Vibration Therapy: Shaking Off Knee Pain (part 1)
June 18, 2009 by ted
Filed under VIBRATION THERAPY
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
Well I think we’re wonderfully made
I see the article speaks of overuse and imbalances so maybe if we worked and rested as God intended instead of sitting long hours at a desk or in a vehicle and then walking or running long distances(1/2 marathon races)for fun, our bodies just might hold together better, but hey what’s with the philosophical discussion?
At least Lloyd will get some “good” points for his dislike of distance running as a sport but I’m gonna submit that his punishment for all his “bad deeds” will be just him and a hungry lion in a large field with no trees in sight. He might even get to enjoy running!
I would like to compliment our angel Gabriel for another fine article. It is articles such as these – that are relevant to the general public as well as people such as myself – that help make this site special.
Completely agree with a dislike of distance running as a sport.
John,
Thanks for the compliment. I was wondering if you could shoot me an email when you have a chance. I have a few questions that I think you could certainly help me out with given your background and knowledge base.
Yo can click my name to get to my site and the contact form. That will send it over to me.
Gabriel, Thank you for this article. All frivolity aside it is very interesting to me as I have proven the effectiveness of vibration therapy for knee injury.
When I first came into Vibra-Train I had two injuries, one was a medial cartilage tear in my right knee. Choosing conservative treatment over surgery It was slowly healing but weak and would “catch” when I walked longer distances or uphill. Vibration training at Vibra-Train never hurt my knee whereas other other exercise did.
But, here’s a warning, I visited another brand studio and let them put me through their regular (long) workout. I became fatigued with getting down onto my knees or lying on the floor then getting up again and I twisted sideways quite badly opening the tear in my knee.
Lloyd took my right off the regular workout program and instead I used the Vibra-Train machine that has side handlebars for support (to take some of the pressure off my knees) and I simply did a series of 60second squats and rests). I did this for about 3 weeks 2-3 times a week and my knee settled down again well.
I omitted to say that the vibrations did NOT hurt me knee, it was from being fatigued and so having less muscle support when getting up from lying on a floor.
Forward a year, my knee was strong and I walked/jogged 2 half marathons, then when doing a 3rd within a month of a previous event, I turned sideways to look at a Marshall who was giving instructions (that I knew to be unusual as I’d done the course before). That sudden turn was bad. Once again I tore cartilage, same knee and this time it extended around to the back of the knee. In was working in a job that required me to stand for hours and walk about a small area. My leg became very swollen above the knee and I was in constant pain. My physio is my best friend at these times
Swelling was a serious problem as I had to continue working.
Back to just assisted squats at Vibra_Train which really helped relieve the swelling and the pain. Once again I had reasons not to choose surgery and now after a year my knee is strong and maybe 95% healed. An interesting fact: Xrays show a very wide band of cartilage in my knees, much more than would be expected for my age and activities I’ve participated in. Either I’m just lucky or vibration training has built up the width of cartilage. I don’t have access to original scan or xrays so I don’t know my starting point. I’m more careful now and although I still love walking quite long distances I stroll rather than race walk.
3 points here to do with knee injuries….
(a) In my opinion walking down stairs, toe hitting ground first is very bad for your knees and will aggravate any problem. Landing on your heels might seen strange at first but can help protect them considerably.
(b) Getting in and out of pose incorrectly or without thought is very dangerous. Just as in life it is sometimes the mundane things that injure us.
eg… I once hurt my ankle badly stepping off a curb wrong. Never had an ankle injury all my life playing sports.
(c) I believe anabolic activity can be produced in almost any tissue given precise stimulation. Bone, muscle, cartilage etc…
Hi Lloyd,this probabaly is in the wrong heading so please accept my apaologies.My cousin has been diagnosed with frozen shoulder in both shoulders and is in a lot of pain.He has had injections in them but they havent really helped as of yet.I was wondering if there is any pose/exercise that would help him out.I own a Bodyshaker junior which he can use.I must point out he is a diabetic in his early forties and also complains of hip pain aswell.All help greatly appreciated.
Willie,
First off, I am not trying to step on Lloyd’s toes here and am aware this question was directed at him. I only am responding because this is a subject that I have already begun to work on and feel I can help you out. I have treated several frozen shoulder patients and have found that the vibration platform can be of significant benefit once the individual has moved through the 1st phase of the dysfunction. This is often caused the “freezing stage” and during this phase, too much stimulation of the joint will likely serve to only aggravate the condition. There can be benefits to limited exposure, but often the patient’s fear and extreme pain makes this a tough call. I usually choose to avoid it as it may create a permanent fear in the patient and future exposure may be tough to convince him or her to attempt. Most important thing during this phase is to maintain whatever movement is available, pain management strategies, rest and ice.
During the 2nd phase (”frozen”), exposure to the vibration platform in either Lloyd’s “pushup” or “plank” position is a great way to stimulate blood flow to the region, promote relaxation in the collagen tissue (most important), begin to reactivate unused muscle tissue, and overload the sensory system to temporarily block pain signals. You must immediately stretch the shoulder after exposure during this phase and follow it up with home exercises.
Finally, in the third and final phase (”thawing”), these same poses, along with the tricep pose, serve to further reactivate the muscle tissue and hopefully restablish efficient movement.
There are many other factors to consider with frozen shoulder when deciding to pursue this form of treatment; other medical issues and potential limitations at the top of the list.
Lloyd, again, I apologize for responding to this question and would certainly be grateful to have your input on this subject as well.
Hope that helps Wille.
Di,
Your story is inspiring and it is EXACTLY the type of situation that continues to pop up in my clinic. The vibration therapy has allowed people with extensive histories of injury and reinjury achieve real goals without the “yo-yo” effect of traditional resistance training when it comes to cartilage injuries that do not fully heal.
I think something else to point out when dealing with runners is that your pelvis’ are always out of alignment and I have done in one single session with the vibration platform what has taken me 2 weeks of manual mobilization to achieve. This application will be described further in a future article.
That pelvis stuff sound familiar?
Gabriel, It’s interesting and slightly amusing that I have 3 injury conditions and all 3 are written off in the comments on this article. ( Lloyd has suggested I’ve become accident prone and so is against me skiing in August
)
Knee cartilage, core stability weakened somewhat after a fall left me with gluteus medius injury and nerve pain right down my left leg, made worse by sitting in cars for travel and even watching tv or sitting at a desk (piriformis muscle problem). This was then other injury that was “healed” by vibration training and a large amount of recovery took just 6 weeks. I’d had physio and seen an osteopath regularly for a year previously with good results but not lasting. I’m not going to claim 100% healing as I have a weakness left but have not had nerve pain down my leg for over a year. Any twinge of glutes soreness has be repeating the pelvic stability and stretch positions at the end of my regular program i.e just one repeat makes so much difference.
The in December last year I had two minor accidents compounded by flu which together gave me a rotator cuff injury of one shoulder and a partially frozen shoulder of the other. I could not lift one arm much above horizontal. You are right about using vibration therapy in the 2nd phase although I could not have coped with either position you say to do. This may be dependant on the force of the machine used and if it is lineal or pivotal. I only reintroduced after 4 months and now at 7 months I still do a modified push-up – which is a standing type of push-up only possible on a machine with side vibrating handlebars of which Vibra-Train have the only ones. Again maybe push-up would be possible on a therapy machine of less force than the ones I use. Along with physio hands on massage to break up scar tissue across my back (maybe from a childhood injury or just built up over time) and some shoulder massage, cortisone injections twice, theraband stretches, I used a low force special machine that was in the R&D area. I couldn’t use a regular high force machine except for squat position and I sure proved the term “whole body vibration” as I felt the vibration into my shoulders even with the target muscle group being mostly the quads. One special position I still utilise for ongoing freeing up of my shoulders is simply holding onto the Vibrating handlebar of the Vibra machine with a straight but relaxed arm thereby allowing the vibration to travel along the arm into the shoulder area. (I am standing on the floor not on the platform). This position (not part of the regular problem so it is therapy not training) has been my “life-saver”.
Note: It is not possible on any machine apart from the Vibra-Train so not available to most people. I’d like to see other companies develop machines with side vibrating handlebars or I hope that Vibra-Train will soon be available worldwide so people can get all the benefits I’ve gained. You might laugh and say middle-age, overweight, minor sport activities plus a few accidents have made me a liability to society – which might have been true without access to treatments, the best of which has been vibration training/therapy. I am healthy, fit, regaining strength already more than many people, and I have high energy (I can see Lloyd laughing at that last point).
Sorry, I was interupted while writing – should have written, knee cartilage tear was told of in previous comment, second injury was glutes/piriformis.
Also.. I only reintroduced PELVIC STABILITY after 4 months and now at 7 months I still do a modified push-up.
We get the detractors saying results like mine are anecdotal only but for me they are very real and in each instance except the shoulders I had many months of traditional therapy first, allowing enough for healing but still had pain on beginning vibration training/therapy which was effective after ony a few weeks. I thoroughly recommend it as a part of treatment.
Gabriel….
This is a community, a community you now belong to through your sharing of experiences and advice. The fact you “give” and not just “take” or “use” means you have earnt the right to jump in whenever you want. No apologies ever needed.
Willie….
What Gabriel and Di have said. But a good first move to make is just kneeling in front of the machine , arms outstretched, with hands flat on the plate, head down. ( like Muslim prayer position )
Do not let him force this move, it is NOT a stretch.
Hip pain…. Squat position with support for the arms.
Get back to use with results.
Thank you Lloyd..it is a pleasure to contribute.
Di,
Sounds like you certainly have had no shortage of experience with Physiotherapy. Frozen shoulders can be a nightmare and the 2nd phase can last a year in severe cases. So starting treatment with vibration during this phase can differ from person to person.
Gluteus medius, nerve pain, meniscus…guess the pelvic malaligment things hit home pretty well. I am glad you have found such relief and motivation with vibration training. There will always be detractors…that is for sure.
BTW – I am actually finishing the next part of the knee series which deals with both meniscus tears and patellofemoral pain. i am sure you will have quite a bit to contribute.
Gabriel, thanks for your comments. I am now over 6 months post injury and still have a way to go. The rotator cuff is good and strengthening is now the answer. The frozen shoulder is still a problem especially as, thinking I was stronger than I am, I did it some damage a little over a week ago and then could not lift that arm above my head again for 5 days.
You are right – I’ve had a lot of experience of physio in past 4 years. I’ve found it important to find a practitioner who also has experience in manual therapies (not always the norm here). My Physio has also contributed to my life by guiding and encouraging my process and learning in fitness studies, so along with huge help from Lloyd also I am now a registered Fitness Consultant and my specialty interest is Vibration Training and Therapy.
I am fortunate to not have anything to contribute to patellofemoral pain. I can do shin splints and compartment injury *laughs* and the stupidity of still taking part in a race – just because I wanted the “buzz” of running over our harbour bridge which is normally closed to pedestrians.
Gabriel,
I went to your site and my message did not go through. It said something about spam filter, to type in the 7th word, and there weren’t any words there. I will try again another time.
Sorry about that….web design flaw. Email me at ptgde at hotmail dot com. Look forward to chatting.
just realized I put your name in the name box…oops
Gabriel,
Email Lloyd if you have his email and he can give you mine.
lloyd, gabe, and DI,
Thanks so much for the plethora of information. I royally blew my knee out snowboarding this year and seems like I have hit a roadblock with my recovery. It was suggested to me to look into vibration therapy, and I stumbled upon this site.
Not even counting all the described benefits stated throughout this site, this article/comments alone has persuaded me to purchase a machine. I can only hope that through determination and hard work that I can have a success story like DI’s.
This knee injury is a real pain in the ass when trying to find that ‘fine line’ of exercise/rest ratio. A vibration machine looks like it will help me get some exercise without having to work my knee in a negative manner…and help rebuild it at the same time.
Just wanted to say thanks =)
Dom,
Glad you found the information on this site helpful. Be sure to read through the articles on this site thoroughly before making a purchase and make sure you are performing the exercises on the platfom properly and with caution. “Desperate” users can easily overuse the platforms. Good luck and be sure to get back to us once you have started you vibration therapy regimen.
May I ask…can you define “blew out”? Assuming a ligament injury? Did you have surgery?
Gabriel,
Yes, this site is an amazing resource for reviews/info on specific machines as well. I was considering going with a Vibraslim until I read:
http://www.vibrationtraining.net/2007/10/warning-to-home-users-heres-how-you-are-getting-cheated/
The post and most comments pertaining to the vibraslim are almost 2 years old. That said, it looks like vibraslim has a newer model, but still way iffy.
Other than the Vibraslim consideration, I saw that lloyd recommended the HyperGravity and the Wave…since I currently live in Southern California. HyperGravity looks beefy and more of a solid product…with a fitting pricetag to boot. No displayed price for the Wave.
Even though the Vibraslim looks like a total ripoff, I was curious to opinions of whether or not it would benefit my rehab at all…or have a negative effect. Also, I saw a link to the Pineapple gyms/machines. Any comments on those machines for rehab?
A little about my injury since you asked; Overshot a landing, basically falling ~30 feet down, almost completely onto one leg, onto ice. Wasn’t pretty. I compressed my knee so that I caused severe trauma to the cartilage and chipped a little piece off my femur. I also tore all (that I am aware of) the muscles in my calf area and around my knee.
Muscles are all healed(but atrophied) and I have been nicely recovering via stretching techniques/herbal supplements, and my knee has been doing wonders as of late. For normal walking around the house/short trips I don’t need to use a cane anymore. But my range of motion is still at about 90% and the knee still has slight swelling. My circulation is a problem right now too…feet get cold easily, etc etc.
My injury has prevented me from basically living life like what it once was. The last thing I want is surgery, so I have been taking the best care of it that I possibly can. Extreme sports may not be in my future anymore, but I still would like to have an active life where my knee can be used.
If a vibration machine can effectively assist the healing then it will be a small price to pay to get my life as a whole back on track. And from the user comments, it looks like it will! …as long as I pick the right machine and use it properly.
Any more advice or paths in the right direction would be greatly appreciated!
Hi Dom, I suggest you have a talk to the guys at Wave and see if you can arrange a demo of their machine. They are physios and will guide you.
Wow…that’s a rough one! Sounds like you are doing well despite the trauma though. Muscle can always be built back up (unless the nerve is damaged of course). The circulatory issues seem like a major component of the final steps of the recovery too but that should also be responsive to the vibration training. The “loose body” (bone chip) will certainly potentially create a bit of recovery yo yo if it interferes with range of motion. These chips have a tendency to move around a bit and with vibration, you need to be prepared for that possibility. Has that been the case? If not, I wouldn’t be concerned.
I am not sure about Wave. From my understanding, it is more of a therapy platform than a training platform and it seems you are stradling two worlds here (therapy and training). Probably good to get Lloyd to weigh in here.
If you are in Southern CA, take a trip to Hypergravity and demo the platform anyway. Be sure to go twice as the first time may be unreliable for getting the feel of this unique form of training. I have used it with success on several individuals in your situation. The strength / hypertrophy (muscle building)results take some time and require work, but things like circulatory changes and ROM improvements (which go hand in hand) are quite rapid. Again, Lloyd would be a good source of whether or not the safety program he has created is the way to go for you given your goals.
Hope that helps. Di made a good recommendation though so talk to the people at Wave and see how they differ.