Research and Clinical Trials

Vibration for Pain Management

Hollins M. (Aug, 2017). Pacinian Signals Determine the Direction and Magnitude of the Effect of Vibration on Pain. Perception, 46(8), 987-999.

"Intermittent vibration was used to minimize peripheral vibratory adaptation. Pain records at 12 and 50 Hz were similar; pooling them revealed significant hypoalgesia at the highest amplitude. At 80 Hz, in contrast, the middle amplitude produced hypoalgesia, but a significant shift toward hyperalgesia occurred at the highest amplitude."

High frequency, low amplitude is best at pain relief.

Cheatham SW, Stull KR, Kolber MJ. (Aug 8, 2017). Comparing of a Vibrating Foam Roller and a Non-vibrating Foam Roller Intervention on Knee Range of Motion and Pressure Pain Threshold: A Randomized Controlled Trial. Journal of Sport Rehabilitation, 1-23. doi: 10.1123/jsr.2017-0164.

"The vibrating roller demonstrated the greatest increase in PPT [pressure pain thresholds] (180kPa, p< 0.001), followed by the non-vibrating roller (112kPa, p< 0.001), and control (61kPa, p<0.001). For knee ROM [range of motion], the vibrating roller demonstrated the greatest increase in ROM (7 degrees, p< 0.001), followed by the non-vibrating roller (5 degrees, p< 0.001), and control (2 degrees, p<0.001)"

Vibrating roller was found superior for knee pain relief compared to regular roller or control.

Lam PH, Hansen K, et al. (Nov, 2015). A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial Evaluating the Effectiveness of Daily Vibration After Arthroscopic Rotator Cuff Repair. American Journal of Sports Medicine, 43(11), 2774-82. doi: 10.1177/0363546515599630.

"5 minutes of vibration was applied daily after arthroscopic rotator cuff repair for 6 months. Vibration did provide acute pain relief at 6 weeks after surgery (visual analog scale [VAS] score, 2.24 6 0.29 cm) compared with placebo (VAS score, 3.67 6 0.48 cm) (P\.003). ... High-frequency, low-magnitude vibration did provide acute pain relief on application 6 weeks after arthroscopic rotator cuff repair surgery."

Vibration shown to reduce pain after rotator cuff repair surgery.

Zafar H, Alghadir A, Anwer S, Al-Eisa E. (Aug, 2015). Therapeutic effects of whole-body vibration training in knee osteoarthritis: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 96(8), 1525-32. doi: 10.1016/j.apmr.2015.03.010.

Studies demonstrated mixed results in favor of additive effects of WBV for reducing pain and improving function in knee OA. There was considerable variation in the parameters of the WBV included in this systematic review.

Conclusion: WBV training reduces pain and improves function in individuals with knee OA.

Kakigi R, Shibasaki H. (1992). Mechanisms of pain relief by vibration and movement. Journal of Neurology, Neurosurgery, and Psychiatry, 55(4), 282–286.

"Concurrently applied vibratory stimuli to and active movements of the fingers significantly reduced and prolonged pain SEPs, increased pain threshold, and prolonged RT, indicating that an increase in the inhibitory mechanisms of painful feeling was induced by the concurrently adopted sensory inputs mediated by large myelinated fibres."

Vibration coupled with finger movement was found to increase pain tolerance.

Roy EA, Hollins M, Maixner W. (Aug, 2003). Reduction of TMD pain by high-frequency vibration: a spatial and temporal analysis. Pain, 101(3), 267–74.

"Under some conditions, vibration delivered to the skin can reduce pain (vibratory analgesia). ... The results document for the first time that vibratory analgesia occurs in TMD chronic pain conditions."

Vibration has been found to reduce pain.

Weerakkoby NS, Percival P, Hickey MW, Morgan DL, Gregory JE, Canny BJ, Porske U. (2003). Effects of local pressure and vibration on muscle pain from eccentric exercise and hypertonic saline. Pain, 105(3), 425–435.

"When muscle pain was generated in an unexercised triceps by injection of hypertonic (5%) saline, controlled local pressure applied to the sore area increased pain levels by 32% while pressure plus vibration reduced this to 11%."

Vibration found to reduce muscle pain after saline injection.

Yarnitsky D, Kunin M, Brik R, Specher E. (Jan, 1997). Vibration reduces thermal pain adjacent dermatomes. Pain, 69(1-2), 75–7.

"We found a significant decrease in mean VAS [visual analog scale] rating when simultaneous vibratory stimuli were given to the dermatome adjacent to that receiving thermal stimulation, or to the same dermatome on the contralateral side. ... The finding that vibration can reduce pain across dermatomes may allow for more flexible design of stimulation therapy for pain."

Findings that vibration reduces thermal heat pain when applied nearby.

Vibration for Repair

Bilgin HM, Celik F, Gem M, Akpolat V, Yildiz I, Ekinci A, Ozerdem MS, Tunik S. (Jul, 2017).  Effects of local vibration and pulsed electromagnetic field on bone fracture: A comparative study. Bioelectromagnetics, 38(5), 339-348. doi: 10.1002/bem.22043.

"The results of the present study suggest that application of direct local LMHFV (low-magnitude, high-frequency vibration) on fracture has promoted bone formation, showing great potential in improving fracture outcome."

Low magnitude, high-frequency vibration has been found to promote bone formation.

Benedetti MG, Boccia G et al. (Jul 18, 2017). Localized muscle vibration reverses quadriceps muscle hypotrophy and improves physical function: a clinical and electrophysiological study. International Journal of Rehabilitation Research, 40(4), 339-346. doi: 10.1097/MRR.0000000000000242.

"The LMV [localized muscle vibration] group showed a significant change in Western Ontario and McMaster Universities Osteoarthritis Index score, Visual Analogue Scale score, Timed Up and Go test, Stair Climbing Test, and knee flexion. These improvements were not significant in patients treated with neuromuscular electrical stimulation. ... In conclusion, the present study supports the effectiveness of local vibration in muscle function and clinical improvement of patients with knee OA."

High frequency vibration, but not electrostim, improved physical function and reverses hypotrophy of quadriceps.

Imaie R, Osumi M et al. (May, 2017). Effect illusory kinesthesia on hand function in patients with distal radius fractures: a quasi-randomized controlled study. Clinical Rehabilitation, 31(5), 696-701.

“[Tendon vibration] was an effective post-surgery management strategy not only for pain alleviation, but also hand function in patients with distal radius fractures...improvements persisting for up to two months.”

Improvements shown in injured limb after using vibration.

Peer KS, Barkley JE, Knapp DM (Dec, 2009). The acute effects of local vibration therapy on ankle sprain and hamstring strain injuries. Physical Sports Medicine, 37(4), 31-38. doi: 10.3810/psm.2009.12.1739.

“Relative to the post-control condition, local vibration for 10 minutes
significantly (P < 0.03 for all) increased ankle dorsiflexion and eversion and hamstring flexibility, and significantly (P <or=0.05) decreased perceived ankle and hamstring stiffness.”

Local vibration was found to reduce percieved stiffness and increase flexibility.

Bakhtiary AH, Fatemi E, Khalili MA, Ghorbani R. (2011). Localized Application of Vibration Improves Passive Knee Extension in Women with Apparent Reduced Hamstring Extensibility: a Randomized Trial. Journal of Physiotherapy, 57(3), 165–171. doi: 10.1016/S1836-9553(11)70037-6.

"At baseline, the mean lack of knee extension was 27 deg (SD 9) in the experimental group and 24 deg (SD 8) in the control group. At 8 weeks, this had changed to 13 deg (SD 5) in the experimental group and 23 deg (SD 9) in the control group. ... An 8-week regimen of localised application of vibration over the hamstring muscles significantly reduces knee extension lack in women with reduced range on the passive knee extension test."

In hamstring muscles, the application of vibration was found to reduce the lack of knee extension.

Rubin C, Xu G, Judex S. (Oct, 2001). The anabolic activity of bone tissue, suppressed by disuse, is normalized by brief exposure to extremely low-magnitude mechanical stimuli. FASEB Journal, 15(12), 2225-2229.

"After a 28 day protocol, bone formation rates (BFR) in the proximal tibia of mechanically stimulated rats increased compared with age-matched control (+97%). Disuse alone reduced BFR (-92%), a suppression only slightly curbed when disuse was interrupted by 10 min of weight bearing (-61%). In contrast, disuse interrupted by 10 min per day of low-level mechanical intervention normalized BFR to values seen in age-matched controls. This work indicates that this noninvasive, extremely low-level stimulus may provide an effective biomechanical intervention for the bone loss that plagues long-term space flight, bed rest, or immobilization caused by paralysis."

Low magnitude, high frequency vibration found to normalize bone loss in rats.

Lau W.Y., Nosaka K. (Aug, 2011) Effect of vibration treatment on symptoms associated with eccentric exercise-induced muscle damage. American Journal of Physiology Medicine & Rehabilitation, 90(8), 648-657. doi: 10.1097/PHM.0b013e3182063ac8.

"Immediately after the vibration treatment, a significant (P < 0.05) decrease in the magnitude of delayed-onset muscle soreness and muscle strength and an increase in pressure pain threshold and range of motion were found."

Vibration was found to delay soreness, increase range of motion, and increase pain threshold.

Thompson WR, Yen SS, Rubin J. (2014). Vibration therapy: clinical applications in bone. Curr Opin Endocr Diabetes Obes, 21(6), 447–453. doi: 10.1097/MED.0000000000000111.

"Animal and human studies suggest that high-frequency, low-magnitude vibration therapy improves bone strength by increasing bone formation and decreasing bone resorption. There is also evidence that vibration therapy is useful in treating sarcopenia, which confounds skeletal fragility and fall risk in aging. Enhancement of skeletal and muscle strength involves regulating the differentiation of mesenchymal stem cells to build these tissues; mesenchymal stem cell lineage allocation is positively promoted by vibration signals."

Vibration has been found to regenerate bone strength.

Thompson WR, Et al. (May, 2015). Low-Magnitude, High-Frequency Vibration Fails to Accelerate Ligament Healing but Stimulates Collagen Synthesis in the Achilles Tendon. Orthopedic Journal of Sports Medicine, 3(5). doi: 10.1177/2325967115585783.

“Additional physiological mechanisms [of] vibration include improved blood flow to injury and enhanced hormonal responses, including testosterone and growth hormone, evidence for a more systemic effect [on] tissue healing.”

LMHFV is found to increase collegen among other things in rats.

Weinheimer-Haus EM, Judex S, Ennis WJ, Koh TJ. (March, 2014). Low-intensity vibration improves angiogenesis and wound healing in diabetic mice. PLoS One, 9(3).

"Our findings indicate that LIV [low intensity vibration] may exert beneficial effects on wound healing by enhancing angiogenesis and granulation tissue formation, and these changes are associated with increases in pro-angiogenic growth factors."

Increase in wound healing in conjuction with low intensity vibration.

Blackburn JT. (Nov, 2014). Whole Body and Local Muscle Vibration Reduce Artificially Induced Quadriceps Arthrogenic Inhibition. Archives of Physical Medicine Rehabilitation, 95(11), 2021-8.

"WBV [whole body vibration] and LMV [local muscle vibration] improve quadriceps function equivocally after simulated knee pathology, effectively minimizing quadriceps [anthrogenic muscle inhibition] AMI. Therefore, these stimuli may be used to enhance quadriceps strengthening, therefore improving the efficacy of rehabilitation and reducing the risk of osteoarthritis."

Vibration for Athletic Training and Post-Surgical Rehabilitation Local Vibration improves rehabilitation and reduces the risk of osteoarthritis.

Pamukoff DN, Et al. (Jul, 2016). Whole-Body and Local Muscle Vibrations Immedietly Improve Quadriceps Function in Individual with Anterior Cruciate Ligament Reconstruction. Archives of Physical Medicine Rehabilitation, 97(7), 1121-9.

"WBV [whole body vibration] and LMV [local muscle vibration] acutely improved quadriceps function and could be useful modalities for restoring quadriceps strength in individuals with knee pathologies."

Vibrations were found to improve and strengthen quadricep muscles.

Filippi GM, Brunetti O, Botti FM. (Dec, 2009). Improvement of stance control and muscle performance induced by focal muscle vibration in young-elderly women: a randomized controlled trial. Archives of Physical Medicine Rehabilitation, 90(12), 2019-25. doi: 10.1016/j.apmr.2009.08.139.

60 sedentary women had three 10-minute vibration sessions a day for 3 consecutive days applied to contracted or relaxed quadriceps, or received placebo (non-vibrated group). At 24 hours, the area of sway decreased by 20%, vertical jump increased by 55%, and leg power increased by 35%. These effects were maintained for at least 90 days.

Repeated Muscle Vibration is non-invasive and shown to improve muscle performance.

Brunetti O, Botti FM et al. (Dec, 2012). Focal vibration of quadriceps muscle enhances leg power and decreases knee joint laxity in female volleyball players. Journal of Sports Medicine and Physical Fitness, 52(6), 596-605.

"18 volleyball athletes, (age=22.7 ± 3 years) were assigned to vibration on contracted or relaxed quads or sham vibration (NV). Combined bilateral voluntary contraction and rMV of the quadriceps muscles is a short-lasting, non-invasive technique that can significantly and persistently improve muscle performance and knee laxity in volleyball women players."

Vibration on contracted leg muscles in female athletes increases performance.

Luo J, McNamara BP, Moran K. (Jul, 2005). A portable vibrator for muscle performance enhancement by means of direct muscle tendon stimulation. Medical Engineering Physics, 27(6), 513-522.

"Both amplitudes (0.5 and 1.2 mm) and all three frequencies (30, 65 and 100 Hz) tested, significantly enhanced EMG [muscle electromyography] activity (p<0.05), with 1.2 mm and both 65 and 100 Hz resulting in significantly greater enhancements (p<0.05)."

Vibration of different amplitudes and frequencies were found to enhance EMG activity.

Gilsanz V, Wren TA, Sanchez M, Dorey F, Judex S, Rubin C. (2006). Low-level, high-frequency mechanical signals enhance musculoskeletal development of young women with low BMD. Journal of Bone and Mineral Research, 21(9), 1464-1474.

"Short bouts of extremely low-level mechanical signals, several orders of magnitude below that associated with vigorous exercise, increased bone and muscle mass in the weight-bearing skeleton of young adult females with low BMD [bone mineral density]."

Vibration was found to increase bone and muscle mass.

Gusi N, Raimundo A, Leal A. (Nov, 2006). Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial. BMC Musculoskeletal Disord, 7(92). doi: 10.1186/1471-2474-7-92.

"The 8-month course of vibratory exercise using a reciprocating plate is feasible and is more effective than walking to improve two major determinants of bone fractures: hip BMD and balance."

Long term use of vibration is found to improve bone mass and balance.

Brunetti O, Filippi GM, Lorenzini M, et al. (Jun, 2006). Improvement of posture stability by vibratory stimulation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatology Arthroscopy, 43(11), 1180-1187.

"It is concluded that short lasting proprioceptive activation by vibration may lead to a faster and more complete equilibrium recovery probably by permanently changing the network controlling knee posture."

After surgery followed by localized vibration, subjects regained posture and balance much faster compared to the control.

Imtiyaz S, Vegar Z, Shareef MY. (Jan, 2014). Delayed Onset Muscle Soreness To Compare the Effect of Vibration Therapy and Massage in Prevention of Delayed Onset Muscle Soreness (DOMS). Journal of Clinical and Diagnostic Research, 8(1), 133-6.

"Muscle soreness was reported to be significantly less for experimental (vibration and massage) group (p=0.000) as compared to control group at 24, 48, and 72 hours of post-exercise. ... Range of motion demonstrated significant recovery in experimental groups in 48 hours (p=0.0016) and 72 hours (p=0.0463)."

45 nonathletic women were randomized to 15 minutes of massage, 5 minutes of focal vibration, or no intervention prior to exercise. Vibration therapy and massage are equally effective in prevention of DOMS. Vibration therapy reduced pain and decreased 48h LDH level.

Vibration was used to reduce muscle soreness and increase range of motion after exercising.

Vegar Z. Imtiyaz S. (Jun, 2014). Vibration Therapy in Management of Delayed Onset Muscle Soreness (DOMS). Journal of Clinical and Diagnostic Research, 8(6), LE01-4. doi: 10.7860/JCDR/2014/7323.4434.

“Vibration therapy improves muscular strength, power development, kinesthetic awareness, decreased muscle sore, increased range of motion, and increased blood flow under the skin. VT was effective for reduction of DOMS and regaining full ROM.... and lower creatine kinase levels in the blood.”

Vibration therapy was used to increase range of motion, muscle strength, and blood flow while decresing soreness.

Koh HW, Cho SH et al. (Sep, 2013). Effects of vibratory stimulations on maximal voluntary isometric contraction from delayed onset muscle soreness. Journal of Physical Therapy Science, 25(9), 1093-5. doi: 10.1589/jpts.25.1093.

"MVIC [maximal voluntary isometric contractions] measurements showed statistically significant differences in the vibration group compared with the control group. Vibratory stimulation had a positive effect on recovery of muscle function from DOMS [delayed onset muscle soreness]."

DOMS was induced in the musculus extensor carpi radialis longus of 60 adults. Ultrasound or vibratory stimulation for 10 minutes or control was used. Vibration, not ultrasound, boosted muscle recovery.

Broadbent S, Rousseau J, J. Throp RM, Choate SL, Jackson FS, Rowlands DS. (Sep 2010). Vibration Therapy Reduces Plasma IL6 and Muscle Soreness After Downhill Running. British Journal of Sports Medicine, 44(12), 888–894.

"29 male recreational runners (33 (8) years; V(O2)peak 57 (6) ml kg(-1) min(-1)) completed a 40-min downhill run and were randomly allocated to a VT [vibration therapy] group or Control group. ... VT reduces muscle soreness and IL6."

Vibration therapy was found to decrease soreness.

Cryotherapy for Pain Management

Song M et al. (Jul, 2016). Focal Cryotherapy for Pain: Compressive cryotherapy versus cryotherapy alone in patients undergoing knee surgery: a meta-analysis. Springerplus, 5(1), 1074.

“Compressive cryotherapy tended to have less pain than cryotherapy
alone at POD2 and POD3, while compressive cryotherapy had a strong tendency towards less swelling over cryotherapy alone at POD1 and POD2.”

Compressive cryotherapy has shown to be beneficial during early recovery from knee surgery.

Hart J et al. (Nov-Dec, 2014). Cryotherapy for Recovery - Quadriceps Muscle Function After Rehabilitation With Cryotherapy in Patients With Anterior Cruciate Ligament Reconstruction. Journal of Athletic Training, 49(6), 733–739. doi: 10.4085/1062-6050-49.3.39.

"After ACL reconstruction, patients ... who performed rehabilitation exercises immediately after cryotherapy experienced greater strength gains than
those who performed cryotherapy or exercises alone."

Cryotherapy paired with rehabilitation excercies were found to be most beneficial after ACL reconstructive surgery.

Liying Pan et al. (Oct, 2015). Comparison the effects of pressurized salt ice packs with water ice packs on patients following total knee arthroplasty. International Journal of Clinical and Experimental Medicine, 8(10), 18179-18184.

"PIP [pressurized salt ice packs] is a cheap, safe and simple method, which is more effective than WIP [water ice packs] on reducing pain and swelling degree of patients. Thus, PIP is recommended in clinical nursing work."

A compressing pack with -18 degree C cold worked better than standard ice and water for pain and swelling.

Pournot H. et al. (Jul, 2011). Time-course of changes in inflammatory response after whole-body cryotherapy multi exposures following severe exercise. PLoS One, 6(7), e22748.

IL-1b (Post 1 h) and CRP (Post 24 h) levels decreased and IL-1ra (Post 1 h) increased following cryotherapy, supporting the decrease in pro-inflammatory cytokines activity, and increase in anti-inflammatory cytokines.

Whole body cryotherapy was found to reduce inflammation.

Why Vibration and Cryotherapy Together

Cryotherapy reduces inflammation but also persistently reduces blood flow.Vibration vasodilates, cancelling the vasoconstriction effect while adding pain relief and separating muscle fibers to reduce stiffness. An increased number of residual cross-bridges between myosin heads and actin is thought to largely contribute to this exercise-induced increased stiffness (Proske and Morgan, 2001) which vibration addresses.

Why vibration instead of electrostim? Electrostim doesn’t increase blood flow, because it is the pulsatile vibration that mimics rapid heart rate, releasing nitric oxide and vasodilating. Electrostim doesn’t cause muscle twitching in the amplitude and frequency that actual
motion does.

Bieuzen F, Et al. (Sep-Oct, 2012). Recovery After High-Intensity Intermittent Exercise in Elite Soccer Players Using WEINOPLUS Sport Technology for Blood-Flow Stimulation. Journal of Athletic Training, 47(5):498-506.

High frequency vibration, but not electrostim, improved physical function and reverses hypotrophy of quads. This is probably because electrostim doesn’t promote hormonal repair gene expression.

International Journal of Rehabilitation Research. Jul 18, 2017.