intensity and high load exercise. If you can do that, you will provide an extra advantage to generate additional forces. Additional forces lead to lifting more, or lifting with more power. This is what every coach looks for.

As you can see, there are many ways to integrate vibration within a sports performance setting. Which way is dictated by the experience and abilities of the strength coach. Are they into power lifting? Or do they focus more on functional training? Use vibration training as an extension of your own skills and knowledge and if applied correctly, will give you the advantage over other teams.