BOHR International Journal of Neurology and Neuroscience

2023, Vol. 1, No. 2, pp. 87–92

DOI: 10.54646/bijnn.2023.12
www.bohrpub.com

METHODS

Whole-Body vibration therapy: an overview

Jasmin Nisamudeen 1 , Binoy Mathew K. V. 1* and Roshan Bijlee K. N. 2
1 Department of Physiotherapy, Composite Regional Center of Skill Development Rehabilitation and Empowerment of Persons
with Disabilities-Kozhikode, Calicut, India
2 Composite Regional Center of Skill Development Rehabilitation and Empowerment of Persons with Disabilities-Kozhikode,
Calicut, India

*Correspondence:
Binoy Mathew K. V.,
[email protected]

Received: 04 July 2023; Accepted: 18 July 2023; Published: 11 August 2023

Concern has been raised about whole-body vibration training (WBVT), which activates skeletal muscles by
employing vibrations rather than a mass load or dynamic exercise. As vibration massage and local vibration applied
to muscles show promising benefits, vibration treatment and exercise became widely used in rehab. Studies are
still being conducted to fully comprehend the cumulative impacts and long-term safety of this training program.
This study gives an outline of WBVT, explaining its physiology and advantages as well as some safety aspects,
contraindications, and instructions for applying it in a clinical environment.
Keywords: WBVT, QOL, posture, frequency, tonic vibration reflex, eccentric exercise

1. Introduction clinical and physical conditions. For preserving astronauts’

skeletal muscle mass and strength and enhancing athletic
Vibration training (VT), which stimulates the skeletal performance, WBVT is a common training technique that
muscles by using vibrations rather than a mass load increasingly gains attention in exercise rehabilitation. (2).
or dynamic exercise, has drawn a lot of concern (1). Whole-body vibration is a low-intensity exercise that uses
It has acquired popularity as a practical strategy for a platform that oscillates and generates sinusoidal vibrations.
enhancing muscle function since it is a non-invasive physical There are two widely used types: (1) a side-alternating (also
therapy that offers vibration platforms for passive exercise known as horizontal) oscillating platform that employs a
stimulation (2). Whole-body vibration training (WBVT) has fulcrum to alternately elevate the left and right sides of
emerged as an effective approach for improving muscular the body and (2) a vertical platform that delivers tri-axial
performance and inducing adaptive neuromuscular changes acceleration with the majority of the vibration in the vertical
through biomechanical and physiological effects (3). Whole- direction, raising the body equally (4).
body vibration (WBV) has gained popularity as a technique
for clinical and performance improvement. Numerous
studies have emphasized the advantages of including WBV 2. History
as a low-intensity exercise because of its capacity to raise
bone mineral density (BMD) in osteoporosis patients while Scientists originally created whole-body vibration technology
also lowering fall risk due to an improvement in balance and in the second half of the twentieth century to prevent
strength (4). astronauts from losing bone density and developing atrophy
Whole-body vibration training effects depend on a in their muscles, caused by zero-gravity exposure. WBV,
number of variables, such as fundamental vibration often referred to as indirect vibration, involves exposing
parameters, vibration mode, training posture, and training people to repetitive oscillations produced by a mechanical
frequency (3). The duration of work, rest intervals, number instrument that produces sinusoidal waveforms with a
of sets, and sessions are adjusted based on the patient’s certain amplitude and frequency. Commercial vibration

87
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platforms have proliferated in performance spaces and Exercise performed on vibrating platforms can influence
institutions around the country during the past 20 years. the skeletal system in two ways: by potentiating muscle
As a result, researchers in sports performance and athletic contractions, which are essential for bone health, and
training have started investigating the use of WBV in trained by transmitting vibration as a mechanism for strain
individuals (5). activation that encourages bone growth and increases bone
JM Granville made a major advancement in the discipline mineral density. Vibration has also shown the potential to
in 1881 when he first presented the idea of employing influence pain perception through a mechanism analogous
mechanical vibration to relieve pain. WBVT, however, did to transcutaneous electric nerve stimulation (TENS). The
not become well-known or widely used as a training method combination of rapid cyclic contractions and the valuable
among athletes until the 1980s. Individuals participating sensory information provided by mechanical oscillation on
in WBVT experience external oscillation vibrations while the platform can improve flexibility and proprioception.
standing on a vibrating platform. Although the majority While hormonal responses to WBV exercises have been
of platforms use one or both of the widely used energy identified, their replication has not been consistent. Ongoing
transfer technologies, their technical capabilities vary. While studies are being conducted to gain a comprehensive
some devices use a vertical vibration mode that sends understanding of the cumulative effects and long-term safety
vibrations simultaneously to both feet, others use a seesaw- of this training regimen (7).
like side-alternating mode. Since these two methods focus During vibration exercise, the muscle-tendon complex
on different neurophysiological movement patterns, there is undergoes cyclic changes between elongation and shortening
a continuous discussion concerning whether the strategy is due to the vibration stimulus. This vibration-induced
more advantageous (6). stretching and shortening trigger reflex contraction through
the activation of primary and secondary spindle endings
and Golgi tendon organs. The stretch reflex and H-reflex are
3. Physiological changes suppressed, whereas corticospinal excitatory pathways are
facilitated. Research has shown that vibration can elongate
Vibration therapy and exercise were extensively utilized the gastrocnemius muscle-tendon complex by approximately
in rehab, with vibration massage and local vibration 1% of its total length. Vibration also affects electromyography
applied to muscles showing promising results. Vibration (EMG) activity, exhibiting vibration-synchronous EMG
massage has been discovered to possess circulatory responses in specific muscles. Additionally, vibration
effects. Moreover, when vibration is applied to muscle exercise increases energy metabolism and adenosine
bellies, it promotes motor responses, even in cases of triphosphate (ATP) turnover (8). The sinusoidal oscillations
pathological conditions. The tonic vibration reflex, a energize muscle spindle primary endings, leading to the
reflexive action triggered by vibration therapy, is widely activation of α-motor neurons, and has been recognized
regarded as one of the primary factors responsible for as the tonic vibration reaction, fast eccentric-concentric
the increased neuromuscular stimulation observed during involuntary contractions. Various propositions propose
and following such therapy. Vibration also stimulates adaptive muscular mechanisms associated with vibration
somatosensory regions of the cerebral cortex and amplifies therapy, including muscle activity synchronization, Golgi
the myotatic reflex, thereby enhancing voluntary movements. tendon organ stimulation, activation of antagonistic muscles,
Furthermore, the elevation in muscle temperature, improved and potential modulation of neurotransmitters such as
perfusion, and reduction in mechanical vibration can dopamine and serotonin (9).
potentially have a favorable effect on force production Vibration exercises elicit acute neuromuscular responses
(7). Various theories have been proposed to explain the and increase serum anabolic hormone concentrations,
WBV responses, including the tetanic vibration reflex, similar to resistance exercise (10). The precise mechanism
angiogenic factors promoting capillary growth, hormone by which the body responds to vibratory stimuli remains
secretion, and stem cell activation. These acute effects uncertain. However, the activation of the neuromuscular
are attributed to the activation of the “tonic vibration system, particularly the tonic vibration reflex, is a commonly
reflex,” which induces muscle contractions primarily proposed mechanism. WBVT optimizes the stretch reflex
in the lower limbs. Following a single WBVT session, and motor unit recruitment through sensory stimulation
positive effects have been observed, such as improved blood and afferent pathways. The neuromuscular system may also
circulation, enhanced muscle performance and balance, adjust muscle activity to dampen vibrations, contributing to
and increased production of human growth hormone. improved motor unit synchronization and overall muscle
WBVT also shows potential for improving postural control function. Additionally, there is speculation that WBVT may
and intermuscular coordination and counteracting muscle have a preventative effect on muscle damage by distributing
atrophy and bone density loss associated with immobility contractile stress more evenly among active muscle fibers
(5, 6). through eccentric exercise (11).
10.54646/bijnn.2023.12 89

The musculoskeletal system relies on dynamic mechanical Muscle oxygenation and blood flow are strongly
loading to maintain bone strength and muscle function. connected. During exercise, blood flow to the working
Reduced functional loading, often caused by conditions muscle increases as a result of a variety of factors, including
that limit mobility, can lead to bone fragility. Dynamic increased oxygen and fuel requirements and raised carbon
mechanical loading is necessary for bone development, dioxide and hydrogen ion concentrations, among others.
with varying intervals between loading episodes. Within Changes in peripheral blood flow due to WBV treatment
the bone matrix, dynamic load offers both magnitude may disclose a possible mechanism of action for WBV
and frequency components. Vibration therapy, specifically therapy. One typical therapeutic goal of employing
low-intensity vibration (LIV), delivered as a low-magnitude, treatment approaches is to improve circulation at the
high-frequency stimulus, provides a safe and effective site of musculoskeletal injury during the fibroblastic repair
means to supply mechanical signals to the musculoskeletal and maturation-remodeling phases of healing. These indices,
system. In addition, the combination of large- and high- which are numerical assessments of the cardiovascular
frequency, low-magnitude signals generated from muscle system’s autonomic function, can be a helpful tool for
contractions plays a crucial role in maintaining bone determining operational stress. Physical vibration was shown
strength. Vibration therapy targets various cell types to be connected to the workload by the percentage of heart
involved in bone remodeling, including mesenchymal rate reserve, but driving duration was not. The construction
stem cells, osteocytes, and osteoclasts. It promotes machine’s remote operators, who experienced the least
the differentiation of bone-forming cells (osteogenic vibration while running it, also had much lower MSEs and
differentiation) while reducing bone resorption. Moreover, HRV indices than the riders, who felt the most vibration.
vibration therapy’s low-intensity mechanical signals have As a consequence, the hypothesis that the physical vibration
anabolic effects on bones, potentially mediated indirectly of construction workers negatively affects the HRV and
through extraskeletal tissues. Notably, vibration therapy MSE was confirmed. Furthermore, it was demonstrated that
enhances muscle strength, size, and performance, possibly the driving time of the construction machine was inversely
by improving neuromuscular efficiency. Additionally, it connected with the vibration intensity of the operating
stimulates the expression of anabolic genes in tendons and environment, as well as the HRV and MSE measurements.
may increase bone density by reducing fat accumulation. The operator’s various HRV indices are lower in this
The underlying molecular mechanisms responsible for circumstance because of a greater sympathetic nervous
these responses involve enhanced β-catenin signaling, system tone and sympathetic balance in a setting with high
improved gap junction communication, and acceleration vibrations and a lower parasympathetic nervous system
of the cell nucleus. Remarkably, these mechanisms operate tone (14).
independently of traditional factors such as matrix strain
or fluid shear. WBVT shows promise in improving bone
quality and strength, particularly for individuals unable to 4. General effects
engage in high-impact exercises. Low-intensity WBV has
demonstrated the ability to increase BMD and enhance Vibration therapy offers promising benefits for individuals
muscle function. Combining WBV with exercise has yielded with different clinical populations. In Parkinson’s disease,
positive outcomes, especially among post-menopausal the therapy improves motor symptoms by using random
women and individuals with low bone density (12). vibrations with specific parameters. For fibromyalgia
The cutting-edge complete active rehabilitation patients, the focus is on pain and fatigue control, employing
osteoporosis rehabilitation plan (ICARO), which includes vertical vibrations at designated frequencies. Frail adults with
WBV, is essential. The beneficial effects of vibratory treatment osteopenia can enhance their balance and increase BMD
on bone formation are supported by the piezoelectric through side-alternating vibrations. Each clinical population
hypothesis. This idea states that when pressure is applied requires tailored exercises and varying frequencies to address
to bones, an electrical potential difference is created that their specific needs, showcasing the versatility and potential
accelerates the process of bone growth. WBV prevents of vibration therapy in promoting overall well-being and
disorders like osteoporosis and sarcopenia by increasing symptom management (7).
the levels of growth hormone (GH) and testosterone in Whole-body vibration training is gaining recognition as
the blood. The advantages of vibration treatment are a viable practice to improve neuromuscular function in
explained by the fact that the upright posture is regarded physical therapy, particularly for older adults. It offers
to be a more effective bone-growth stimulator than convenience as it can be easily administered at home or
the horizontal position. Furthermore, vibration therapy at rehabilitation centers by having participants step on a
enhances neuromuscular coordination and improves muscle vibrating surface during training sessions. WBV provides
strength, which is particularly beneficial for individuals with several benefits across multiple organs and systems in
osteoporosis because it lowers the possibility of falls and the body. In older adults, it has been shown to improve
consequent fractures (13). balance, strength, functional mobility, decreased oxygen
90 Nisamudeen et al.

intake, quality of life, increased blood flow, increased of repetitions per exercise may vary from 1 to 3. The
bone mineral density, decreased body fat percentage, and frequency refers to the rate at which cycles or oscillations
improved cardiovascular, vascular, and pulmonary functions. occur within a second and usually falls within the range
Its applications span a variety of fields, including the of 6–45 Hz. The magnitude of vibration is directly related
rehabilitation of people with cerebral palsy and stroke, the to the gravitational force acting on the body in the vertical
treatment of musculoskeletal pain, and the monitoring of direction. It is commonly quantified in multiples of Earth’s
blood sugar in diabetic patients. Additionally, WBVT has gravity (up to 15 g) to indicate the intensity of the vibration
demonstrated its ability to enhance physical capabilities in experienced. The frequency of sessions is the number of
older adults with sarcopenia, and some evidence suggests times per week the exercise is performed, ranging from
that systemic vibration may have even higher rehabilitative 1 day to 1 week. To increase the intensity of the exercise,
benefits for older adults and patients than for the general participants can incorporate additional weights, such as a
population (15). weighted vest or dumbbell. Finally, participants may choose
A number of chronic illnesses and ailments, such as to perform vibration exercises barefoot, in socks, or with
fibromyalgia, persistent lower back pain, osteoporosis, and tennis shoes, depending on their preference and comfort.
multiple sclerosis, may benefit from WBVT (6). In terms of These factors collectively contribute to the characterization
changes in maximum isometric and isokinetic force, plasma and customization of vibration exercise protocols (7).
creatine kinase activity, muscle soreness, and pressure point Due to the availability of several devices with varying
threshold (PPT), the WBVT lessened the effects of exercise- features, the scientific literature on vibration treatment is
induced DOMS (11). There are several WBVT devices complicated. While low-intensity vertical vibrations are often
available today that produce WBV using different mechanical accepted successfully, the use of high-intensity exercise
concepts. The cardiovascular, musculoskeletal, endocrine, equipment may have negative consequences. Devices can
and neurological systems all react to WBV treatment in produce high-magnitude ( > 1 g) or low-magnitude (1 g)
a thorough manner (9). In order to mechanically engage forces, depending on the combination of displacement and
muscles, WBVT stimulates neuromuscular activity in the frequency that causes the body to accelerate. It’s vital to
form of muscle reflexes. Studies on WBVT’s effectiveness remember that equipment promoted as fitness supplements
are conflicting. There have been reports of both favorable frequently weighs more than 4 g, making it inappropriate
outcomes (increased flexibility, power, muscular strength, for elderly or fragile individuals looking to strengthen their
and performance) and unfavorable or no outcomes. This bones. Therefore, while choosing a treatment plan, doctors
uncertainty is a result of various study designs, populations and rehabilitation professionals are advised to pick tools
investigated, and WBV devices being employed (11). that give low-intensity (1 g), horizontally directed vibrations
at high frequencies (30–100 Hz), and clear information
regarding vibration characteristics (12).
5. Characteristics Utilizing all of the lower leg muscles while employing
personalized WBV on the lower body will maximize the
In vibration training, the body is subjected to mechanical biochemical reaction. As a result, hormone levels rise,
vibration on a shaking platform. However, when the which is related to the volume of muscles used during
person is unable to stand, specialist equipment has been exercise and their intensity. The lack of agreement on the
used, such as a chair or a standing frame. Vertical best way to create WBV training programs, however, has
platforms oscillate synchronously up and down, whereas produced erratic outcomes. Muscle activation and motor unit
side-alternating platforms oscillate on the left and right sides recruitment can be enhanced by tailoring WBV by altering
of a fulcrum. Horizontal and random vibration platforms are its amplitude and frequency. Acceleration, duration, and
also employed, but to a lesser extent. From the platform’s external load are all WBV size characteristics that have been
lowest position to its highest point, its displacement might linked to pain. According to recent studies, the testosterone
vary from 1 to 14 mm. Vibration training methods may response is size-independent, whereas the GH response is
entail applying the stimulus once, several times, or over dramatically increased when WBV is delivered to the upper
an extended period of time. The exposure may be acute extremities (10).
or chronic in nature. Exposure times per application might Both very high (> 100 Hz) and extremely low (20 Hz)
range from 15 s to 10 min. Standing exercises or a variety vibrational frequencies might have negative consequences.
of activities, such as static or dynamic motions, can be used The entire body’s resonance frequency is in the low-
in vibration exercises. Squats, lunges, and calf raises are frequency band, which causes great transmissibility and
examples of lower-body workouts. Push-ups, body planks, negative impacts. To counteract these effects, clinical studies
and triceps dips are examples of upper-body activities. frequently use WBV in the frequency range of 20–60 Hz.
Typical specified joint angles and foot placements are full High frequencies can strain muscles and damage soft tissues,
or half squats and broad or narrow stances. Rest periods and those above 60 Hz may worsen the symptoms of hand-
between exercises can range from 10 to 60 s, and the number arm vibration syndrome (HAVS). In untrained women,
10.54646/bijnn.2023.12 91

knee extensor muscle torque was increased by WBV at it is advisable to begin with a shorter duration, decreased
30 Hz frequency and 4 mm peak-to-peak amplitude over frequency, and displacement from a peak to a peak during
the course of 8 weeks. Factors such as load-bearing and the initial sessions. Each exercise should not last more than
exercises during vibration therapy can enhance muscle 20–30 s in the beginning to allow for enough recovery time.
strength and physical performance. However, the research However, it is important to note that this principle may not
discrepancies arise due to variations in vibration parameters be applicable when performing basic standing exercises. By
and subject posture. High-frequency WBV may have escalating the exercise’s amplitude, frequency, length of time,
negative consequences, and low-frequency and low-intensity and repetition count while reducing the recovery period, one
vibrations are ineffective. Further investigation is needed to can progress in intensity. Proper foot positioning is vital,
establish optimal WBV protocols with scientific justification ensuring that feet are properly positioned on the ground
for parameter choices (16). with the toes slightly inclined outward. Certain exercises,
such as calf lifts and single-leg squats, can be executed with
this proper foot placement. The handrail can enhance safety,
6. Safety aspects but for certain balance exercises, it may not be necessary.
It is important to avoid a locked knee position during all
Modifying standards to account for vibration in exercises to restrict the propagation of vibration from the
rehabilitation and exercise is crucial. Vibration transmission torso to the head. The healthcare provider should conduct
varies across the body parts and postures, with resonance close monitoring of common side effects, such as brief
at around 5 Hz in the trunk and below 20 Hz in the itchiness, skin redness, tightness in the muscles, headaches,
lower extremities. Adjusting posture and using side- mild tenderness in the knees, and discomfort in the front
alternating vibration significantly minimize the transmission. of the foot. When considering the possible advantages and
Knee flexion and side-alternating vibration can reduce acknowledged risks, WBV exercise can be advantageous for
transmission to the head and trunk. While the potential clinical populations in situations where alternative means
harm from exercise-related resonance is uncertain, caution of exercise are impractical due to time limitations, a lack
is advised for frequencies around 5 Hz and below 20 Hz. of interest in participating in traditional programs, a lack
Novices should be educated about potential risks, and of finances, or an inability to perform load-bearing impact
unauthorized access to vibration platforms should be activities (7).
prevented. Hand-transmitted vibration causes vibration
white finger disease, which impairs hand function. It
remains unclear if similar conditions occur in the lower 8. Contraindications
extremities. Recommendations for occupational exposure to
hand-held vibration tools should be considered, and further Whole-body vibration therapy has several contraindications,
investigation is required to comprehend the dangers of high particularly related to various health conditions. People who
vibration during whole-body activities (8). have recently had a myocardial infarction, a pacemaker,
prosthetic heart valves, hypertension, uncontrolled venous
thrombosis, or an aortic aneurysm should avoid participating
7. Implications for practice in WBV training, according to the cardiovascular experts.
In the musculoskeletal domain, individuals with hip or
When selecting a device, it is advisable to choose a validated knee endoprosthesis, lower body metal implants from
machine with peer-reviewed published data. Independent osteosynthesis, osteoporosis with a vertebral fracture, an
confirmation of parameters such as acceleration, frequency, acute spinal disk herniation, recent fractures, an acute
and amplitude is preferable. Some devices have limited soft tissue injury, joint inflammation, or recent fractures
options for manipulating frequency and displacement, should avoid participating in WBV training. In terms
offering pre-defined programs with poorly described of neurological conditions, WBVT is not recommended
vibration characteristics. Instead of depending simply on for those who have deep brain and/or spinal cord
vendor recommendations, it’s critical to utilize the lowest stimulation, epilepsy, migraines, peripheral neuropathy,
effective dose, adhere to established training routines, and decreased cognition that interferes with exercise training, or
employ vibration settings that have been shown to be safe and any other neurological condition. WBVT is also prohibited
effective. Before participating, it is important to seek medical in cases of acute limb edema, pregnancy, tumors or
clearance when working with clinical populations (7). metastases, reduced skin integrity, recent surgery, and
When initiating a training regimen involving WBV, it is incontinence of the bowel or bladder. It is essential to
essential for individuals to wear footwear equipped with take these contraindications into account and seek guidance
thin and rigid soles. The purpose of this recommendation from healthcare professionals to ensure the safety and
is to avoid excessive dampening of vibration resulting from appropriateness of WBVT based on individual health
footwear. To make sure the consumer can withstand WBV, conditions and considerations (7).
92 Nisamudeen et al.

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