A few weeks ago, I wrote about whole body vibration. I’m going to shake things up a bit (pun intended, sorry) and write about Focal Vibration Therapy.
Focal Vibration Therapy has been shown to be an effective tool in neurological rehabilitation. For spasticity management, I believe it holds incredible potential. It may even play a role in the treatment of sialorrhea (excessive drooling). I’ve been exploring ways to make Focal Vibration Therapy accessible and affordable since therapy-grade vibration devices can run well over $1000. That’s just not within reach of most families, nor do I think it is necessary. More about devices later…
Over the past ten years, there have been a handful of research studies looking at the effectiveness of focal vibration for the treatment of spasticity (muscle tightness/hyperactivity due to an injury to the brain or spinal cord). Focal vibration is a fascinating option because the standard treatments of spasticity include oral medications, injection therapies, and orthopedic & neurological surgery.
Well, what is focal vibration therapy anyway? Focal vibration is simply using a device to administer high frequency vibration to a specific body part. The vibration does not have to be strong; but, it does need to be applied to the right area, for the optimal amount of time, at the best frequency.
One theory of how focal vibration works to reduce spasticity is by triggering the Tonic Vibration Reflex (TVR). What happens is the vibration stimulation activates sensors in the muscle (step 1). When these sensors detect the vibration, it sends a signal to the spinal cord through a sensory nerve (step 2). Then, the spinal cord has a control center (3) that turns down the volume on the opposite muscle group by sending a signal down a nerve to those muscles (step 4). This is a regular, very helpful reflex. It makes sure that when we are using a muscle or group of muscles to perform a motion, it is very helpful to “turn off” the opposite muscles so they don’t “fight” the ones trying to do a job. We are using this reflex to “turn off” or at least “turn down the volume” of the spastic muscle by stimulating the opposite ones with the vibration. Ta-da…less spasticity with no real side effects!
Now, in all fairness, focal vibration can’t eliminate the need for other spasticity treatments such as medications, injections, or surgeries. There is a good amount of research supporting the use of focal vibration; but more research is still needed to determine the best location to apply the stimulation, how strong the vibration should be, and at what frequency. Also, how long the spasticity reduction lasts varies quite a bit from study-to-study, minutes to days.
Now, without further delay, how do we do it?
As a mentioned above, vibration devices can be quite expensive. But, I believe I have found a couple of options that are much more affordable. The most versatile is the PADO CM-07 Dual Motor Percussion & Vibration Therapy Massager for Back & Sports Pain, Sciatica, Neck, Leg, FootPADO CM-07 Dual Motor Percussion & Vibration Therapy Massager.
It is unique because it has both vibration and percussion heads. When the head of the device moves towards-and-away from the body, that’s percussion. Percussion is the most common type of massage device. They are really all the rage for those overworked, sore muscles. When the head of the device moves side-to-side across the body, that’s vibration. Vibration tends to be subtler. It’s more of that gentle rub as opposed to that vigorous soft-tissue massage. The studies I reviewed all utilized vibration. But, I’ve been wondering if percussion can be beneficial or even superior. If I reason it out, each time the percussion pushes on a muscle/tendon, it would apply a stretch to that structure, similar to when your doctor checks your reflexes by tapping on your knee with a reflex hammer. But, this would be like Tommy Lee, drummer for Mötley Crüe, playing drums on your knee with a pair of reflex hammers. This type of stretch triggers the Muscle-Stretch Reflex which should elicit a similar inhibitory reflex to opposite muscles just like the Tonic Vibration Reflex. Since I haven’t found any studies investigating the use of percussion instead of vibration, what I’m saying here is all speculation. I think it is worth a try since there are so many percussion massage devices out on the market right now and many are quite affordable such as the Wahl Delux Deep Tissue Percussion Therapeutic Handheld Massager which provides only percussion but its highest setting is quite strong.
Also, like the Pado, the intensity is adjusted using a continuous dial as opposed to a push-button that selects between a few different settings. I find the continuous dial very helpful in finding just the right amount of percussion/vibration based on effect and patient’s tolerance (most find it quite tolerable or even enjoyable!). I’ve started giving it a go. I’ll chime back in down the line after I’ve had more experiences!
Now, the technique is quite straightforward. The vibration should be applied to the musculotendinous junction, the area where muscle becomes tendon. A good rule of thumb is the musculotendinous junction is about two-thirds the way down the length of the muscle. Find that spot and place the vibration head there.
As an example, to relax the calf muscle, apply the vibration to the Tibialis Anterior, the muscle in front, just to the outside of the shin bone. Hold steady for about three minutes.
For spastic hamstring muscles, apply the vibration to the front on the thigh a bit above the knee cap.
I’m hoping that future research will give us more guidance in the type of vibration/percussion, the location, and “dose” that will give the most spasticity reduction. For now, I think the current body of evidence is compelling enough to give focal vibration a go.
Murillo N, Valls-Sole J, Vidal J, Opisso E, Medina J, Kumru H. Focal vibration in neurorehabilitation. Eur J Phys Rehabil Med. 2014 Apr;50(2):231-42.
Celletti C, Camerota F. Preliminary evidence of focal muscle vibration effects on spasticity due to cerebral palsy in a small sample of Italian children. Clin Ter. 2011;162(5).
Russo EF, Calabrò RS, Sale P, Vergura F, De Cola MC, Militi A, Bramanti P, Portaro S, Filoni S. Can muscle vibration be the future in the treatment of cerebral palsy-related drooling? A feasibility study. Int J Med Sci. 2019 Sep 20;16(11):1447-1452.
JenFu Cheng MD 