Using Whole Body Vibration Physical Therapy Sport IN AND Clinical Practice and Treatment Exercises Alfio Albasini PT, PostGradManipTherap, Private Practicioner International Teacher, McConnell Institute, Neurodynamic Solutions (NDS) Member of CEC Otto Bock Member of SUPSI and USI, Università della Svizzera Italiana Martin Krause Bachelor Applied Science (Physiotherapy), Graduate Diploma Health Science (Exercise and Sport), Master Applied Science (Manipulative Physiotherapy), Certificate IV Workplace Assessment and Training Graduate Certificate Health Science Education, Back in Business Musculoskeletal & Sports Physiotherapy, Pro Cure Physiotherapy Pty Ltd Australia. Ingo Volker Rembitzki Physical therapist, Certified MT and MLT, Chairman of the Clinical Excellence Circle of Otto Bock Health Care Company, Project manager Medical Affairs; Instructor WBV therapy. FOREWORD BY Martha R. Hinman, PT, EdD Professor, Dept. of Physical Therapy, Director, Transitional DPT Program, Hardin-Simmons University. Edinburgh  London  New York  Oxford  Philadelphia  St Louis  Sydney  Toronto  2010 First published 2010, © Elsevier Limited. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333; e-mail: [email protected]. You may also complete your request online via the Elsevier website at http://www.elsevier.com/permissions. ISBN 978 0 7020 3173 1 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Authors assumes any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. The Publisher Working together to grow The libraries in developing countries publisher’s policy is to use paper manufactured www.elsevier.com | www.bookaid.org | www.sabre.org from sustainable forests C Printed in China Foreward by Professor Martha R. Hinman The influence of new technology on the practice of physical therapy and sports medicine continues to challenge our ability to scientifically test the efficacy of products designed to enhance physical performance. Whole body vibration (WBV) equipment is one example of this new technology. Although it is difficult to estimate the current number of companies that market WBV equipment, the number has grown exponentially in recent years; a Google™ search will produce close to 150,000 web sites, depend- ing on the search terms used. Skeptics of WBV claim that this just another fitness fad, while other critics cite the ‘unproven claims’ made by WBV manufacturers who are hoping to cash in on consumer demands for new cures to old health care problems. Over the past 5–10 years, I have received hundreds of phone calls and e-mails from individuals worldwide who are seeking health care advice on the benefits of WBV for conditions ranging from motor weaknesses to osteoporosis to autism. Unfortunately most health care professionals, like myself, are faced with more questions than answers when it comes to WBV exercise. Thus, these authors have helped to fill this information void by providing the first in-depth analysis and synthesis of the growing body of research on whole body vibration. They have coupled the results of numerous published studies with their own vast experience to provide an overview of the biomechanical and physiological effects of whole body vibration, as well as training guidelines to address a variety of physical impairments and functional goals. Whether your professional background is in sport science or rehabilitation, you will find evidence-based treatment parameters for improving muscle strength and power, soft tissue flexibil- ity, balance and postural stability, bone density, peripheral circulation, and more. In chapters 5 and 6, the authors have also provided an illustrated, stepwise guide to help the novice practitioner utilize this new exercise modality in a safe and effective manner. These authors, and the researchers whose work they have drawn from, have given us an excellent start. Like any initial work, this text is not necessarily an exhaustive review on the subject, but it does provide the scientific basis, clinical rationale, and treatment parameters needed to incorporate WBV into a physical therapy treatment plan or athletic Foreward by Professor Martha R. Hinman viii training regimen with a reasonable assurance of success. And, hopefully, the outcomes experienced by these patients and athletes will be docu- mented and added to the burgeoning body of knowledge that is needed for WBV to gain universal acceptance as a standard part of our clinical practice. Martha R. Hinman, PT, EdD Professor, Dept. of Physical Therapy Director, Transitional DPT Program Hardin-Simmons University Abilene, TX 79698-6065 325-670-5828 C Acknowledgements I would like to commence by acknowledging my colleagues and coau- thors, Ingo Rembitzki and Martin Krause. In particular, the latter has tirelessly given a major contribution to our book and without him this book would never have happened. A special thanks is addressed to Salvatore Germano for his technical support during all the difficulties we had with our software and hardware. I would like to thank Giuseppe Sarcinella, who created the photographs as well as the video. I would like to acknowledge Federica Nobile for her contribution, as a volunteer, for spending several hours on the platform during the shooting in order to obtain the optimal angle for the photos. Special thanks is extended to Natalie Meylan, Development Editor, for her great support whilst obtaining all the permissions we needed for this book and Rita Demetriou-Swanwick, Commissioning Editor, who helped me through the process of writing this book. Lastly, the person who deserves the most gratitude of all is my wife, Astrid. She not only supported me during the entire period of this work, but she also took care of our two daughters, Aline and Aisha, during my absence due to international teaching and congress commitments. I will always be grateful to her because she allowed me the possibilities to achieve so many different steps during my career, always assisting me and protecting me and I hope that this book will give her some satisfaction as well. Alfio Albasini I would like to thank my co-authors and the publishers for their time and patience in developing this book. Furthermore, I’d like to express my deepest gratitude to all my teachers past and present who have imparted their wisdom and knowledge. The scientific advancement of Australian Musculoskeletal Physiotherapy is a telling tribute to these people. With the edition of this book I hope that I can also serve to stimulate and advance the art & craft of clinical practice through the Applied Sciences. Finally, I would like to dedicate this book to my parents Norbert & Sonja – who have always supported me, and my wife, Marianne and my son, Saxon who give me so much joy and happiness. Martin Krause Acknowledgements x I would like to express my gratitude to my friends Alfio Albasini and Martin Krause, my co-authors, for their good cooperation and excellence support. I would like to thank my family, my wife and my kids Rahel and Fabio Laurent for their understanding and support during the entire period of this work and all the professional colleagues and specialists who have helped me to become a specialist in this new field of whole body vibration training therapy over the last 9 years. I would also like to thank my patients for their patience and excellent cooperation during the practi- cal work. My quite special gratitude goes to Prof. Felsenberg from whom I learned much more than just WBV through his work on bone material and muscle reactions. Lastly, I would like to acknowledge Dr. Martin Runge, the Person who taught me the basics of WBV in the fields of geriatrics, muscle and bone physiologies. I hope this book can contribute to the learning and understanding which is evolving in this interesting field of therapy. Ingo Volker Rembitzki C 1 Introduction Alfio Albasini and Ingo Rembitzki Vibration training and vibration therapy, also known as whole body vibration (WBV), biomechanical stimulation (BMS), and biomechanical oscillation (BMO) date back to ancient Greece. Recently, vibration training has been reinvented as a new form of exercise that is becoming more frequently used to improve muscle strength, power and flexibility as well as coordination. Increasingly, WBV can be encountered in different well- ness, fitness and rehabilitation centres as well as medical centres. Various professional sports clubs, such as AC Milan (soccer), Anaheim Mighty Ducks (ice hockey) and Chicago White Sox (baseball), are using WBV for their recovery and strengthening regimens in addition to their warm-up sessions. Individual professional athletes, including the legendary cyclist Lance Armstrong and Austrian skiing star Herman Maier, have incorpo- rated vibration platform sessions into their training schedules. Initially, vibration was used only for specific parts of the body (BMS). Later, a system with a counter movement (lateral or horizontal displace- ment) around a fulcrum was licensed in Germany, in 1996. Individuals using this tool could stand on their feet so that the whole body was stimu- lated with a sinusoidal vibration; hence the term whole body vibration was coined. This should not be confused with the vibration experienced in occupational injuries where the body passively vibrates over long periods of time. In the latter case, occupational vibration differs in its duration (e.g. heavy machinery driver) and also in the nature of its form, whereby sporadic movements are induced in the body, as in an air com- pression hammer, at a totally different frequency (>100 Hz) of vibration 1 Introduction 2 from that of WBV. The combination of duration and sporadic nature of movement appears, with the markedly higher frequency, to cause the deleterious effects. In contrast, WBV employs low-amplitude (<10 mm) and low-frequency (<65 Hz) mechanical stimulation of the human body for short durations (<30 min) to attain an effective and safe way to exercise musculoskeletal structures. History In 1880, Jean-Martin Charcot, a French neurologist, examined the surpris- ing improvements in the condition of pilgrims suffering from Parkinson’s disease. He surmised that such improvements were attributable to the vibration from the horse-drawn and railway carriages. Based on this idea he then developed a chair with a helmet that vibrated electrically. Between 1890 and 1910, Charcot’s ideas were developed further by different thera- pists. G. Taylor (USA), G. Zander (Sweden), and J. H. Kellogg (USA) produced different kinds of vibration therapy for the arms and back. In 1960, Dr. Biermann, a West German, published the paper ‘Influence of cycloid vibration massage on trunk flexion’ in the American Journal of Physical Medicine. In 1970, Professor Vladimir Nasarov developed a vibration training programme as an effective method for athletes. He observed an improve- ment in power and flexibility using Biermann’s ideas in practical exercises. A short time later, this localized vibration training started to be used by the Russians in their space programme to prevent bone density changes in astronauts. They recognized that this new idea for exercise had the potential to provide suitable countermeasures for preventing bone and muscle loss for astronauts under microgravity conditions. WBV was later used to enhance the performance of Soviet athletes during their exercise training (Nasarov & Spivak 1985). These two authors were the first to highlight the association between strength and power development and whole-body or segment-focused vibration training. They assumed that repetitive eccentric vibration loads with small amplitudes would effec- tively enhance strength, because of a better synchronization of motor units. Professor Nasarov was a Russian athletics coach who first applied vibration stimulation in sport. Basically, he wanted to help athletic performance based on the principle that by applying vibration to a distal muscle it would be transmitted to more proximal muscles. The special device he used generated vibration at a frequency of 23 Hz. Profes- sor Nasarov found that the vibration produced an increase in the range of motion (ROM) of the involved joint, speculating that a shift in C the pain threshold had occurred (Nasarov 1991 cited in Künnemeyer & History 3 Schmidtbleicher 1997). He also hypothesized that vibration training, besides improving flexibility, would also improve blood flow. The first study (Fig. 1.1) which combined weight training and vibration training was performed by Issurin et al (1994). These researchers found a 46% improvement after weight training with vibration (3 weeks, three times a week, 44-Hz frequency with amplitude of 3 mm, 30 m/s2). The same weight training without vibration had a progression of only 16%. In a second study presented by Issurin and Tenenbaum (1999), 14 amateur and 14 elite athletes were subjected to vibratory stimulation during bilateral biceps curl exercises (Fig. 1.2) at a frequency of 44 Hz and with an oscillation of 3 mm peak to peak. They were also engaged in power exercises without vibration. The results in the elite athletes were an increase in explosive strength exertion for maximal and mean power of 10.4 and 10.2%, respectively, whereas in the amateurs the improvement was 7.9 to 10.7%. In 1996, the first side-alternating vibration platform simulating the human gait was licensed in Germany. By 1998 vibration platforms with Pulley Amplitude 3 mm Frequency 44 Hz Vibratory stimulation device Load Figure 1.1 Combination of vibration training and weight training.  Reprinted from Issurin VB, Liebermann DG, Tenenbaum G (1994) Effect of vibratory stimulation training on maximal C force and flexibility, Journal of Sports Sciences 12: 561–566, 1994, with permission from Taylor & Francis.