As clinical research director for numerous chiropractic clinics, I am asked to consult on some very interesting cases. Recently, a 14-year-old female and her parents asked one of my clients for advice.
A few months prior to their visit, the patient’s school nurse found a positive sign for scoliosis, and X-rays by their family chiropractor showed a Cobb angle of 14 degrees in the thoracics and 9 degrees in the lumbars. The family chiropractor recommended six weeks of whole-body vibration, followed by spinal manipulations and exercise.
About a month after starting whole-body vibration, the girl began experiencing spinal pain. The family came to my client for a second opinion. They asked if whole-body vibration could be causing the pain.
My client’s follow-up X-rays revealed an increased Cobb angle of 22 degrees in the thoracics and 15 degrees in the lumbars. The patient’s rapid angle progression and accompanying pain were likely the result of whole-body vibration.
Inconsistent for MSK Populations
Over the past 20 years, whole-body vibration has gained much popularity, especially for improving bone mineral density and neuromuscular performance. Proponents of this therapy say it activates bone receptors and enhances a hormonal response to stimulate bone building. They also say it can stimulate muscle contractions, leading to increased neuromuscular motor-unit recruitment and muscular force production.
The theoretical benefits of whole-body vibration sound alluring. However, research has failed to find consistent benefits of this therapy in musculoskeletal populations. Early animal and clinical studies, and even some contemporary studies, have had serious methodological research flaws and undependable results.
As health care professionals, we owe it to our patients and colleagues to critically appraise the quality of the evidence and filter out poor-quality research and ineffective or harmful interventions before we share our opinions and recommendations.
Neuromuscular Performance
Multiple research teams have demonstrated that whole-body vibration fails to improve neuromuscular performance. Two clinical trials found that whole-body vibration training did not induce any central neural adaptations or increase neuromuscular performance.3,8 A systematic review examining nine randomized clinical trials found no improvement in neuromuscular performance from whole-body vibration.7
Hibino, et al., performed a randomized clinical trial and demonstrated that whole-body vibration training failed to improve muscle strength, balance performance, or body composition.4 Other randomized clinical trials also found that whole-body vibration does not change neuromuscular performance and postural control, or enhance muscle mass and strength.1,10
Bone Mineral Density
Whole-body vibration has not demonstrated benefits related to fracture risk or bone mineral density. In a systematic review of eight randomized clinical trials, researchers found no clinically important improvements in bone mineral density.9 In a systematic review and meta-analysis of 13 randomized trials, whole-body vibration did not improve bone mineral density in older women.6
The Agency for Healthcare Research and Quality Effective Health Care Program commissioned a review that found there was insufficient evidence in the scientific literature to support whole-body vibration therapy’s ability to increase bone mineral density or lower fracture risk on a clinically significant scale.12
DadeMatthews, et al., found in a meta-analysis of 30 studies that there was no improvement in bone density after whole-body vibration.2 These findings were unchanged regardless of vibration type, vibration frequency, or duration.
Science Has An Open Mind
Science is not a static body of knowledge, but an ever-evolving process of discovery that welcomes diverse viewpoints. Thus, we must be open to new research findings. Whole-body vibration may offer promising potential for prevention and rehabilitation in other patient conditions.
Whole-Body Vibration Risks
Unfortunately, the 14-year-old patient in our consultation case experienced very serious harms as a result of whole-body vibration. The therapy increased the curvatures of her scoliosis and caused her pain. This detrimental outcome could have been prevented if her family chiropractor had only done his homework.
Multiple research teams over the past 20 years have published black-label warnings against the use of whole-body vibration in patients with scoliosis.5,11
The Downsides of Popularity
When something is popular, it is human nature to not have a critical eye. The common term for the phenomenon of failing to question popular beliefs is groupthink. Groupthink occurs when a group of people values harmony and conformity over critical thinking and independent analysis.
In such situations, individuals may suppress dissenting opinions or avoid raising questions in order to maintain group cohesion and avoid conflict. This can lead to acceptance of popular views or decisions without critical thought. In health care, the results of groupthink can be harmful.
We may not be able to halt the popularity of whole-body vibration for musculoskeletal care. However, we owe it to our patients to critically assess this therapy and inform them of its hidden dangers.
References
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