Multiple Sclerosis patients are increasingly engaging in vibration exercise with the hopes that this new found technology can help them. Due to the success stories on vibration therapy, it’s hard not to become optimistic about it’s applications. Some are starting to call it a cure. Unfortunately it’s not a cure. Fortunately, experience has shown that it can be beneficial. This article outlines the current research behind vibration exercise for MS, in addition to providing some clinical experience in what patients can expect from this form of exercise therapy.
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.
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