As a Physical Therapist, I often encounter individuals who suffer from more complex and often painful conditions.

These individuals, whether it is their joints (Rheumatoid Arthritis), their tendons or bursae (Connective Tissue Rheumatism), their muscles (Regional Myofascial Pain Syndrome) or their whole entire body (Fibromyalgia), struggle day in and day out with nowhere to turn.

Since I have utilized Vibration Therapy to treat these patients, one thing has been clear; the ability they have to push their bodies physically while reducing their pain is unlike any other intervention. Vibration Therapy as well as Vibration Training, when done correctly and safely, is a highly beneficial exercise program with little to no negative musculoskeletal stress.

Due to the unique complexities of the issues mentioned above, they are deserving of their own articles. My goal with this article however, is to raise awareness to another condition that in itself is a problem and can benefit from Vibration Therapy. A condition that has an increasing amount of connectivity to each of the above mentioned conditions…..

“Benign Joint Hypermobility Syndrome (BJHS)”

Definition:

This medical diagnosis, inaccurately termed “benign” usually takes anywhere from 2 – 5 years to be identified and properly diagnosed. It is defined as “the occurrence of musculoskeletal pain in and around hypermobile joints (otherwise referred to as joints with “loose” or “lax” ligaments) in the absence of systemic rheumatological disease”. The latter portion, I believe, is inaccurate as a general rule however, and time will likely prove this point.  So how exactly does BJHS become problematic and how does Vibration Therapy help?  It all starts and ends with communication.

Lost In Translation:

By nature, the function of ligaments is to provide stability to our joints. This stability allows the primary movers of our joints, the muscles, to carry out their functions efficiently. Surrounding all muscles and ligaments, and connecting everything together, is fascia. Within the ligaments, muscles, and fascial tissue are “reporting stations” (aka joint receptors) whose vital function is to relay the information relating to these specific tissues to our brain. This communication system is called Proprioception. This crucial information traveling to the brain determines the nature of the information going away from the brain. It is a two way street of dependency and includes not only messages to and from the connective tissue, but to and from other vital body functions. This information also dictates the release of nutrients and neuropeptides. Neuropeptides control our mood, energy levels, pain and pleasure reception, body weight, and ability to solve problems; they also form memories and regulate our immune system.

When these systems, as a result of hypermobility and the resulting movement dysfunction, become inefficient, the information systems become altered. This leaves us, with a reversal of roles (tight muscles and fascia around loose joints), and both an alteration in the transmission of the nutrients and neuropeptides as well as detrimental changes in circulation and oxygen supply. For the muscles fortunate enough to maintain their normal function, they inevitably compensate, become overworked, and develop internal dysfunction (Ever heard of a “trigger point”? That is internal dysfunction of a muscle).  Finally, to complete the downward spiral, with all of the above considered, the end result is unavoidable stress to the joints and their internal structure.

Re-establishing Communication and Function via Vibration:

To effectively treat BJHS you must selectively harness the mechanical energy of the platform to create proper restorative changes to “the system”. This can be accomplished in several ways:

• Increasing Local Circulation – Utilizing the muscle spindle (a reporting station) and the stretch reflexes it creates, we can rapidly restore local blood flow. In BJHS, this is crucial for restoring oxygen supply to the muscles so that trigger point (aka “knots’) reduction can occur. With reduced internal muscle tension, the muscle’s efficiency is restored, and there is improved permeability of the tissue to nutrients and fluids, including water. Water, a vital component of fascia further allows for improved connective tissue mobility. With better circulation and improved tissue mobility, tissue healing occurs more rapidly and restricted areas where nerves perforate the connective tissue are released. This all contributes to the mechanism by which we experience pain relief.
• Improving Muscular Stability – Through excessive stimulation of the muscle spindle, we can increase the tone (resting tension level) of the muscle. Normally known for aesthetic benefits only, in BJHS, this assists in creating muscular stability for a joint that is unsupported by its ligaments. Being that excessive mobility is where this syndrome originates, this benefit gets to the “root” of the problem and is the most crucial component of restoring normal function and eliminating pain.
• Improving Muscle Flexibility – For those muscles that have become shortened in an attempt to stabilize the joints, we can now utilize selective stretching positions on the platform to normalize their length. In this case, we utilize vibration and the overwhelming sensory feedback that it provides to “hush” the muscle spindle so that a rapid increase in length of the muscle is achieved. This must be done slowly and carefully to avoid harming the tissue.
• Improving Lymphatic Mobility – Although this is not specific to BJHS, the rapid amount of muscle contractions created by the vibration platform assists lymphatic system mobility. By stimulating the millions of one-way valves in this system, Vibration Therapy further improves the diffusion and movement of fluid between the cells. Better fluid movement means better cell health and improved tissue repair rate.
• Restoring Normal Communication – Finally, through stimulation of the proprioceptive system and its reporting stations that have been discussed in length already, we are able to improve body communication; this includes the speed, accuracy, and appropriateness of the information that is transferred between the body and the Central Nervous System. This restoration process, deserving of its own 100 page article, is the final step in maximizing the therapeutic applications of Vibration Therapy for BJHS.

Written by Gabriel Ettenson, MSPT

Gabriel is a Physical Therapist in NY, NY

You may contact him at equilibriumpt.com

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

www.equilibriumpt.com- NY Physical Therapy

In my previous article, I discussed the first two of four phases of a Vibration Therapy treatment protocol.

The final stages of this protocol include the flexibility and strengthening phases; usually occurring simultaneously.

In an effort to avoid redundancy on subject matter covered so thoroughly in previous articles written for this site, I would rather “move on” and turn my attention to the central nervous system while pondering the question, “what is all this vibration doing to our brains?”

Vibration and Stress

Many studies over the years have suggested that vibration, imposed on the human body through an external device, is an example of a harmful mechanical stress on the body, and can therefore have a significantly negative impact. In this case, as many individuals might think, the word stress is used to describe, as defined by Merriam -Webster, “a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation.”

However, this word has many definitions and for the vibration training and vibration therapy devotees out there, those who have experienced the euphoric feeling of 2400 involuntary muscle contractions in 60 seconds, stress is better defined as “a force exerted when one body or body part presses on, pulls on, pushes against, or tends to compress or twist another body or body part.” It is through the POSITIVE impact on the central nervous system that this type of mechanical stress keeps my training clients and physical therapy patients hungering for more.

The Effects of Vibration on the Central Nervous System

So…How is this form of stress responsible for the happiness some people experience as they laugh their way out the door from a WBV session; the “freedom of movement” that they speak about so often; the sudden burst of energy described by my clients in e-mails the day after using the Hypergravity platform; the ability my stiff arthritic patients have to “bounce” up the spiral staircase leading out of my building? On more than one occasion, I have even heard of enhanced psychic abilities …no lie!

If their brains and spinal cords had a voice, I believe they would answer these questions with three words: Neurogenesis, Serotonin, and Endorphins. These three things, time and time again, have all been positively linked to exercise. Even better, they have all been linked through legitimate scientific research (and to think, here in NY, everyone wants rats to be exterminated!).

Neurogenesis refers to the creation of new nerves, and occurs in an area of the brain known as the hippocampus, the same region where learning and memory occur. The process of neurogenesis, according to researchers, has to do with exercise stress-induced formation of a brain protein (known as BDNF) whose job it is to not only create new neurons, but to protect the existing neurons and enhance communication between them (otherwise referred to as synaptic plasticity). It is through synaptic plasticity that all learning and memory can occur in the brain. This includes muscle memory and motor learning, two important concepts that are clearly enhanced through WBV.

Now, as BDNF levels rise in the brain, so do the levels of another brain protein referred to as SERT. I can happily say that this protein is responsible for increasing serotonin levels in the brain. For those who are unfamiliar with serotonin, it is a type of chemical, called a neurotransmitter, that is responsible for mood elevation, feelings of ecstasy, increased sexual desire and function, and improved sleep. What more can you ask for in life, I ask?–How about a “runner’s high?”

“Runner’s high” is a term used to describe what is otherwise known as an endorphin rush. Endorphins are chemicals released by the pituitary gland in response to stress (there’s that word again) or pain. In general, it takes up to 30 minutes to release endorphins through traditional exercise, but with more intense “hyper”stimulation of the central nervous system, such as that with vibration training, this release occurs much more quickly. Once released, endorphins do everything from blocking pain to creating a sense of euphoria or exhilaration. Interestingly enough, endorphins bind to the same receptors in the brain as heroin and morphine (anyone ever heard the term “addicted” from their clients?) and by blocking pain, it is theorized that this is what allows for the continued presence of serotonin in the brain. See the connections here everyone?

Although more research is still required, there is a clear potential connection between whole body vibration, increased central nervous system stress, relief from pain, mood elevation and exhilaration, and, most importantly, neurological brilliance. These are just a few more bullets on the growing list of benefits of vibration training and vibration therapy. They are also just a few more reasons that we need to keep fighting to establish its legitimacy, and hopefully open everyone’s eyes, and brains, to its incomparable value.

Written by Gabriel Ettenson, MS, PT. He is the owner of Equilibrium Physical Therapy in New York City. He can be reached through equilibriumpt.com.

Although Neuromuscular Re-Education has no universally accepted definition, it generally refers to a treatment technique or exercise performed by an individual with the purpose of improving, via the nervous system, the level of communication between the body and the brain.

Because of the fact that vibration training and vibration therapy exercises rely on the involuntary stretch reflex, there is a significant amount of communication occurring between the brain and the contracting muscles with each individual exercise.

This serves to “jump start” the muscle through the severely high frequency of muscle contractions thereby enhancing the patient’s ability to efficiently recruit the muscle fibers, coordinate movement being performed by the joint, and muscle tissue, and reduce the typical post-injury mechanical dysfunction in a much more rapid fashion than traditional exercise; exercise that relies on voluntary movement.

This is often best demonstrated by having the patient perform a multi-planar exercise (an exercise that combines movements along several planes of motion. For example, raising a weight from the floor, in front of your left leg, to overhead using the right arm. This movement requires that the weight be raised up (sagittal plane), moved left to right (frontal / coronal plane) and rotated from in front to behind during the motion (transverse plane).

Proprioceptive Training

Also built in to the neuromuscular re-education process of this phase is something referred to as proprioceptive training. Proprioception is defined as the sense of the relative position of neighboring parts of the body. The proprioceptive system provides feedback solely on the status of the body internally. It is the sense that indicates whether the body is moving with required effort, as well as where the various parts of the body are located in relation to each other (thank you Wikipedia!).

In my practice it is joint position that is of primary concern to my patients. Much like in Phase 1 mentioned above, proprioceptive information is sent to the brain by certain receptors in the joints so while performing an exercise on the platform, this positional information “battles” the vibratory information already being overwhelmingly supplied to the brain. With careful consideration to the position being held during an exercise on the platform, certain case-specific movements can be performed in adjacent regions with the intention of actively enhancing the proprioceptive information being sent to the brain by those regions.

Successful enhancement of this proprioceptive communication is best measured by having the patient perform a simple region-specific proprioceptive exercise before and after exercising on the platform (i.e. pelvic clocks – #1 below or single leg balance exercises – #2 below)

#1

What is even more exciting about this phenomenon is that, in some cases, the proprioceptive benefits are seen in regions located far from those being stimulated. In the articles to follow, I will discuss the 3rd and 4th phases of treatment as well as other areas that have peaked my interest and that of my patients as well.

Written by By Gabriel Ettenson, MS, PT

Gate Control Theory

In order to understand this phase, it is important to understand the gate control theory.

This theory states that throughout the nervous system of the human body are many types of nerve fibers responsible for relaying all the sensory information from our limbs, tissues, and organs to our brain.

One type, collectively known as nociceptive nerve fibers, is responsible for providing us with the unfortunate sensation of pain. On the other end of the spectrum lie another group of nerve fibers known collectively as non-nociceptive fibers. These fibers provide information related to all non-painful stimuli; among which is vibration.

By utilizing the vibratory feedback of the machine on a painful area, one can successfully assist in “closing the gate” and therefore reduce the level of pain being experienced by the individual. Ever bump your head and immediately start rubbing the area you bumped? How about shaking the area immediately after the trauma? Those are examples of you trying to “close the gate”.

How Vibration Therapy is Applied.

Through selective, carefully applied exposure (direct or indirect, depending on the area) of an injured region to the vibration platform, the significantly high level of vibratory information being absorbed by the individual’s body helps temporarily override the pain information being sent to the brain.

The brief window of opportunity provided by this phenomenon, a window that can stay open for longer and longer periods of time with multiple treatments, allows the patient to increase their joint and tissue mobility, painlessly contract the muscles more forcefully, and tolerate what would otherwise be considered intolerable manual therapy treatment techniques. Additionally, through exposure to the vibration, local blood flow is increased to the region thus helping to further create a state of relaxation in the surrounding muscle and improve lubrication of the surrounding joints.

In the clinic, success is best measured through subjective reports of pain (0-10 pain scale) and range of motion testing (how far a body part can move without pain). In most cases, these two measurements improve simultaneously.

Next week I’ll discuss the second use of Vibration Therapy which is neuromuscular re-education.

Article written by Gabriel Ettenson, MS, PT

After approximately 18 months of reading, contemplating and theorizing, over 6 months of tests and trials on over 100 willing participants in the form of physical therapy patients, and one inspirational “debate” on this site, I determined that it was time for me to sit down and organize my thoughts and experiences thus far with vibration therapy.

I am presenting these thoughts and experiences to you, fellow vibration enthusiasts; thoughts and experiences brought about through careful analysis and cautious experimentation. My intention here is to do nothing more than provoke thought and encourage further discussion on the present and future applications of vibration THERAPY.

For the “research obsessed” readers, before the smoke billows out of your ears, note that I do fully realize that most of what I am presenting here is not indisputably backed by research nor am I suggesting that anyone else utilize my methods without carefully considering whether these methods are appropriate for their individual clinical situations. In the words of fellow forum visitor Larry Leigh,

“In the end result, even though health professionals preach ‘evidence-based practice’, they all use methods and techniques which WORK FOR THEM. They cannot always produce 10 research studies which back up that particular technique.”

I am aware that my usage of a whole body vibration platform for therapy may be considered too experimental by some, but it is not without thought, experience, and consideration of well established scientific principles. In the words of the Seneca Indian tribe, “It’s not because things are difficult that we dare not venture. It’s because we dare not venture that they are difficult.” The only way to continue to evolve the science and legitimacy of these amazing devices is to continuously ask yourself, “what if?”.

Origins

As a Physical Therapist, I spend a great deal of time “manipulating” my patient’s bodies. Through successful “manipulation” of their musculoskeletal system, lymphatic system, circulatory system, and nervous system, I am able to reduce pain, encourage tissue healing, restore efficient movement, strengthen their bodies, and promote long term health and wellness.

Throughout my 10 years working with patients it has been the nervous system that has proven to be the most challenging of all to manipulate and it is because of this difficulty that I became interested in whole body vibration (WBV) and the concept of vibration therapy.

Initially, I only viewed WBV as a select means to utilize the nervous system, via the stretch reflex, to rapidly strengthen my patient’s weak muscles and in doing so, improve their motor function. Having done little research at the time, I did not realize how many other potential benefits it could potentially provide to my patients; benefits that I will discuss in more detail later. Finally, after reading through as much of the research and information as possible, spending hours browsing through posts on this site, trying out several platforms, and speaking with several WBV manufacturer representatives, I chose a Hypergravity platform (not a plug…I swear!), typed up my WBV waiver, and prepared to revolutionize my practice.

Well, it didn’t quite go as planned! When it came time to use it with my patients initially, I found myself questioning whether a majority of my patients were appropriate candidates for vibration therapy. What was the reason behind this hesitation you ask? They all shared a common feature….they were in PAIN! I had become so consumed with the idea of strengthening that I failed to realize that most people at the strengthening phase of their therapy program were already used to other forms of exercise and were therefore less “pliable” to newer, unfamiliar forms of strengthening.

It was the patients in the early phase of treatment that needed to be introduced to vibration therapy and I couldn’t quite figure out how to do that without potentially flaring them up and forcing them to “run for the hills”. My inexperience, fears of malpractice suits, and the difficulty finding reliable information on vibration therapy began to quickly overpower my drive to provide a new, unique, and potentially beneficial form of treatment to my patients. Fortunately, one of my patients, a pain management researcher at Sloan Kettering Hospital in New York, reintroduced me to the Gate Control Theory.

By applying this theory, I realized that the vibratory feedback of the machine itself could be the key to not only introducing my patients to vibration therapy gently, but to creating immediate reductions in their pain levels therefore allowing them to further progress and eventually experience the many other benefits of vibration therapy. The benefits presented so clearly in the previous articles on this site. After success with several patients, I developed a vibration therapy progression that has, thus far, proven quite helpful in efficiently and thoroughly rehabilitating my patients; no matter what their needs be.

Next week I’ll define Gate Control Theory and explain how this theory is used in relation with WBV to help my patients.

Written By Gabriel Ettenson, MS, PT