Whole Body Vibration: for Athletic Performance, Fall Prevention, Bone Loss and Low Back Pain?

Whole-body vibration (WBV) is a relatively new tool used by physical therapists that delivers vibrations across a range of frequencies (15-60 Hz) and displacements (<1-10mm) to stimulate muscles and elicit motor potentials so as to facilitate muscle strength, power, balance and bone remodeling.1-6 Current devices utilize chairs or vertical displacement plates where oscillations are completed from left to right and whole-body vibration plates, which provide uniform oscillations in an up and down manner.1-6

At present, there is limited research on the physiologic mechanisms surrounding the use of WBV; however, some investigators have made the claim that WBV stimulates the neuromuscular system similar to resistance training.7 Others have suggested that WBV may enhance muscle spindle activity8 and corticospinal excitability.9,10 Nevertheless, the optimal frequency and amplitude of WBV remains to be elucidated. However, a frequency and amplitude of 60 Hz and 4 mm, respectively, has been shown to produce the strongest myoelectric activity.11 In general, high-frequency stimulation is thought to be advantageous for bone health,12 while low frequency stimulation may stimulate neural adaptation and strength gains.13

WHOLE BODY VIBRATION FOR ATHLETES

Strength and conditioning training augmented with WBV has been shown to improve athletic performance via increased muscle strength14-20 and flexibility.21 WBV has also been shown to facilitate motor unit recruitment and synchronization of muscles via increased reflex muscle activity, which may ultimately lead to improved training adaptation and faster recovery.22 A recent systematic review of soccer players, divers and MMA fighters concluded that WBV is a safe and useful strategy for improving physical condition.23

Following 10 minutes of WBV, volleyball players experienced increased testosterone and growth hormone levels, decreased cortisol and improved vertical jumping ability.1,2 Likewise, following 6 weeks of WBV on a soft, unstable surface, athletes experienced improved reaction times in lower limb muscles.24,25 In the post-surgical population, WBV may enhance recovery, perhaps even in athletes that have undergone ACL reconstruction, as WBV has been found to increase knee muscle isokinetic strength when combined with a standard rehabilitation program.17

WHOLE BODY VIBRATION FOR FALL PREVENTION & JUMPING HEIGHT

A number of studies have found WBV to be useful in untrained individuals. For example, untrained adult women experienced increased vertical jumping height and improved balance following WBV.4 WBV also led to greater improvements in leg extensor muscle strength and function than resistance exercises in untrained individuals.Furthermore, there is moderate to strong evidence that WBV prevents falls due to improvements in neuromuscular function, particularly in patients that cannot tolerate vigorous exercise.26

WHOLE BODY VIBRATION FOR BONE LOSS

According to animal studies, WBV prevents bone loss secondary to disuse, hormonal withdrawal and glucocorticoid exposure.26 Notably, a recent systematic review of 10 studies and 462 postmenopausal women under the age of 65 found that WBV resulted in improved bone mineral density of the femoral neck.27

Following 6-months of whole body vibration, administered three times per week, postmenopausal women demonstrated a statistically significant increase in hip bone mineral density compared to those performing resistance exercises and age-matched controls.28 While WBV with vertical stimulation did not increase lumbar spine bone density better than a wellness control, rotational stimulation resulted in a statistically significant improvement.29 Nevertheless, a 2011 systematic review and meta-analysis of 13 randomized controlled trials totaling 896 subjects concluded that WBV had no effect on bone mineral density in older women.30

Due to the mixed results of WBV trials for bone density, a number of investigators have suggested that WBV may reduce some of risks associated with osteoporosis in other ways.31 For example, although a 2014 trial found no increase in bone density following an 18-month regiment of high-intensity WBV to 710 postmenopausal women, the investigators nevertheless reported significantly less falls and fractures compared to the control group.32 Interestingly, WBV has been shown to significant increases in maximum leg strength in postmenopausal women.6,33,34 Moreover, WBV is associated with improved physical fitness,30,35,36 neuromuscular function,37 mobility and balance in the elderly population.38

WHOLE BODY VIBRATION FOR LOW BACK PAIN

A recent systematic review and meta-analysis of 16 controlled trials found that WBV has a positive effect on musculoskeletal pain, with long treatment durations being particularly advantageous.39 However, WBV did not perform significantly better than other conservative treatments.39 Despite the link between occupation vibration and low back pain,40 there is evidence to suggest that WBV may be a useful adjunct treatment for non-specific low back pain,1,41,42  as it has been shown to decrease cortisol levels, improve proprioception, increase strength and decrease pain.1-6,43

Notably, a recent case series of 42 patients with nonspecific low back pain reported significant improvements in lumbar proprioception and decreased low back pain following 12-weeks of WBV exercise.44 Wang et al directly compared WBV with general exercise in an randomized clinical trial of 84 patients with non-specific chronic low back pain.45 After 12 weeks of training, the WBV group experienced lower levels of pain and disability.45 Moreover, the WBV exercise group demonstrated significantly better lumbar joint position sense, quality of life and global perceived effect.45

In a separate randomized controlled trial, patients with non-specific low back pain that received 24 treatments of tilting, low frequency WBV experienced significantly greater improvements in strength, stability, proprioception, function and pain compared to those in the non-treatment control group.43 Notably, WBV with both vertical and horizontal stimulation seems to reduce low back pain and improve core muscle strength.46

Interestingly, a recent systematic review of 16 controlled trials involving 763 patients with chronic conditions, including respiratory, musculoskeletal, neurological, urological, and metabolic diseases even concluded that WBV may improve health-related quality of life.47

CONCLUSIONS

WBV appears to be an evidence-based intervention for enhancing athletic performance, fall prevention, reducing non-specific low back pain and disability, and perhaps even improving bone mineral density in postmenopausal women. The specific neurophysiologic effects of WBV are unknown and the most effective amplitudes and frequencies for WBV in various conditions remains to be elucidated.

AUTHORS

Mahesh Patel, PT, MPT, Cert. DN
Staff Physical Therapist, Randolph Health Deep River Physical Therapy
Fellow-in-Training, AAMT Fellowship in Orthopaedic Manual Physical Therapy
Asheboro, NC

Ricardo Portillo, PT, DPT, Cert. DN
Clinical Director, Border Therapy Services
Fellow-in-Training, AAMT Fellowship in Orthopaedic Manual Physical Therapy
El Paso, TX

Raymond Butts, PhD, DPT, MSc (NeuroSci), Dip. Osteopractic
Senior Instructor, American Academy of Manipulative Therapy
Louisville, KY

James Dunning, PhD, DPT, MSc (Manip Ther), FAAOMPT, Dip. Osteopractic
Director, AAMT Fellowship in Orthopaedic Manual Physical Therapy
Montgomery, AL

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