What Works for Pain Part 2: Whole Body Vibration
When you hear “whole body vibration exercise”, it’s hard not to think of the vibrating bands in the 50’s young people were using in lieu of REAL exercise. After all, standing on a plate that jiggles just doesn’t seem like enough work to be good for you.
The concept of vibration for wellness began much earlier. In 1895, in fact, the same guy who brought you cornflakes, Dr. Kellogg, included sessions on a vibrating chair as part of his wellness routine. Vibrating for health fell out of vogue, but in the 60’s Russian cosmonauts were including vibration as a mechanism to build up bone mass to withstand the effects of zero gravity.
The reason vibration is making a comeback, and the reason it worked for the cosmonauts, is multifaceted. Most cells in the body perform their functions via protein channels. These convoluted 3-d mini-mazes in the cell wall allow everything from ions to molecules to proteins in and out of the cell. If you think about an ion like sand going through an hourglass, you get the idea of how protein channels limit the in and out motion and productivity of the cell. Now imagine tapping the hourglass - everything gets through faster. On the most basic level, whole body vibration works for bone density and function because all the tiny movements of the joints, bones and tendons undergo tiny stresses at a really fast rate, and it efficiently affects a lot of body parts at once.
While any long-term changes in tendon or bone strength will help pain, the short term gains are probably from a different source, called gate control. Long-term, when you’re stronger, you can withstand the tiny accumulation of pulled muscles from getting out of balance or accidentally pulling harder than a joint can take. For pain, though, vibration stimulates a motion nerve (the Abeta nerve) that runs alongside the sharp pain nerve. These two nerves and a temperature sensing “C fiber” travel together to the spine, and send one summary message to the brain. Jiggle something enough and the brain only gets motion, not pain (like when you rub a bumped elbow or shake a finger you’ve slammed).
While many studies find local vibration effective for pain at about 150 jiggles/second, it’s hard to do that with a whole plate with someone sitting on it. Most research on whole body vibration is pretty low frequency, about 10-30 shakes per second, or 10-30Hz - still pretty fast! Many of these also are looking at varied amounts of daily use over a varied number of weeks. Nonetheless, whether because of stimulating the growth centers through faster protein channel functions, or whether the natural subtle pulling and pushing from vibration builds strength, the overwhelming consensus from randomized controlled trials is positive. Whole body vibration decreases musculoskeletal pain.
While the research on non-specific or whole body pain (e.g. fibromyalgia) is less supportive, new research for other kinds of pain like diabetic neuropathy and burn pain are encouraging. Recent evaluation of local vibration in higher frequencies supports both pain relief and healing, but I will cover that in a future post.
There is a great deal of support for whole body vibration and performance and athletic recovery. American-made vendors like VibePlate have been supplying the fitness and elite athlete community for years. For pain, there is sufficient information to support that if you hurt and someone offers you a ride on a jiggling chair, say YES! As a recent orthopedics magazine noted, it’s time we’re less skeptical of good vibrations.
Whole Body Vibration Therapy
What is it?: You stand or lie down on a plate that wiggles or goes up and down
Does it work?: Yes, for low back pain, improved strength, rheumatoid arthritis, osteoarthritis, healing burns
Why does it work?: Subtle loosening of tight joints and muscles reduces long term pain; Gate Control stimulation of motion nerves (ABeta) block out some pain while you’re doing it, like rubbing a bumped elbow; perception centers in the brain focus on motion, not pain. Vibration stimulates repair of bones and tendons, and activates and strengthens muscles which protect painful areas.
When doesn’t it work?: Fibromyalgia patients might have had slight improvement in quality of life, but studies weren’t great quality and it didn’t work well for pain. For autism behaviors, vibration plates weren’t effective. Osteoarthritis outcomes were mostly positive, but mixed.
Who shouldn’t do it?: Out of 33 studies, two cases of bleeding and one kidney stone that may have been shaken loose were the worst complications. People with Raynauds may also find vibration decreases circulation in their hands or feet.
What don’t we know?: We still don’t know the optimal Hz (frequency) for pain relief, and we don’t know whether extended use at high amplitudes will cause nerve damage. Rats and jackhammer operators show nerve damage with prolonged exposure to intense (high amplitude) vibration. While the much lower amplitude of most plates is unlikely to cause problems, extended use of vibration more than 30 minutes at a time hasn’t been proven to be safe.
How to do it: For pain, 15-30HZ (900 - 1800 RPM) for 15 minutes twice a week is the best studied. Either just stand or sit, or do very gentle bends and movements while on the plate.
Scand J Med Sci Sports. 2017 Feb 10. Whole-body vibration training as a workplace-based sports activity for employees with chronic low-back pain. 2.5x/week x 3 months
Kaeding TS1, Maddalozzo G, Guzman RJ, Dvorak RV, Maddalozzo WA, Milroy DA, Koshinski RS. Whole body vibration: an effective treatment for painful diabetic neuropathy. J Pain Relief. 2015; 4(2):1-4.
7. Cochrane DJ, Stannard SR, Firth EC, Rittweger J. Acute whole-body vibration elicits post-activation potentiation. Appl Physiol. 2010;108(2):311-319
Wang LZ, Zhao M, Ma J, et al. Effect of combining traction and vibration on back muscles, heart rate and blood pressure. Med Eng Phys 2014;36(11):1443-1448
Fibromyalgia: Moretti E et al. Disabil Rehabil. 2017 Feb 10:1-12. Efficacy of the whole-body vibration for pain, fatigue and quality of life in women with fibromyalgia: a systematic review.