5 Whole body vibration
Treatment with patients or athletes
Preparation for therapy
The proposed exercises are based on theoretical evidence from Chapters 2 and 3, as well as the clinical evidence documented in Chapter 4. In fact, one of the most important aspects of WBV is the variability in the prescription of dosage as well as the variability in the protocol used during WBV training. Moreover, this variability gives clinicians the possibility of modifying their procedure according to the type of population and the clinical outcomes attained. Most significantly, the initial assessment and subsequent reassessment define the clinical reasoning process. It appears that some groups of people and even certain subpopulations of the same condition receive more benefit from WBV than others. Therefore, it is important to match the correct dosage and protocol for each individual case based on its own clinical history.
In Chapter 4 different investigators identified parameters, variables of safety, progression and evaluation techniques which can be used not only to determine the efficacy of the treatment and training but also to highlight the clinical assessment tools which can be used to determine the selection of dosage depending upon the stage at which the patient or the athlete finds themselves. In this manner, clinical outcome not only defines a suitable population but also determines the progression of treatment or training. The spectrum of dosage will be illustrated here.
This chapter is an example of practice-based evidence derived from several years of unpublished experience. Although the following devices show a rotational device, the application of dosage applies to other types of devices as well. Importantly, evidence-based medicine has been employed by using similar exercises, protocols and guidelines to those that were discussed in Chapter 4. Since the acute and long-term effects of WBV have been extensively illustrated in Chapter 4, we will not mention them again. Interested readers should view this chapter’s Appendix for a table highlighting the protocols used, outcomes attained and populations investigated in published research. Additionally, examples of assessment and reassessment tools can also be found in the Appendix. Clinical reasoning and clinical trials are a two-way street whereby each has an influence on the other, thereby defining directions for future clinical research.
Fundamental principles
Guidelines
Guiding the patient through WBV therapy
Warm-up exercises are recommended at the start of every training therapy session
• Stimulation frequency: initially 5–12 Hz, later increased to 18–40 Hz.
• Feet positioning: parallel, e.g. at low amplitude.
• Body positioning: the knees and hips are bent gently in relaxed standing.
• Training duration: e.g. 1 min low frequency, then 1 min high frequency, 3 min back to low frequency.
Instructions to the client
• Ask the client to report any unusual events.
• Inform the client that WBV can stimulate the bladder and that they should empty the bladder prior to training.
• Mention that with prolonged exercise itching can occur. This is a desirable and expected sign of increased circulation and an effect on soft tissue hormones.
• Specifically question the list of contraindications and document the checklist of clarifications.
Example of an assessment form used in the preparation for training/therapy
| Surname, first name | Street name, number |
| Post code | Town |
| Telephone | |
| Sex | Date of birth |
| Age | Height |
• Information on general health
| Are there any other general health issues? |
| What are your reasons for carrying out the training system? |
• What physical activities do you undertake?
Table 5.4 What physical activities do you undertake?
| Occupation |
| Leisure time |
| Sport (× per week) |
| Are there any other things which we should note? |
Contraindications Yes  No  Candidate for training? Yes  No  |
| Place, Date, Signature |
Possible side-effects
• Blisters in the soles of the feet or on the hands, in the case of the four-point kneeling position.
• Itchiness in the area of stimulation.
• Short-term drop in blood pressure.
Conclusion
The posture is often described in the literature where only the knee joints are mentioned. Obviously, their position cannot be changed in isolation as the relevant positions of the hip and ankle joint determine the body posture. The upright positioning of the torso can be measured from the distance between the sternum and the pelvis. Even here, the values given are desirable aims which can be achieved over the duration of treatment. In the relaxed state, the tips of the feet are similar to during walking, i.e. turned outwards at approximately 7°. Variation in the position of the feet changes the client’s distribution of the vibrations in their body and thereby affects their different muscle groups.
Guidelines and indications using examples of exercises for specific clinical conditions
The following guidelines were accumulated over several years of clinical experience.
Standard guidelines
What follows is a description of the therapeutic basis for the application of WBV for
• the maintenance of the therapeutic treatment management plan even with a change in therapist;
• the most frequent therapeutic goals; and
The vibration therapy is suitable for:
Explanation and introduction of WBV training and WBV therapy sessions
S-series (S = stretching)
• Aim: Stretching to improve elasticity and joint range of motion. Stretching should be incorporated into the commencement of each training session so as to optimize the muscle elasticity.
• Vary the knee position between extended and slightly bent positions. Vibration should be felt in the body part where it is needed.
• Frequency: 10–18 Hz, subjectively comfortable ‘swing frequency’ (varies with the individual’s posture and hence resonance frequency).
• Time/duration: Slowly attain the end position until a significant stretching can be felt; maintain this position for 10–30 s and then return to the starting position. Two or three repetitions. Repeat each exercise for 1–2 min.
B-series (B = balance)
• Aim: Improved stability, in particular for lateral balance in the ankles.
• Frequency: 5–12 Hz–the lower the frequency, the harder the exercise (varies with the individual client and posture).
• Time: Every exercise should be undertaken for 1–2 min, several repetitions of each exercise are possible, several times per day.
F-series (F = force)
• Aim: Improved muscle strength and muscle mass.
• Training progression involves increased strength and muscle mass through the addition of weights of up to 50% of body weight.
• Increase weights when more than 12 repetitions can be reached in a given time or else vary the base of support (fatigue of muscles must be reached).
• Frequency: from 25 to 40 Hz (varies with the training device).
• Time/duration: To the point of fatigue of the musculature.
• The number of sets and repetitions of these exercises should be based on what is standard practice in weight training. A 48 hour rest between training sessions is recommended.
P-series (P = power (watt) = force × velocity)
• Aim: Increase muscle power of the proximal musculature and spinal musculature.
• Duration: two or three times for 2 min, with 1-min break using walking.
• Deep squats to 90°. The heels should remain on the vibration platform:
• Where insecurity exists the client can hold on; otherwise, the aim is not to hang on.
Guidelines for vibration therapy in low back pain
Treatment sequence
• Through the examination by the doctor and/or therapist, the aims and objectives of therapy are determined based on the deficits which need to be rectified.
• If deficits are found in strength and/or power then treatment will be directed at the P- and F-series.
• If the deficits are more to do with stability then exercises from the B-series are selected.
• Where the deficit is in the range of movement then exercises from the S-series are selected.
Examples of exercises
• The exercises should be carried out over a period of time and in all circumstances should be pain-free!
• Strength training should be adapted to the increasing strength of the client.
• The exercises should always be executed in a manner which protects the back.
• Duration of training should be of the order of 10 min.
Table 5.5 Example of a stretching exercise
| Duration of exercise | 3–10 min |
| Frequency | 5–12 Hz |
| Amplitude/foot placement | Low to high |
| Starting position | Standing, ideally not holding on. Bend the knees slightly. Direct vibration into the various body parts. Then bend the torso forwards, backwards, sideways and into rotation. Ideally, maintain the position at the end of range for 3–5 s |
Table 5.6 Force and power training
| Duration of each application of exercise | 3–5 min |
| Frequency | 15–30 Hz |
| Amplitude/foot placement | Low to middle depending upon comfort |
| Starting position | Exercises out of F- and P-series alternately. In principle exercise examples from B-series could also be incorporated here |
| Number of repetitions per series without a break | 1 |
| Break between applications | 1–2 min |
Table 5.7 Post-training relaxation
| Duration of exercise | 1–2 min |
| Frequency | 5–10 Hz |
| Amplitude/foot placement | Low |
| Starting position | Loose, with slightly bent knees and without holding on, move the whole body slightly. Importantly, the soles of the feet must remain completely on the vibration platform |
Guidelines for the treatment of osteoporosis/osteopenia
Treatment aims
• The aim of treatment is the improvement of muscle strength and power. Through the application of maximal muscle strength, the bones react through Wolff’s law by building more bone.
• Additionally, the balance training can reduce the risk of falling, which thus decreases the likelihood of fractures.
Treatment guidelines
• Aim: The treatment of osteoporosis with WBV is a combination of the previously described S-, B-, F- and P-series.
• The treatment objectives are established from the examination by the therapist or doctor.
• If deficits in power or strength are found then exercises predominantly in the P- and F-series are selected.
• If the impairment is more in the area of coordination, then exercises are prescribed from the B-series.
• Where muscle stiffness and lack of elasticity are present, then exercises in the S-series are selected.
Exercise examples
• The exercises should be conducted over a longer period (at least 6 months) and should not in any circumstances be conducted if the person is experiencing pain.
• Strength training should be individually selected based on the concepts of progressive training.
• The exercises can be undertaken by older clients.
• Duration of a training session should be 15–20 min.
• Within 6 months, two or three training sessions per week should be undertaken, with at least 1 rest day for recovery between training sessions.
Table 5.8 Therapeutic familiarization with WBV
| Duration of exercise | 1–3 min |
| Frequency | 5–12 Hz |
| Amplitude/foot placement | Low |
| Starting position | Standing with slightly bent knees. If possible without holding on. The vibration can be directed to various body parts through changes in the centre of gravity and slowly straightening the knees. Stretching exercises out of the S- and B-series |
Table 5.9 Therapeutic application of WBV
| Duration per application | 3–5 min |
| Frequency | 15–30 Hz |
| Amplitude/foot placement | Middle to high depending upon comfort |
| Starting position | Exercises varying between the F- and P-series. Also some of the exercises from the B-series may be appropriate |
| Number of applications per series without a break | 1 or 2 |
| Breaks between the applications | 1–2 min |
| Duration | 1–2 mins |
| Frequency | 5–10 Hz |
| Amplitude/foot placement | Low |
| Starting position | Relaxed, moving the body gently forwards and backwards with slightly bent knees while not holding on. The soles of the feet must stay fully on the vibration plate |
Training with vibration for osteoporosis and osteopenia is safe. The training duration is short without any major loading of the cardiovascular system. Muscle strength and power can be built up progressively, thereby stimulating bone growth through improved muscle strength.
Guidelines for reducing the likelihood of falling
Aims of therapy
| Increased strength through | Hypertrophy of muscles and power |
| Reduced falls through | Improved coordination and power |
| Improved flexibility through | Stretching exercises which improve energy absorption and therefore muscle range of movement and hence power |
Therapy methods
• Aim: Prophylaxis against falling through exercises from series P, F, B and S.
• Emphasis of therapy is determined as a result of the findings from the examination carried out by the therapist or medical doctor.
• If deficits are found in muscle power and strength then exercises are chosen from series P and F.
• If the impairment is one of coordination then the emphasis of therapy is series B.
• Where muscle stiffness and lack of elasticity are problematic then exercises from series S are given a higher priority.
Examples of exercises
The duration of treatment in clients who are at risk of falling varies between individuals.
In order to maintain/sustain mobility and power the training in these individuals should become daily routine. Progression occurs with increasing strength of the client. Divide training into sets and repetitions. At least 48 hours rest between exercise sessions are required. Balance training can be carried out several times per day. These exercises can be carried out with older individuals.
Table 5.12 Stretching/balance exercises
| Duration of exercises | 2–6 min |
| Frequency | 5–12 Hz |
| Amplitude/foot placement | Low to middle |
| Starting position | In standing, carry out exercises from series B and S. The number of repetitions is individually tailored. Importantly, the whole body is gradually brought to an end-of-range position of stretching |
| Balance | Placing one foot alternately on the lowest position, slightly lift the other foot and hold at 5 Hz without support for 5–30 s |
| Duration per session | 3–5 min |
| Frequency | 25–30 Hz |
| Amplitude/foot placement | Middle to high depending upon comfort |
| Starting position | Exercises alternating from series F and P. Additionally exercises from series B can be applied |
| Number of repetitions | Sets of 10 |
| Sets | 3 sets per exercise |
| Interval between sets | 10–20 s |
| Interval between sets | 1–3 min |
| Additional weights | 70% of individual maximal strength (the maximal strength is the weight that a person can lift once) |
Related posts:
Introduction
Theoretical considerations in the clinical application of WBV to sarcopenia, osteoporosis and metabolic syndrome
Biomechanics: Principles of WBV
Indications and contraindications in the clinical application of WBV: Immediate and long-term effects and their influence on the selection of dosage
WBV as a warm-up prior to sport: Effects on flexibility
Neuroendocrine Abnormalities in Female Athletes
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