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.