Vibration. by: J. Stephen Guffey, PT, Ed. D.

Transcription

1 Vibration Therapy Applications Manual by: J. Stephen Guffey, PT, Ed. D.

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3 Table of Contents Introduction 4 Contraindications 5 Treatment Instructions 6 Balance and Fall Prevention 7 Knee Rehab 8-9 Low Back CVA / Stroke 12 Sketetal and Osteoporosis 13 Circulation 14 Range-of-Motion and Stretching 15 General Strength 16 Research References 17-20

4 INtroduction Vibration therapy is an exceptional addition to the clinician s toolkit for the purposes of increased strength, improved balance, and improved flexibility. Using a moderate degree of creativity, the clinician can incorporate the vibration platform into most exercise programs. This clinical manual is intended to serve as a starting point for the user. It would be impossible to list the entire universe of exercises that could be performed with the device. Indications for treatment are generally the need for increased strength, balance, muscle endurance, and flexibility. Not all exercises outlined in this manual are appropriate for all patients. The rate at which a patient progresses through a series of exercises is left to the discretion of the clinician. Science Behind Whole Body Vibration Whole body vibration is a neuromuscular training method which uses a vibration stimulus to incite an involuntary response in muscles. Mechanoreceptors (muscle spindles and Golgi Tendon Organs GTO) are the sensory organs of the muscle which are sensitive to mechanical stimulation. Muscle spindles send information to the brain regarding the tension of the muscle, causing the muscle to contract when excited. Conversely, when the GTO (located where the tendon and muscle meet) is excited, it causes the muscle to relax. When stimulated by vibration, the muscles spindles, tendons and GTO send impulses to the brain and cause the muscles to contract and relax at the rate of vibration, a phenomenon called Tonic Vibration Reflex (TVR). This response recruits nearly 100% of the muscle fibers in contraction and enhances neuromuscular efficiency. Skeletal muscles contract and release at the same frequency of the vibration, for example if standing in a squat position on the vibration platform set at 30 Hz, muscles will contract and release 900 times in a 30- second session.- impossible to simulate during a normal exercise regime. The mechanical rationale behind using a whole body vibration platform is a simple, yet powerful formula: Force = Mass X Acceleration. In traditional strength training, force production is primarily affected by Mass or increasing load by adding weight to an exercise. In whole body vibration therapy, we look at the acceleration variable. The acceleration variable is increased as the result of the platform rapidly moving up and down at a specific frequency. Acceleration is controlled by two key variables: Amplitude While all vibration devices produce vibration in three different directions front and back (x), sideways (y), and up and down (z), the most safe and effective platforms produce sufficient vertical vibration while limiting vibration in the horizontal plane. Research has shown that significant vertical amplitude (2-6 mm) is required to generate

5 adequate loading on both the muscular and skeletal systems. Conversely, vibration in the horizontal plane may cause significant side effects after prolonged use. Z Frequency - Frequency (Hz) is equally important. Research shows that the body responds positively to vibration in the Hz range. The acceleration forces X resulting from vibration cause the muscles to contract. Due to this involuntary contraction of the muscles, many more muscle fibers are recruited than in a voluntary movement (Issurin & Tenenbaum 1999). This is confirmed by heightened EMG activity (Bosco et al. 1999, Delecluse et al. 2003). This rapid contraction and relaxation of muscles at 25 to 50 times per second works as a pump on both the circulatory and lymphatic systems, increasing the speed of blood flow and lymphatic drainage throughout the body (Kerschan-Schindl et al. 2001; Lohman et al. 2007). CONTRAINDICATIONS Due to the nature of vibration therapy, patients should not use this device if the following conditions apply: Y Pregnancy Hip or knee implants Pacemaker Recently placed screws, pins, bolts or spirals Acute hernia, discopathy, or spondylitis Serious cardiovascular disease or any heart condition Acute thrombosis or blood clots Epilepsy Serious diabetes History of detached retina Advanced arthrosis, arthropathy, and advanced RA General Instructions To avoid possible injury: Do not lean back on the heels during treatment. Do not straighten the legs when standing upright on the platform. Rubber-soled shoes are recommended during treatment. Use contoured mat when barefoot, wearing socks, or anytime the body comes into direct contact with the platform during treatment.

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7 Balance and Fall Prevention Treatment Parameters Frequency: 30Hz Amplitude: Low Treatment / Rest Times (seconds) 30s / 90s beginning 30s / 60s intermediate 30s / 30s advanced Total Treatment: 3 10 min. Treatment Recommendations Sessions to include warm up and cool down with mix of resistance, balance and flexibility exercises. 2-3 times per week, 4-12 week program. Employing short form survey (SF-36) and/or Get Up and Go tests for patient evaluation is recommended. Exercises 1. Double-leg stance, knees slightly bent, weight towards the balls of the feet. 1.1 Eyes open, hold stability bar. 1.2 Eyes open, release stability bar. 1.3 Eyes closed, release stability bar. 2. Double-leg stance, dynamic mini-squat, weight towards the balls of the feet (3-4 sec. cycle). 2.1 Eyes open, hold stability bar. 2.2 Eyes open, release stability bar. 2.3 Eyes closed, release stability bar. 3. Single-leg stance, knee slightly bent, weight towards the balls of the feet, alternate legs. 3.1 Eyes open, hold stability bar. 3.2 Eyes open, release stability bar.

8 Knee Rehab Treatment Parameters Frequency: 30Hz Amplitude: Low Treatment / Rest Times (seconds) 30s / 90s beginning 30s / 60s intermediate 30s / 30s advanced Total Treatment: 3 10 min. Treatment Recommendations Sessions to include warm up and cool down with mix of resistance, balance and flexibility exercises. 2-3 times per week, 4-12 week program. Employing short form survey (SF-36) for patient evaluation is recommended. Exercises 1. Place limb on vibration platform (30s / 30s) 1 3 sets. 2. Double-leg stance, static mini-squat, weight towards the balls of the feet (3-4 sec. cycle). 2.1 Eyes open, hold stability bar. 2.2 Eyes open, release stability bar. 2.3 Eyes closed, release stability bar. 3. Double-leg stance, dynamic mini-squat, weight towards the balls of the feet (3-4 sec. cycle). 3.1 Eyes open, hold stability bar. 3.2 Eyes open, release stability bar. 3.3 Eyes closed, release stability bar.

9 4. Double leg stance, dynamic calf raises (3 4 sec. cycle). 4.1 Hold stability bar 4.2 Release stability bar 5. Double-leg stance, dynamic knee bend 45, weight towards the balls of the feet (3 4 sec. cycle). 5.1 Eyes open, hold stability bar. 5.2 Eyes open, release stability bar. 5.3 Eyes closed, release stability bar. 6. Double-leg stance, dynamic knee bend 45 to calf raise (3 4 sec. cycle). 6.1 Eyes open, hold stability bar. 6.2 Eyes open, release stability bar. 6.3 Eyes closed, release stability bar. 7. Dynamic hamstring curl w/strap (30s / 30s) 1 3 sets. 7.1 Eyes open, hold stability bar. 7.2 Eyes closed, hold stability bar. 8. Forward static lunge (30s / 30s, 3 5 sets). 9. Forward dynamic lunge, 3-4 sec cycles (30s / 30s) 3-5 sets.

10 Low Back Treatment Parameters Frequency: 30Hz Amplitude: Low Treatment / Rest Times (seconds) 30s / 90s beginning 30s / 60s intermediate 30s / 30s advanced Total Treatment: 3 10 min. Treatment Recommendations Sessions to include warm up and cooling down with mix of resistance, balance and flexibility exercises. 2-3 times per week, 4-12 week program. Employing short form survey (SF-36) for patient evaluation is recommended. Exercises 1. Double-leg stance, knees flexed 10-15º, weight towards the balls of the feet, slight pelvic tilt. 1.1 Eyes open, hold stability bar. 1.2 Eyes open, release stability bar. 1.3 Eyes closed, release stability bar. 2. Double-leg stance, dynamic (lordosis to slight kyphosis) pelvic tilt (3-4 sec. cycle), weight towards the balls of the feet (30s / 60s). 2.1 Eyes open, hold stability bar. 2.2 Eyes open, release stability bar. 2.3 Eyes closed, release stability bar. 10

11 3. Wide double-leg stance, knees slightly bent, weight towards the balls of the feet. Dynamic left to right weight shift (30s / 60s). 3.1 Eyes open, hold stability bar. 3.2 Eyes open, release stability bar. 3.3 Eyes closed, release stability bar. 4. Double-leg stance, dynamic squat 45 (3 4 sec. cycle). 4.1 Eyes open, hold stability bar. 4.2 Eyes open, release stability bar. 4.3 Eyes closed, release stability bar. Advanced 5. Medicine ball exercises, knee bent (30s / 30s) 1-3 sets. 5.1 Eyes open, core muscles engaged, raise ball from waist to overhead. Maintain neutral pelvic position. 5.2 Eyes open, core muscles engaged, therapist tosses ball from short distance directly at patient, waist height. 5.3 Eyes open, core muscles engaged, therapist tosses ball from short distance for patient to catch, just to right of center and then left of center. 6. Resistance band isometric crunches 3-4 sec. cycle (30s / 30s) 1-3 sets. 6.1 Eyes open, holding bands in both hands with elbows flexed to 90, knees slightly bent. Perform standing isometric crunches. 11

12 CVA / Stroke 12 Treatment Parameters Frequency: 30Hz Amplitude: Low Treatment / Rest Times (seconds) 30s / 90s beginning 30s / 60s intermediate 30s / 30s advanced Total Treatment: 3 10 min. Treatment Recommendations Sessions to include warm up and cooling down with mix of resistance, balance and flexibility exercises. 2-3 times per week, 4-12 week program. Employing short form survey (SF-36) and/or Get Up and Go tests for patient evaluation is recommended. Note: Not all patients with hemiplegia are appropriate for this treatment approach. Obviously, the patient must have the ability to remain standing with only moderate assistance to benefit from the technique. The involved leg techniques are clearly advanced exercises. Exercises 1. Double-leg stance, knees slightly bent, weight towards the balls of the feet. 1.1 Eyes open, hold stability bar. 1.2 Eyes open, release stability bar. 1.3 Eyes closed, release stability bar 2. Double-leg stance, dynamic mini squat (3-4 sec. cycle), weight towards the balls of the feet. 2.1 Eyes open, hold stability bar. 2.2 Eyes open, release stability bar. 2.3 Eyes closed, release stability bar. 3. Single-leg stance, knees slight bent, weight towards the balls of the feet, alternate legs. 3.1 Eyes open, hold stability bar. 3.2 Eyes open, release stability bar. 3.3 Eyes closed, release stability bar.

13 Skeletal & Osteoporosis Treatment Parameters Frequency: 30Hz Amplitude: Low Treatment / Rest Times (seconds) 30s / 30s Total Treatment: 5 10 min. Treatment Recommendations Sessions to include warm up and cooling down with mix of resistance, balance and flexibility exercises. 2-3 times per week, 4-12 week program. Employing short form survey (SF-36) and/or Get Up and Go tests for patient evaluation is recommended. Exercises 1. Seated on a chair on the floor, place one leg on the platform, alternate legs. 2. Double-leg stance, knees slightly bent, weight towards the balls of the feet. 2.1 Eyes open, hold stability bar. 2.2 Eyes open, release stability bar. 2.3 Eyes closed, release stability bar. 3. Walking in-place. 3.1 Eyes open, hold stability bar. 3.2 Eyes open, release stability bar. 13

14 Circulation Treatment Parameters Frequency: 30Hz Amplitude: Low Treatment / Rest Times (seconds) 30s / 90s beginning 30s / 60s intermediate 30s / 30s advance Total Treatment: 4 10 min. Treatment Recommendations Sessions to include warm up and cooling down with mix of resistance, balance and flexibility exercises. 2-3 times per week, 4-12 week program. Employing short form survey (SF-36) into for evaluation is recommended. 14 Exercises 1. Double-leg stance, knees slightly bent, weight towards the balls of the feet static, or dynamic movement. 1.1 Eyes open, hold stability bar. 1.2 Eyes open, release stability bar. 1.3 Eyes closed, release stability bar. 2. Double-leg stance, dynamic mini-squat (3-4 sec. cycle), weight towards the balls of the feet. 2.1 Eyes open, hold stability bar. 2.2 Eyes open, release stability bar. 2.3 Eyes closed, release stability bar. 3. Single-leg stance, knee slightly bent, weight towards the balls of the feet, alternate legs. 3.1 Eyes open, hold stability bar. 3.2 Eyes open, release stability bar. 3.3 Eyes closed, release stability bar.

15 Range of Motion & Stretching Treatment Parameters Frequency: 30-50Hz Amplitude: Low - High Treatment / Rest Times (seconds) 30s / 30s Total Treatment: 4 10 min. Treatment Recommendations Sessions to include warm up and cooling down with mix of resistance, balance and flexibility exercises. 2-3 times per week, 1-3 sets. Exercises 1. Calf Raises: Static or dynamic (3-4 sec. cycle), knees slightly bent, hold in stomach, maintain balance. 2. Hamstring: Stand length wise on platform, feet hip width apart, knees slightly bent, bend forward at the waist. 3. Hip Flexor Stretch: Place one knee on platform, place the opposite foot forward, push hips forward. 15

16 General Strength Treatment Parameters Frequency: 30-50Hz Amplitude: Low - High Treatment / Rest Times (seconds) 30s / 60s Total Treatment: 2 10 min. Treatment Recommendations Sessions to include warm up and cooling down with mix of cardiovascular, resistance, balance and flexibility exercises. 2-3 times per week, 10 reps for each muscle group, 1-3 sets. 16 Dynamic Exercises 1. Push ups (3-4 sec. cycle) 1-3 sets. 1.1 Hands on platform, knees on floor (cushion). 1.2 Hands on platform, plank position. 2. Abdominals (3-4 sec. cycle) 1-3 sets. 2.1 Seated on platform with slight recline, perform crunches 3. Triceps Dip (3-4 sec. cycle) 1-3 sets. 3.1 Back to platform, hips on floor, hands on platform. 4. Calf Raises (3-4 sec. cycle) 1-3 sets. 4.1 Stand on platform - knees slightly flexed. 5. Squat (30s / 60s) 1 3 sets. 5.1 Perform squat with or without external load. Release stability bar.

17 References Balance and Proprioception 1. Cheung W.H., Mok H.W., Qin L., Sze P.C., Lee K.M. & Leung K.S. (2007). High-frequency whole-body vibration improves balancing ability in elderly women. Archives of Physical Medicine and Rehabilitation. 88(7) Bruyere O., Wuidart M.A., Di Palma E., Gourlay M., Ethgen O., Richy F. & Reginster J.Y. (2005). Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents. Archives of Physical Medicine and Rehabilitation. 86(2) Runge M., Rehfeld G. & Resnicek E. (2000). Balance training and exercise in geriatric patients. Journal of Musculoskeletal and Neuronal Interactions. 1(1) Bautmans I.,Van Hees E., Lemper J.C. & Mets T. (2005). The feasibility of whole body vibration in institutionalized elderly persons and its influence on muscle performance, balance and mobility: a randomized controlled trial. BMC Geriatrics. 22;5: Bogaerts A, Verschueren S., Delecluse C., Claessens A.L. & Boonen S. (2007). Effects of whole body vibration training on postural control in older individuals: a 1 year randomized controlled trial. Gait & Posture. 26(2) Rees S.S., Murphy A.J. & Watsford M.L. (2008). Effects of whole body vibration on postural steadiness in an older population. Journal of Science and Medicine in Sport. [Epub ahead of print]. 7. Fontana T.L., Richardson C.A. & Stanton W.R. (2005). The effect of weight-bearing exercise with low-frequency, whole body vibration on lumbosacral proprioception: a pilot study on normal subjects. The Australian Journal of Physiotherapy. 51(4) Blackwell Science Ltd. Clinical Physiology and Functional Imaging 22,2, Circulation 1. Kerschan-Schindl K., Grampp S., Henk C., Resch H., Preisinger E., Fialka-Moser V. & Imhof H. (2001). Wholebody vibration exercise leads to alterations in muscle blood volume. Clinical Physiology. 21(3) Otsuki T., Takanami Y., Aoi W., Kawai Y., Ichikawa H. & Yoshikawa T. (2008). Arterial stiffness acutely decreases after whole-body vibration in humans. Acta Physiologica. [Epub ahead of print]. CVA (Stroke) 1. DOI: / Clin Rehabil 2007; 21; 782 Tekla Kornélia Tihanyi, Mónika Horváth, Gábor Fazekas, Tibor Hortobágyi and József Tihanyi patients with stroke. 2. Short-term effects of whole-body vibration on postural control in unilateral chronic stroke patients: Preliminary evidence. Am J Phys Med Rehabilitation 2004;83: Knee Rehab 1. Exercise Physiology and Biomechanics Laboratory and Laboratory of Motor Control, Faculty of Physical Education and Physiotherapy, Department of Kinesiology, Katholieke Universiteit Leuven, Leuven, BELGIUM. 2. Moezy A., Olavaei G., Hadian M., Razi M. & Faghihzadeh S. (2008). A comparative study of whole body vibration training and conventional training on knee proprioception and postural stability after anterior cruciate ligament reconstruction. British Journal of Sports Medicine. 42(5) Savelberg H.H., Keizer H.A. & Meijer K. (2007). Whole-body vibration induced adaptation in knee extensors; consequences of initial strength, vibration frequency, and joint angle. Journal of Strength and Conditioning Research. 21(2)

18 4. Savelberg H.H., Keizer H.A. & Meijer K. (2007). Whole-body vibration induced adaptation in knee extensors; consequences of initial strength, vibration frequency, and joint angle. Journal of Strength and Conditioning Research. 21(2) Rittweger J., Mutschelknauss M. & Felsenberg D. (2003). Acute changes in neuromuscular excitability after exhaustive whole body vibration exercise as compared to exhaustion by squatting exercise. Clinical Physiology and Functional Imaging. 23(2) Roelants M., Delecluse C. & Verschueren S.M. (2004). Whole-body-vibration training increases knee-extension strength and speed of movement in older women. Journal of the American Geriatrics Society. 52(6) Bogaerts A., Delecluse C., Claessens A.L., Coudyzer W., Boonen S. & Verschueren S.M. (2007). Impact of whole-body vibration training versus fitness training on muscle strength and muscle mass in older men: a 1- year randomized controlled trial. The Journals of Gerontology. 62(6) Low Back 1. Jörn Rittweger, MD,* Karsten Just, MD, Katja Kautzsch, MsPsych, Peter Reeg, MD, and 2. Dieter Felsenberg, PhD, SPINE Volume 27, Number 17, pp , 2002, Lippincott Williams & Wilkins, Inc. 3. Iwamoto J., Takeda T., Sato Y. & Uzawa M. (2005). Effect of whole-body vibration exercise on lumbar bone mineral density, bone turnover, and chronic back pain in post-menopausal osteoporotic women treated with alendronate. Aging Clinical and Experimental Research. 17(2) Neuromuscular 1. Bosco C., Colli R., Introini E., Cardinale M., Tsarpela O., Madella A., Tihanyi J. & Viru A. (1999). Adaptive responses of human skeletal muscle to vibration exposure. Clinical Physiology. 19(2) Roelants M., Verschueren S.M., Delecluse C., Levin O. & Stijnen V. (2006). Whole-body-vibration induced increase in leg muscle activity during different squat exercises. Journal of Strength and Conditioning Research. 20(1) Bakhitiary A.H., Safavi-Farokhi Z. & Aminian-Far A. (2007). Influence of vibration on delayed onset of muscle soreness following eccentric exercise. British J Sports Med 2007;41: doi: /bjsm ABERCROMBY, A. F. J., W. E. AMONETTE, C. S. LAYNE, B. K. MCFARLIN, M. R. HINMAN, and W. H. PALOSKI. Variation in Neuromuscular Responses during Acute Whole-Body Vibration Exercise. Med. Sci. Sports Exerc., Vol. 39, No. 9, pp , Luo J., McNamara B. & Moran K. (2005). The use of vibration training to enhance muscle strength and power. Sports Medicine. 35(1) Annini G., Padua E., Castagna C., Salvo V.D., Minichella S., Tsarpela O., Manzi V. & Dettavio S. (2007). Effect of whole body vibration training on lower limb performance in selected high-level ballet students. Journal of Strength and Conditioning Research. 21(4) Bogaerts A., Delecluse C., Claessens A.L., Coudyzer W., Boonen S. & Verschueren S.M. (2007). Impact of whole-body vibration training versus fitness training on muscle strength and muscle mass in older men: a 1- year randomized controlled trial. The Journals of Gerontology. 62(6)

19 8. Da Silva M.E., Fernandez J.M., Castillo E., Nunez V.M., Vaamonde D.M., Poblador M.S. & Lancho J.L. (2007). Influence of vibration training on energy expenditure in active men. Journal of Strength and Conditioning Research. 21(2) Abercromby A.F., Amonette W.E., Layne C.S., McFarlin B.K., Hinman M.R. & Paloski W.H. (2007). Variation in neuromuscular responses during acute whole-body vibration exercise. Medicine and Science in Sports and Exercise. 39(9) Neuromuscular EMG 1. Carmelo Bosco, Marco Cardinale, Olga Tsarpela, Eur J Appl Physiol (1999) 79: Cardinale, M., and J. Lim. Electromyography activity of vastus lateralis muscle during whole-body vibrations of different frequencies. Journal of Strength and Conditioning Research, 17(3): ,. National Strength & Conditioning Association. 3. Hazell T.J., Jakobi J.M. & Kenno K.A. (2007). The effects of whole-body vibration on upper- and lower-body emg during static and dynamic contractions. Applied Physiology, Nutrition, and Metabolism. 32(6) Range of Motion 1. Flexibility Enhancement with Vibration: Acute and Long-Term. Med. Sci. Sports Exerc., Vol. 38, No. 4, pp , van den Tillar R. (2006). Will whole-body vibration training help increase the range of motion of the hamstrings? Journal of Strength and Conditioning Research. 20(1) Skeletal and Osteoporosis 1. Verschueren S.M., Roelants M., Delecluse C., Swinnen S., Vanderschueren D. & Boonen S. (2004). Effect of 6- month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study. Journal of Bone and Mineral Research. 19(3) J Bone Miner Res 2004;19: Published online on December 22, 2003; doi: /JBMR Key words: osteoporosis, anabolic, mechanical loading, vibration, low-level, frequency, osteogenic, muscle, skeleton, aging, menopause, bone, antiresorptive JOURNAL OF BONE AND MINERAL RESEARCH Volume 19, Number 3, 2004 Published online on December 22, 2003; doi: /JBMR American Society for Bone and Mineral Research Iwamoto J., Takeda T., Sato Y. & Uzawa M. (2005). Effect of wholebody vibration exercise on lumbar bone mineral density, bone turnover, and chronic back pain in postmenopausal osteoporotic women treated with alendronate. Aging Clinical and Experimental Research. 17(2) Gusi N, Raimundo A. & Leal A. (2006). Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial. BMC Musculoskeletal Disorders. 30; Aleyaasin M, Harrigan JJ., School of Engineering, University of Aberdeen, King s College, Aberdeen, UK., Vibration Exercise for Treatment of Osteoporosis: A Theoretical Mode. 19

20 Other 1. Bosco C., Iacovelli M., Tsarpela O., Cardinale M., Bonifazi M., Tihanyi J., Viru M., De Lorenzo A. & Viru A. (2000). Hormonal responses to whole-body vibration in men. European Journal of Applied Physiology. 81(6) International Journal of Medical Sciences, ISSN , (3): Klaus Baum1, Tim Votteler, Jürgen Schiab, Received: ; Accepted: ; Published: Doctoral Program:Empirical and theoretical issues in sport sciences, Program Director: Prof. Dr. Frenkl Ròbert, Supervisor: Prof. Dr. Carmelo Bosco, Budapest Schuhfried O., Mittermaier C., Jovanovic T., Pieber K. & Paternostro-Sluga T. (2005). Effects of whole-body vibration in patients with multiple sclerosis:a pilot study. Clinical Rehabilitation. 19(8) Saggini R., Vecchiet J., Iezzi S., Racciatti D., Affaitati G., Bellomo R.G. & Pizzigallo E. (2006). Submaximal aerobic exercise with mechanical vibrations improves the functional status of patients with chronic fatigue syndrome. Europa Medocophysica. 42(2) Turbanski S., Haas C.T., Schmidtbleicher D., Friedrich A. & Duisberg P. (2005). Effects of random whole-body vibration on postural control in parkinson s disease. Research in Sports Medicine. 13(3)