Vibration Rehab: Time efficiency in your practice

October 3, 2009 by Dr. Jasper Sidhu · 2 Comments

One of the most popular questions I get asked regarding vibration exercise is “why should I incorporate vibration into my practice when I can do the same exercises with other rehab devices?” I pretty much asked the same question when I first started with vibration therapy. However, once you begin using it, there are several major benefits of vibration that starts to become evident.

The two key points is that your rehabilitation time can be cut in half, thereby increasing the efficiency of your practice. The other is what i call the WOW factor for the patient. Let’s take for example patellofemoral pain. Rehab wise, we will usually stretch the tight muscles, try activating the vastus medialis through step ups, muscle stimulation, taping, etc. Then we look at providing some sort of deep massage to the muscles that may have adhesions, and finally we try to strengthen the quad. With vibration exercise, all of this can actually be accomplished in as little as 8 minutes. For some doctors using CPT codes of therapeutic exercise, billing for one unit is between 8 and 15 minutes. What is better? A full rehabilitation protocol embedded in 8 minutes or spending about 15 to 25 minutes doing all the above treatment methods?

Second thing Iv’e seen is the WOW factor. Low tech rehabilitation is the right choice for many, as our goal is to transition the patient to self directed active care. But how many patients end up getting a wall squat and stretching program, then take the exercise sheet home thinking they do it at home, and never end up doing it? Then they come back in a few weeks with the same problem. Vibration exercise is not only quick, but it produces immediate effects, whether it be increased circulation, increased mobility, decreased pain, etc. The patient usually ends up coming back into the office on a regular basis since they can see it working.

So in a nutshell, there has to be solid reasons for including vibration exercise in your practice. I believe these two are the most significant in getting the most out of your time, and the increased compliance of your patients.



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Vibration and Contraindications: Looking at hip and knee replacements

April 7, 2009 by Dr. Jasper Sidhu · 1 Comment

We’ve seen vibration exercise go from becoming a sports enhancement tool, to now being an integral part of rehabilitation and exercise for those that have medically associated conditions that prevent them from engaging in regular training. New research is focused heavily in the medical rehabilitation field. However, as more people use it for therapeutic purposes, questions about WHO can actually use it are starting to appear more frequently. This will be one of several articles talking about the contraindications that are listed for vibration exercise and how someone can benefit from this increasingly popular technology.

Originally, hip and knee replacements were listed as contraindications to vibration training. Some gave the time frame of 1 to 2 years post surgery. The reasoning was mostly directed at the consumer or fitness professional that may have the device in their facilities. Therefore, it had to be a no brainer to when a person can actually use vibration exercise. However, since a lot of chiropractors and therapists have started to use vibration in their practices, more and more are having significant results in recovery and function when utilizing vibration at an earlier time of their rehab process. The following are the key points to take away from all this:

Clinical judgment is allowing for more aggressive treatment approaches:

Therapists and doctors have the clinical knowledge in proper rehab protocols to understand how to place a patient on a vibration platform. By providing supervised care, doctors are able to progress a patient in a step wise manner based on patient presentation. If someone has a hip or knee replacement, the type of exercises or approaches to use with vibration exercise will mostly be dictated by what phase of post recovery they are in.

Early use of vibration can have benefits on things other than just strength gains:

Early use of vibration can also provide distal muscular stimulation from the site of injury or surgery, but also provide a valuable tool in increasing circulation. Most patients, after surgery, are sedentary until they can actively engage in exercise. However, this increased circulation can be produced at a much faster pace with vibration exercise. We have patients that, when able to weight bear, can sit on a chair and place their feet on the platform, or we can lie them down and place the calves on the plate. This can produce deep massage and circulatory effects, thereby accelerating the recovery.

vibration positions are modified to allow for earlier use:

Once a patient is weight bearing, the distal stimulation that vibration can offer has several advantages. We all know the positive effects on bone growth when a stress is applied. This is commonly referred to as Wolf’s law. Also, its not uncommon to see some of our patients able to participate in an intense vibration program where they are exercising the rest of the body while providing a slow gradual integration of treatments to the affected surgical hip or knee. This way, the patient is able to stay fit and increase their activity level while they heal.There aren’t too many treatment modalities that can accomplish this so this is a very important advantage of vibration exercise therapy.

Once a patient is weight bearing, low intensities are used, with as little as 15 to 30 seconds of vibration. Since vibration is fast acting, there is less chance of placing too much stress on the joint. Also, patient feedback is important to assess the reaction to vibration training. We’ve seen patients that have started vibration after 8 weeks post surgery and get significant results in function and strength faster than conventional training.

As always, caution is warranted through supervised care:

The issues that always arise is whether vibration is safe. In the proper hands with proper supervision, it is. It’s as same as asking a post surgical patient to begin walking or running on a treadmill, or go to the gym and start doing squats and lunges, when they may not have any training to do so. Any exercise, when done wrong, can be detrimental to the patient population. For this reason, anyone beginning an exercise program with vibration should be supervised until they are comfortable enough to continue on their own.

As we begin to see better results and more studies coming out on the effects of vibration exercise on various medical conditions, we will begin to see the contraindications start to dwindle and most likely see some of them disappear. Until that point, clinical judgment always rules!



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Effects of Vibration Exercise on Knee Pain and Function

February 19, 2009 by Dr. Jasper Sidhu · 9 Comments

Knee pain and impairment are common conditions that present to a Chiropractic office. Treatment programs range from passive modalities for pain control, low tech rehabilitation, to a full blown comprehensive rehabilitation program. However, vibration exercise platforms are continuing to increase in popularity in offices, providing the doctor with a safe and quick rehabilitation program in a small square footage of area. A couple of new studies have been published in the past several months that take a look at vibration effects on knee pain and impairment. Not only are the results positive, but the implications for practice is significant. Let’s take a look at the most recent study:

Trans T, et al. Effect of whole body vibration exercise on muscle strength and proprioception in females with knee osteoarthritis, The Knee (2009)

This study compared the effects of vibration on knee strength and proprioception to a control group. Results indicated significant increases in knee muscle strength and proprioception with the vibration group. What was interesting was comparing two different types of platforms: one was a balance board with vibration effects, while the other was a flat platform. There was more proprioceptive improvements in the group with balance board vibration. However, there was greater strength increases in the flat platform vibration group. The study is significant because its one of the first few studies to actually take a look at effects on osteoarthritis. The only thing the study did not show was any changes in self reported disease status measurements.

The results of this study point to several key points that need to be considered when looking at implementing a vibration platform in your practice. The strength gains in this study are similar to strength gains seen in other vibration studies so we know that there is an effective increase in strength. The exciting part is that the setting parameters used were relatively low. In a practical setting, we are able to progress the patient to higher parameter levels. Keep in mind that vibration exercise is a high intensity form of exercise, while maintaining minimal load on the body. Utilizing weight exercises at this high intensity is sometimes not possible in light of stresses and shearing forces on the joints. I would expect to see more significant strength gains if the parameters were based on individual progression. However, this is usually not possible in a research study.

This study used vibration exercise 2 times per week for approximately 10 minutes. This is significant for a chiropractic practice that may not have a lot of time to provide a comprehensive rehabilitation program. However, it would have been interesting to see the results from increasing the frequency to 3 times per week, which is sometimes the right amount of dose for any strength training program.

This study didn’t find any changes in self reported disease status measurements, although there were several other studies that have ( Bruyere et al., Cheung et al., Roelants M et al. ). Again, one needs to consider that the progression was consistent and not individualized to each person’s presentation. In addition to simple strength training exercises, I also incorporate muscle facilitation techniques that increase the contraction of the Vastus Medialis. This allows for faster stabilization of the knee joint musculature.

No matter how you cut it, new research into arthritis and vibration exercise are showing positive results. Considering this is an exercise modality that takes up very little space and can be done in a relatively short period of time with minimal loads and stresses on your patient, a Chiropractic practice is now equipped with a unique new exercise modality that can benefit a diverse range of the patient population.

Bruyere O, et al. Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents. Arch Phys Med Rehabil 2005; 86(2): 303-7.

Cheung WH, et al. High – frequency whole body vibration improves balancing ability in elderly women. Arch Phys Med Rehabil 2007; 88(7): 852 – 7.

Roelants M, Declecluse C, Verschueren SM. Whole-body-vibration training increases knee-extension strength and speed of movement in older women. J Am Geriatr Soc 2004; 52 (6): 901 – 8.



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Vibration Exercise and Weight Loss: Getting Past the Hype

December 1, 2008 by Dr. Jasper Sidhu · 5 Comments

Obese individuals are coming into Chiropractic offices more and more these days. We have always been taught in school that obesity is a contributing factor to some of the physical complaints we may see in our office. We would recommend diet and exercise on top of the chiropractic care we offered. However, when I mentioned exercise to some of my obese patients, they would roll their eyes. Initially I had thought that they were unwilling to do exercise. We would sometimes come to our own conclusions based upon stereotypes. However, I have come to learn that the MAJORITY of obese patients DO want to get better. They have struggled with their weight loss and are frustrated by it. When I mention exercise, it’s not that they don’t want to do it. It’s more a question of not being able to do it! This and other issues have always arisen in my practice. However, vibration exercise therapy has been an important modality in helping obese individuals with their exercise program. This blog discusses the underlying principles on why it is so effective, in addition to some of the concerns that you need to address within your practice:

Vibration exercise is a great tool for early adoption of exercise:

Most of the patients that present to my office were prescribed exercise. This could be in the form of an easy walking program, to joining a gym. However, I soon discovered that most of the patients also had medically associated conditions that prevented them from engaging in any exercise program. Their knees hurt when they walked too much. Or they presented to my office with fibromyalgia, which limited them from engaging in an exercise program. You can consider vibration exercise as a very effective early adoption of exercise. The platforms have many therapeutic benefits, from increased circulation to increased flexibility and strength. The most important thing is that there is minimal stress to the joints and ligaments. A patient can start on a very low frequency setting and steadily progress without placing more demands on their joints. My experience is that most of these patients begin to see some changes in strength and flexibility within weeks. The knees hurt less, and they are able to do more. Any increase in activity goes a long way to ensuring they stay on the right path to success. What we have found is that by introducing vibration exercise first, they are able to slowly get into the walking program or the strength training program that they initially could not have done.

Increase in metabolism

We did a 3 month study on the effects of vibration exercise on metabolism and weight loss. An interesting finding was an increase of the resting metabolism in those that underwent vibration exercise. We found about a 12 percent increase. This is quite significant due to the fact that a person’s caloric rate of burn increases, thereby helping them burn more calories. When we think of vibration exercise helping people lose weight, we should look at it from the point of view that it’s an effective exercise that when done the right way, can lead to greater energy expenditure.

Vibration exercise is a strength training program

When we get right down to it, vibration exercise is just another form of strength training, but done faster and easier. Hence, it’s been labelled as a ‘lazy’ person’s form of exercise. However, this ‘lazy’ person effect turns out to be effective when applied to the patient population. The patient population sometimes can’t engage in long bouts of exercise, or simply cannot go through painful ranges of motion to get the strength training effect. Vibration exercise leads to up to 3000 muscle contractions per second, thereby producing a significant strength training effect within minutes. Research has shown that 20 minutes of vibration training can give similar results to strength training for an hour. This is a significant benefit for our patients.

Getting over the hype

At first, it does seem that a vibrating platform that you stand on and lose weight with is probably too good to be true. However, when you look at the underlying physiological principles behind it, in addition to understanding what your goals really are, it’s not hard to see how beneficial it can be for our patient population. We have noticed higher compliance with vibration training, which keeps a person motivated and dedicated to their weight loss goals. Motivation is key to any success. We also change up the program on a consistent basis, thereby ensuring that the person’s body doesn’t adapt to the training effects. We also see that patients that couldn’t engage in conventional exercise can easily start with vibration exercise, thereby increasing their motivation to slowly progress to other forms of activity.

Next time, we will discuss the research behind exercise in general for weight loss and see again, that it’s a combination of exercise, diet, and behaviour changes that ultimately leads to success!



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Importance of Behavior Modification in Weight Loss

October 29, 2008 by Dr. Jasper Sidhu · 8 Comments

I remember even five years ago that weight loss wasn’t a major concern for a lot of health professionals within their practices. I had created a weight loss system that was easily integrated within a chiropractic office. There was a real need to begin providing this service within a practice. The program consisted of exercise, behaviour modification and healthy eating. This blog will discuss the research behind behaviour modification and why it’s a necessary component of any weight loss program. Most of all, it’s quite easy and inexpensive to integrate.

 

Once obesity became labelled as an illness by Health and Human Services Secretary Tommy Thompson, health professionals began to understand that it is something that can affect their treatment outcomes.

Weight loss is gradually being taken more seriously due to the obesity epidemic that is not only hitting the US, but also the world. With obesity comes a wide array of medically associated conditions such as diabetes, hypertension and most importantly, joint and back pain. More and more of these people are seeking chiropractic care and are posing a real challenge to the clinician, making us address the whole person rather than the specific condition they present. If you are looking at integrating weight loss into your practice, research has shown several strategies that work. One of the most effective components to any weight loss program is behaviour modification strategies. These can easily be implemented through the practice and can take as little as 10 minutes. The following is a list of research findings that suggest weight loss is not about a magic pill, but about providing as many effective tools as possible to ensure success.

 

·         Physicians’ weight loss counseling had a significant effect on patients’ understanding of and motivation to lose weight. However, physicians provided insufficient guidance on weight management strategies, possibly because of inadequate counseling skills and confidence:

 

Most of the research does show that a health professional has significant influence over a patient’s weight loss success. As chiropractors, we are in a prime position to be the main influence for these patients considering we have always been rated high on ability to communicate with patients effectively.

 

Behavior modification strategies:

 

·         Daily record of food intake, which can be accomplished through a simple Food and Activity Journal, allowed individuals to lose 64% more weight compared to those who did not record food intake.

 

·         The more contact people have with members of their treatment team, the longer they maintain their weight losses.

 

 

·         When motivational strategies are utilized in a weight loss program, a person has better attendance, self – monitoring, and exercise compliance skills.

 

·         Participants who were recruited with friends had increased weight losses over a 10 month period over those who were recruited alone.

 

·         A person’s weight loss expectation over a six month period can be as much as 28%, while the average weight loss over that same period is approximately 15%. This reinforces the need to provide realistic expectations and goals.

 

·         Overweight people underestimate their caloric intake by as much as 30 to 40%. Some underestimations can be as much as 1200 calories per day.

 

As you can see from the findings, there are many issues involved in the weight loss process rather than providing the simple ‘eat less and exercise more’. One of the biggest frustrations is providing a realistic expectation to a person’s weight loss strategy. As you can see, many people have higher expectations of weight loss than what is achievable through an effective program that doesn’t involve surgery! In this study, people wanted 28% of their body weight lost, although reasonably they could only expect up to 15%. Do you realize that even though these people were told they would only lose up to 15% of their body weight every month for 6 months, they were still dissatisfied with those results? Achieving 28% of body weight is achievable primarily through surgery. Unrealistic expectations are a huge factor in any success you want to achieve with your patients. Reinforcing realistic expectations from the outset and getting a commitment is essential for success.

 

One other important finding is the fact that most underestimate how much they eat by 30 to 40%. This isn’t the fault of the patient, but is an inherent misjudgment that is made. That’s why prepared meals or meal replacements are so popular. If you are going to establish a weight loss program, always take into consideration that unless you are very good at educating on portion control, prepackaged meals or meal replacements may be the more effective and efficient option for some of your patients.

 

As you can see, behavior modification is a critical component of your weight loss program. There are a lot of factors at play other than eating less. There is more at play here than just recommending a magic pill! Most of the behavior modification strategies are things that chiropractors should be comfortable with. We have always been known to provide effective communication and education for our patients. Transferring the same skills to a weight loss program should be easy. As more and more patients are showing up at our offices obese, it should be our prime responsibility to address this alongside their medical conditions.



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Integrating PreHabilitation into your practice

September 23, 2008 by Dr. Jasper Sidhu · 1 Comment

It’s been some time since my last blog. I had the unfortunate task of undergoing meniscal surgery and trying to get back on my feet. It’s amusing how we doctors are the worst patients out there. I can’t remember the number of times being yelled at for not resting enough by my surgeon, chiropractor and therapist! However, there were some positives that came out of it, and that was right before my surgery. A few months ago, I had reinjured my knee and ended up with a very swollen knee with limited range of motion. That’s why I had decided to go for the procedure. At the time of surgery, my surgeon was amazed that I recovered full range of motion and my strength was still there. That’s one reason why I was able to get back on my feet quicker than most. This was all due to doing an effective prehabilitation program. Whenever I talk to other doctors, I start to realise that prehabilitation is not something that everyone does, although the results for your patients will be that much better.

Prehabilitation is not only defined as exercises to develop areas of the body to prevent future injuries, but also ability to maximize strength, flexibility and mobility in people prior to surgery in order to increase functional outcomes after surgery. This is starting to become more and more important in this time and age. People that are showing up at surgery are more sedentary, obese, and have a constellation of health conditions that increases the risk of morbidity and delays recovery following surgery. This is a major reason to begin getting your patients into as best of shape as possible prior to the surgery. The importance of this can’t be underestimated. Research is already showing that prehabilitation leads to better outcomes after surgery.

Prehabilitation is not as difficult to do as one may think. Setting up a small room for various exercise equipment is a good start if you don’t have any. Start off with something simple as bands and a gym ball and work your way to more equipment as interest grows. Marketing prehabilitation to your patients and the public is also important to increase awareness. Since it’s not a service most people know of, education is a key component of making this successful. Another angle to take with prehabilitation is preventing injuries from occurring in the first place. This is popular among sports trainers to prevent injuries in their athletes. But why stop at athletes? Talking about the benefits of prehabilitation is also important for workplace injuries. Back schools have been around for awhile, but there’s also the ability to address other conditions, such as carpal tunnel, knee pain, headaches, etc. By promoting a preventative practice, there will be an increased awareness of your practice in the community. So next time your patient goes for surgery, take advantage of the situation. I’m certainly glad I did.



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Is there a ‘BEST’ sports therapy modality??

August 28, 2008 by Dr. Jasper Sidhu · 2 Comments

What technologies are the most effective in sports rehabilitation and performance? This is the question that was posed to me at the Florida Chiropractic Association convention in Kissimmee over the weekend. There were many different technologies and techniques out there on the trade floor show, so it can become quite overwhelming to any of us in what we need to put in our practice. I was at the tradeshow demonstrating vibration therapy, and since it’s one of the fastest growing modalities out there in the Chiropractic field, it was natural to get these type of questions. Before we jump on board with the latest and greatest, the answer doesn’t lie in the product, but in a simple principle that has been used in sports performance. If we go through the principle first, we can then look at products on the market and see what will fit us the best:

Everything works, and nothing works all the time

Alwyn Cosgrove, a prominent personal trainer, made a good point with this. The principle is simple. If we subject our body to the same stimuli all the time, our body will get used to it and further improvements are minimized. You can see that with some of the gym rats. They will tell you they have been working out for a year and haven’t seen any gains in strength or muscle tone. The problem is they stick to one weight training program and the body eventually plateaus. If you provide different intensities, frequencies and weights to their program, the body experiences something new. This keeps it guessing and gains are continued. For a sports rehabilitation practice, this means that you must be active in progressing someone from simple exercises to something more complex. Not only that, but keep the body guessing by throwing in different tools. If you are using a rocker board for balance and proprioception, progress to a rocker board, or simply progress to functional lunges. Simply put, don’t subject your patients to the same type of exercise all the time. That’s why having as many different tools in your arsenal will lead to better outcomes.

Another chiropractor asked me about vibration training and whether it’s superior to other modalities out there. If we look at the above principal, it’s not the vibration device that makes your program superior to others. It’s HOW you use it. Placing someone on it at the right stage of injury, rehabilitation or performance enhancement is crucial. You have to also align the right exercises with the right goals. You won’t get explosive strength with an athlete if all they do are calf raises on it! That athlete will need to add additional weight and also do plyometric training off it. If an athlete is undergoing rehabilitation following an Achilles strain, gentle static calf raises may be the most effective thing to do.

So when you decide to purchase a piece of equipment that promises unbelievable results for your patients, first ask yourself who you are going to be using it for. Also ask questions regarding the product on how it can be used in different stages of injury. There shouldn’t be a cookbook approach to using it, but basic principles you can follow when developing your own unique programs.



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FACTS AND MYTHS OF VIBRATION EXERCISE THERAPY

August 13, 2008 by Dr. Jasper Sidhu · 2 Comments

Myth: Vibration exercise therapy is something new.

Fact: Vibration, in various forms, has been around for years. Local vibration has been used with the spinal cord population to fatigue muscles and decrease spasticity. Other forms of local vibration have been used to break up scar tissue adhesions, increase blood flow to the area and increase local mobility. As Chiropractors, we have been using localized vibration for years as an integral part of our practice. Vibration exercise therapy is just a novel alternative to generate global effects of vibration as part of an exercise program.

Myth: Whole body vibration has adverse effects similar to occupational whole body vibration.

Fact: Occupational vibration effects is determined by amount of dose of vibration per day and the frequency of that vibration. Vibration exercise therapy utilizes frequencies that are in the safe range. For example, frequencies of less than 20 HZ represents the resonance frequencies of the internal organs. This is why truck vibration contributed to so many low back problems. However, vibration exercise frequencies don’t go into this range. In addition, occupational vibration exposure is cumulative over time with several hours a day of dosage to produce any significant adverse effects. Vibration exercise therapy takes only 15 minutes per day, three times per week.

Myth: Vibration therapy is limited to athletic people that can handle the stress of vibration exercise.

Fact: Initially, vibration exercise therapy has been used by high level athletes to give them that extra edge in competition. However, more and more hospitals, therapy and chiropractic centers are starting to use vibration exercise therapy to increase function and decrease pain. New research is showing the positive effects that vibration therapy is having for the senior population, in addition to people that are compromised with any host of health issues. It’s shifting from the high level athlete to the individual that is unable to engage in conventional exercise due to physical limitations or conditions.

Myth: There is no research to support vibration exercise

Fact: Actually, more and more research is coming out every month in peer reviewed journals showing the positive effects of vibration therapy. In addition, research is being conducted at various North American universities, medical colleges and chiropractic colleges. The positive benefits seen in clinical practice is increasing the interest of the research community.

Myth: All vibration machines are the same.

Fact: As with any therapeutic modality, it is important to do your research into assessing which machine is the right one for you. Safety is extremely important, in addition to understanding that you are getting a consistent dose of exercise every time. Smaller, cheaper machines may not care about limiting lateral motion, which increases shearing forces on the joints. The primary point is that you get what you pay for. It’s important to assess how you will be using it in your practice, who you will be using it on and whether you require a high commercial use for high volume use or something smaller for occasional use.



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Treatment of Low back pain with Whole Body Vibration Therapy: A paradox

July 30, 2008 by Dr. Jasper Sidhu · 3 Comments

Treating back pain with whole body vibration is both effective and time efficient for the doctor. However, it’s sometimes confusing to hear the words ‘whole body vibration’ and ‘back treatment’ in the same sentence! As Chiropractors, we are all well aware of the adverse effects of whole body vibration on back pain. However, new research is showing that when vibration is applied within specific safe frequencies, it has positive benefits on back pain. Since applications of vibration exercise with low back pain is the most requested topic I get, let’s go over the current literature and introduce some rehabilitation concepts that can be applied with vibration exercise.

It’s surprising how much new research is coming out for vibration therapy. Just five years ago, I would be hard pressed to see an article appear in a peer reviewed journal every few months. Currently, new research is being published in such journals as Spine, Stroke, American Journal of Clinical Rehabilitation, to name a few. It appears the focus is slowly shifting towards health benefits as opposed to the initial research in sports performance, although there’s significant research going on in that also.

Here’s a summary of 2 interesting articles about low back pain and vibration therapy that we can discuss:
Rittweger J, Just K, Kauthzsch K, Reeg P, Felsenberg D. Spine 2002: Treatment of chronic lower back pain with lumbar extension and whole-body vibration exercise: 27; 1829 – 1834.

Findings: This was a randomized controlled trial that showed comparable results of reduction in pain sensation and pain-related disability when comparing back extension exercises to vibration therapy. The study also cites that poor lumbar muscle force is probably not the exclusive cause of chronic lower back pain. It is thought that vibration exercise may be activating muscles via reflexes.

In practice, we tend to see a lot of back pain patients. Our take on vibration exercise is that there is an increased proprioceptive effect due to the instability of the platform. This may be activating the deep muscles of the low back. Prior to vibration therapy, we would utilize rocker and wobble boards, based upon treating muscular imbalances through some of the methods taught by Janda. We found that vibration therapy tends to achieve similar results but in less time. Not only are we getting muscle activation, but increased strength gains in the lower extremities.

Belavy DL, Hides JA, Wilson SJ, Stanton W, Dimeo FC, Rittweger J, Felsenberg J, Richardson CA. Spine 2008. Resistive simulated weightbearing exercise with whole body vibration reduces lumbar spine deconditioning in bed – rest. 33: 121 – 131.

Findings: The resistive vibration exercise countermeasures reduced, but did not entirely prevent, multifidus muscle atrophy and passive spinal tissue deconditioning during bed-rest.

This is an interesting study and shows the importance of providing early rehabilitation for anyone with low back pain. It’s already been shown that after an attack of low back pain, there is atrophy of the multifidus muscle. Even after the back pain is gone, a group that did no exercise was still seen to have atrophy. Hence, the importance of exercise cannot be overstated. This study is reinforcing the positive effects of exercise. What makes vibration therapy so unique is that you can utilize it for patients that are unable to engage in conventional therapy either due to decreased mobility or increased pain. When I get an acute low back patient, or a chronic patient with limited mobility and pain avoidance behaviour, starting off their rehab program is as simple as lying down next to the vibration platform and putting two feet on it. Distal stimulation allows activation of the muscles in addition to increased circulation. In this situation, I use vibration therapy as an ‘early adoption of exercise.’ Achieving early strength and flexibility gains is crucial to progress the patient into a more functional program. We have found that vibration therapy allows us to begin this process early enough so that the patient does not fall into sedentary habits.



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Choosing the Right Vibration Platform

July 22, 2008 by Dr. Jasper Sidhu · No Comments

Choosing the right vibration platform is not as easy as one might think. Over the last few weeks, I’ve had a lot of fellow chiropractors ask about which vibration platform I recommend for their practice. The answer really depends on several factors, and not all include specifics on the platform itself. The following are some things to look at when considering a vibration platform for your office:

First thing to note is the amount of space you have available. Some chiropractors have rehabilitation space while others may only have limited space in their treatment rooms. Both locations are effective. We have seen chiropractors place a vibration platform in a treatment room and utilized it as a modality. Others have placed several in their rehabilitation area and utilized it as a modality or something that can be utilized post discharge from chiropractor care. Platform sizes vary in size and can get to taking up as much as 10 square feet of space (includes vibration platform area AND exercise area).

On the other side of the coin, one has to be aware that a larger platform size will give you more flexibility in the types of exercises you can provide your patients. Remember that patients are not just going to stand and do squats. They should have the ability to do lunges, push ups, or lie their extremities on the platform to receive mobilization or deep tissue massage. We have patients with Multiple Sclerosis doing walking patterns to help with proper gait and balance, so size of the platform is an important consideration, especially if you have special populations that you are treating.

Ask about the company’s training and support. Since vibration exercise therapy may be something new for some, it’s essential that you get the support to answer any questions regarding protocols. There’s always the simple exercises, charts, posters and videos that one gets in the mail, but ensure that follow up support is there.

Price. Price seems to be an issue for a lot of chiropractors, and since this technology is steadily being adopted, there are many different companies out there trying to pitch on price. Don’t let price be the factor in your buying decision. I’ve been to an office that used a relatively cheap machine. However, that machine didn’t last long once the doctor started putting their overweight or athletic patients on it. There are machines on the market place that capitalize on the success of vibration therapy but when you look into it, their quality, durability and reliability comes into question. Only way to compare this is to jump on a treadmill that you see in your local gym, and then buy one at a discount store and try to use that at home. Always remember that you are placing patients on these machines and not fit and healthy people. The quality is critical.

Quality is not only critical for your patients, but also for your bottom line. If you are buying for your practice, always ensure that you ask for ‘commercial use’ devices. These devices are meant to be used in a high volume environment, day in and day out.

Ask about translation forces. This basically means a platform’s direction of vibration should be as close to vertical as possible. Any horizontal translation forces leads to shearing forces on the joints and should be avoided. Remember that we are treating patients with health conditions. Therefore minimizing shearing forces is critical.

For those looking at purchasing, make sure you do your research and feel comfortable with the company you are dealing with. The more information you have and the more support you get from the company, the better outcomes you will get with your patients.



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