In the average Physiotherapy clinic, knee pain ranks second among the never ending list of diagnoses requiring intervention.
Whether it is osteoarthritis, torn cartilage (often referred to as a meniscus tear), patellofemoral pain (pain under the knee cap), a ligament sprain, or tendonitis, these conditions can all lead to severe functional limitation and a reduction in one’s quality of life.
In the past, most of these conditions were treated with injections, medication, and ultimately, surgery. Over time however, we have come to realize that through appropriate, individualized, conservative management; part of which should, without doubt, include vibration therapy, there is potential to fully recover “without the need to cut”.
Anatomy of the Knee
The knee joint itself, a pivotal hinge joint, is capable of bending and straightening (flexing and extending) as well as rotating inward and outward (internally and externally rotating). It is comprised of two articulations; one between the femur and the tibia (tibiofemoral joint) and one between the femur/tibia complex and the kneecap (the patellofemoral joint). Supporting the inside and outside of the joint, and primarily responsible for its strength and stability, are multiple ligaments and several groups of muscles; among which are the quadriceps, hamstrings, hip adductors, hip abductors, and the muscles of the calf.
Over time, the relatively simple design of the knee joint coupled with its “undesirable” anatomical location make it highly susceptible to harmful shearing forces, deleterious compressive forces, abnormal patellar tracking created by muscular imbalances, and biomechanical movement dysfunctions leading to overuse injuries and painful trauma to the surrounding connective tissue (tendons, ligaments, muscles and fascia).
The Influence of Vibration on Knee Pathology
We have already established that vibration therapy / training can successfully improve circulation, lymphatic mobility, muscle tone and strength, muscle flexibility, joint proprioception, and most importantly, efficiency of the neuromuscular system. When treating an individual with knee pathology, it is by carefully and selectively harnessing these systemic effects that successful treatment can be accomplished and the long term benefits maintained.
Osteoarthritis (OA): A common degenerative condition, knee OA generally refers to the progressive, degenerative changes to the articular cartilage that lines the surfaces of the bones that comprise the knee joint. It may or may not include wearing of the under surface of the patella (knee cap) as well.
In either case, once the cartilage has deteriorated, the bony surfaces are exposed and with repeated exposure to normal, unavoidable, compressive forces (i.e. walking, standing, stairclimbing, exercise etc.), pain and inflammation will ensue. The end result of these painful changes is a gradual reduction in joint mobility, reduced viscosity of the joint, decreased local muscular activity and support, local connective tissue tightness (including muscle tissue), gait dysfunction, and a reduced overall functional level.
For the individual that suffers from OA, “traditional” therapy interventions, although successful at times, have limitations. Chief amongst these limitations is the inability to consistently tolerate weight bearing exercises (squats, lunges, step activities etc.); an integral part of the recovery process and essential for restoring the support and shock absorbing capabilities of the muscles around the joint.
With vibration therapy, when first considering the squat position, a cornerstone exercise for lower body strength, the design of the platform allows the patient to utilize the upper body to control the amount of weight through the lower body. This helps them maintain their weight comfortably through their heels while successfully holding the appropriate joint angle. Successfully holding this position through a 30-60 second interval will not only “jumpstart” the neuromuscular system, but immediately improve circulation to the joint as well as local muscular activity and tone. This will allow the patient to tolerate further weight bearing exercises; exercises that may include the wide squat, superman squat, lunge, bridge, or unsupported heel raise.
We have only now just begun….outside of the benefits listed above, it is important to understand that, during the squat (as well as most other exercise performed on the platform), there are other systems at work as well. Most important among these systems is the proprioceptive system (please refer to my previous article for more detailed information on this system). When motion is lost in an arthritic joint, as is the case with OA, the proprioceptive system struggles to maintain clear and concise communication with the brain. The resulting issues lead to gait dysfunction, poor balance responses, and poor muscle fiber recruitment. Through vibration therapy, an extremely high amount of activity is placed upon the joint proprioceptors and the system as a whole. As a result there is an over-correction of sorts and this serves to improve the proprioceptive system’s efficiency overall.
Shall I keep going? How about the lymphatic system? One of this system’s responsibilities, as it applies to OA, is to help remove the excess swelling that is typically seen in an arthritic joint (acute and chronic). Often responsible for interfering with local muscle activity, this swelling also occupies space within the joint and creates further limitation in movement. Like no other form of treatment, vibration therapy, through the extremely high number of muscle contractions it creates, significantly enhances lymphatic system mobility and can lead to the quick and efficient removal of excess fluid in the joint.
At this point you are probably quite tired of reading, but I could never live with myself if I didn’t address the final, critical dysfunction seen in the individual with knee OA….reduced muscle flexibility and myofascial restriction. It has been touched upon many times in previous articles on this site, but if there is ever a jaw-dropping benefit of vibration therapy, it’s the way in which it can be utilized safely to override the normal resistance to stretch provided by the muscle spindle and its inhibitory communication with the central nervous system. By utilizing the vibration platform with proper body positioning, muscle length and myofascial mobility can be improved faster than any other flexibility based intervention available (medieval torture devices excluded of course).
I could go on for days, but for those that already participate in a vibration therapy program, it would only be further review. For those who are just beginning to explore this breakthrough technology, I am sure you have enough to push you forward. The rest of the many, many benefits you will gain will only further serve to amaze you!
Written By Gabriel Ettenson, MS, PT
2009 Jul;38(4):448-54. Epub 2009 May 13.
Effects of whole body vibration training on cardiorespiratory fitness and muscle strength in older individuals (a 1-year randomised controlled trial).
Bogaerts AC, Delecluse C, Claessens AL, Troosters T, Boonen S, Verschueren SM.
Division of Musculoskeletal Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium.
BACKGROUND: whole body vibration (WBV) training appears to be an efficient alternative for conventional resistance training in older individuals. So far, no data exist about the vibratory effect on cardiorespiratory fitness. OBJECTIVES: this randomised controlled trial assessed the effects of 1-year WBV training on cardiorespiratory fitness and muscle strength in community-dwelling adults over the age of 60. METHODS: a total of 220 adults (mean age 67.1 years) were randomly assigned to a WBV group, fitness group or control group. The WBV group exercised on a vibration platform, and the fitness group performed cardiovascular, resistance, balance and stretching exercises. The control group did not participate in any training. Heart rate was measured during a single WBV session. Peak oxygen uptake (VO(2peak)) and time-to-peak exercise (TPE) were measured during progressive bicycle ergometry. Muscle strength was assessed by a dynamometer. RESULTS: heart rate increased significantly during WBV training. After 1 year, VO(2peak), TPE and muscle strength increased significantly in the WBV and fitness groups. Both training groups improved similarly in VO(2peak) and muscle strength. The fitness group improved significantly more in TPE than the WBV group. CONCLUSION: WBV training in community-dwelling elderly appears to be efficient to improve cardiorespiratory fitness and muscle strength.
PMID: 19439517 [PubMed - indexed for MEDLINE]
Maturitas. 2009 May 20;63(1):79-83. Epub 2009 Apr 21.
Whole-body vibration augments resistance training effects on body composition in postmenopausal women.
Fjeldstad C, Palmer IJ, Bemben MG, Bemben DA.
Department of Health and Exercise Science, University of Oklahoma, Norman, 73019, United States.
Age-related changes in body composition are well-documented with a decrease in lean body mass and a redistribution of body fat generally observed. Resistance training alone has been shown to have positive effects on body composition, however, these benefits may be enhanced by the addition of a vibration stimulus. OBJECTIVE: The purpose of this study was to determine the effects of 8 months of resistance training with and without whole-body vibration (WBV) on body composition in sedentary postmenopausal women. METHODS: Fifty-five women were assigned to resistance only (RG, n=22), vibration plus resistance (VR, n=21) or non-exercising control (CG, n=12) groups. Resistance training (3 sets 10 repetitions 80% strength) was performed using isotonic weight training equipment and whole-body vibration was done with the use of the power plate (Northbrooke, IL) vibration platform for three times per week for 8 months. Total and regional body composition was assessed from the total body DXA scans at baseline (pre) and after 8 months (post) of training. RESULTS: In the VR group, total % body fat decreased from pre- to post-time points (p<0.05), whereas, the CG group had a significant increase in total % body fat (p<0.05). Both training groups exhibited significant increases in bone free lean tissue mass for the total body, arm and trunk regions from pre to post (p<0.05). CG did not show any changes in lean tissue. CONCLUSION: In older women, resistance training alone and with whole-body vibration resulted in positive body composition changes by increasing lean tissue. However, only the combination of resistance training and whole-body vibration was effective for decreasing percent body fat.
PMID: 19386449 [PubMed - indexed for MEDLINE]
Dtsch Med Wochenschr. 2009 Jul;134(30):1511-6. Epub 2009 Jul 14.
[Effect of whole body vibration exercise on osteoporotic risk factors]
[Article in German]
von Stengel S, Kemmler W, Mayer S, Engelke K, Klarner A, Kalender WA.
Institut für Medizinische Physik, Friedrich-Alexander Universität Erlangen-Nürnberg. simon.von.stengel@imp.uni-erlangen.de
BACKGROUND AND OBJECTIVE: Whole body vibration (WBV) training is a new approach which is currently discussed in the context of reducing the risk of osteoporotic fractures. The study was undertaken to determine the effect of one-year WBV exercise on bone mineral density (BMD) and the number of falls. METHODS: 151 postmenopausal women (68.5 +/- 3.1 years) were randomly assigned to three groups: (1) conventional (multifunctional) training (TG); (2) multifunctional training including WBV (VTG); (3) wellness-control group (CG). The training groups performed multifunctional training twice weekly (60 min; dancing aerobics, balance training, functional strength training). In the last 15 min of each session, leg strength exercises on vibration platforms were performed. The plates were switched on only in the VTG. The CG performed a low intensity gymnastic and relaxation programme (4 x 10 sessions of 60 min). BMD was measured at the hip and lumbar spine at baseline and after 12 months with the DXA method. Falls were recorded daily with the calendar method in a fall log. RESULTS: An increase in BMD at the lumbar spine was measured after one year in both training groups (VTG: + 1.17 +/- 2.4 % vs. TG: + 1.73 +/- 2.4 %). The difference between the TG and the CG was significant (p < .05). Regarding the hip region a loss was noted in the CG (- 0.9 +/- 2.5), whereas the BMD stayed stable in the training groups (TG: – 0.3 %; VTG: + 0.1 %). The fall rate was significantly lower in VTG compared to CG (0.43 falls/person/year (VTG) vs. 1.14 (CG). CONCLUSION: The multifunctional training resulted in a gain of BMD at the lumbar spine. Vibration training did not enhance the effect on bone but significantly reduced falls.
PMID: 19603365 [PubMed - indexed for MEDLINE]
PubMed.Gov
U.S. National Library of Medicine
National Institutes of Health
So this weekend, my parents brought me my own personal gym. The soloflex had stayed up in the second story of my parents hourse for years and they made the mistake of asking me if I could use it. Trying not to exert the overwhemling desperation flowing through my veins, I managed to hold off a few seconds before I responded with a definitive “yes.” So Friday, my parents and my sister came down to College Station to take away the old weight bench and drop off a pretty cool personal gym. Yeah, it’s not the most high-tech training system, but it works for a dude who doesn’t want to pay 30 dollars a month to go to a gym (that isn’t even open and HIS ideal hours) and whose schedule is so strange he doesn’t feel right about using free weights at night alone with a poppy shoulder.
I look at it as a new toy. I approached just like I woudl a video game. Without reading the instructions I decided to see if I could bench press the 50 pound straps on each side. I gradually lowered the weight until 10 pounds were on each side. At first, I felt like a complete whuss, but I did remember my father procide me with sage advice warning me to start with smaller weight. He confirmed it when I called him later by saying “It’s a little harder than you think.” It’s not like free wieghts, those bands can be pretty hard to move even if you are a stacked muscle-head. Maybe that’s why the maximum weight is only 50 pounds.
I had some time last night and before work and I’m pretty sure I’m sore because of my 30-45 minute work out. I still have the butterfly attachment hooked up and it tempts me everytime I walk by. In addition, I’m not sure where I’m going to stick my bike because the soloflex encompasses it’s old hangout. I enjoy the acquirement though. I can watch TV as I fidget with the settings and even run though several sets in a few minutes.
I just hope I dont start to resemble some sort of steroid-driven muscle-head, I’d hate for my super-wide shoulders to prevent me from passing through doors
Loss of Female Hormones Leads to Muscle Loss Tuesday, February 9, 2010 by Susan Lark Declines in muscle mass and physical strength are common effects of menopause. The drop in female hormones at menopause, particularly estrogen, doesn’t just increase body fat; it also diminishes the strength and size of muscles. This muscle loss boosts the risk for a separate set of conditions, including insulin resistance, diabetes, metabolic syndrome, and traumatic injuries caused by loss of strength and athleticism. So, it’s incredibly important that menopausal women hold on to the muscle they have and, ideally, gain back the muscle they’ve already lost. To build muscle in your postmenopausal years, you must add weight training and/or resistance exercises to your natural weight loss plan and workout routine. But lifting weights is not your only option. Studies show that aquatic resistance training and using a whole-body vibration device are both excellent options. I wrote about these suggestions in great detail in the December 2009 issue of my newsletter, Women’s Wellness Today. For more information on this topic, you can subscribe and gain access to years of back issues, including this one.
Low-level mechanical vibrations can influence bone resorption and bone formation in the growing skeleton.
Xie L, Jacobson JM, Choi ES, Busa B, Donahue LR, Miller LM, Rubin CT, Judex S.
Department of Biomedical Engineering, Psychology A, 3rd Floor, State University of New York at Stony Brook, Stony Brook, NY 11794-2580, USA.
Short durations of extremely small magnitude, high-frequency, mechanical stimuli can promote anabolic activity in the adult skeleton. Here, it is determined if such signals can influence trabecular and cortical formative and resorptive activity in the growing skeleton, if the newly formed bone is of high quality, and if the insertion of rest periods during the loading phase would enhance the efficacy of the mechanical regimen. Eight-week-old female BALB/cByJ mice were divided into four groups, baseline control (n = 8), age-matched control (n = 10), whole-body vibration (WBV) at 45 Hz (0.3 g) for 15 min day(-1) (n = 10), and WBV that were interrupted every second by 10 of rest (WBV-R, n = 10). In vivo strain gaging of two additional mice indicated that the mechanical signal induced strain oscillations of approximately 10 microstrain on the periosteal surface of the proximal tibia. After 3 weeks of WBV, applied for 15 min each day, osteoclastic activity in the trabecular metaphysis and epiphysis of the tibia was 33% and 31% lower (P <0.05) than in age-matched controls. Bone formation rates (BFR.BS(-1)) on the endocortical surface of the metaphysis were 30% greater (P <0.05) in WBV than in age-matched control mice but trabecular and middiaphyseal BFR were not significantly altered. The insertion of rest periods (WBV-R) failed to potentiate the cellular effects. Three weeks of either WBV or WBV-R did not negatively influence body mass, bone length, or chemical bone matrix properties of the tibia. These data indicate that in the growing skeleton, short daily periods of extremely small, high-frequency mechanical signals can inhibit trabecular bone resorption, site specifically attenuate the declining levels of bone formation, and maintain a high level of matrix quality. If WBV prove to be efficacious in the growing human skeleton, they may be able to provide the basis for a non-pharmacological and safe means to increase peak bone mass and, ultimately, reduce the incidence of osteoporosis or stress fractures later in life.
PMID: 16824816 [PubMed - indexed for MEDLINE]
Shriners Hospital for Children, Montreal, QC, Canada. frauch@shriners.mcgill.ca
Whole-body vibration training is a method for muscle strengthening that is increasingly used in a variety of clinical situations. Key descriptors of vibration devices include the frequency, the amplitude, and the direction of the vibration movement. In a typical vibration session, the user stands on the device in a static position or performs dynamic movements. Most authors hypothesize that vibrations stimulate muscle spindles and alpha-motoneurons, which initiate a muscle contraction. An immediate effect of a non-exhausting vibration session is an increase in muscle power. Most studies of the longer term use of vibration treatment in various disorders have pursued three therapeutic aims: increasing muscle strength, improving balance, and increasing bone mass. In a small pilot trial in children we noted improvements in standing function, lumbar spine bone mineral density, tibial bone mass, and calf muscle cross-sectional area.
PMID: 19740225 [PubMed - indexed for MEDLINE]
Pub Med. Gov
U.S. National Library of Medicine
National Institutes of Health
Just wanted to say what a geat product the WBV platform is. I was a bit skeptical at first reading about the benefits other people were posting but decided to give it a try. I’ve had various aches and pains for years and tried various exercises (under doctors’ advice)which left me exhausted, and more times than not, left me with more pain than I had before! I’ve had the WBV board for a couple of months now and I don’t know how I’ve lived without it for all these years! I used to suffer from vertigo, plantar faciitis, and back/hip pain on a regular basis….not anymore! I use it everynight for 20 minutes & am working up to 30 minutes at the higher settings. I can tell you that I now get such a sound sleep I can sleep through earthquakes! Thanks Soloflex! E. Montoya
Late for you, early for me
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