The Essentials of Vibrocise
Dr Philip McMillan MB.BS, MRCP(UK)
March 29, 2020
The prevalence of arthritis in the UK is approximately 10 million persons1, with osteoarthritis and rheumatoid arthritis comprising the majority of cases. Morbidity is a major problem, affecting quality of life in a significant number of people. Productivity was found to be poorer at work, and mental health issues and limitations to activity have been noted2,3. The increased mortality risk with osteoarthritis4 has been attributed to the association with cardiovascular disease. The main contributors to cardiovascular risk would be analgesia in the form of NSAIDs and decreased activity because of pain5,6. Any intervention that could reduce the burden of medication and improve the quality of life would be welcomed by arthritis patients.
An understanding of the pathophysiology of joint pain helps to determine how to intervene in the condition. Arthritis is inflammation of a joint with associated pain and sometimes swelling. Joints are composed of bones articulating on each other with articular cartilage preventing bone on bone damage. A remarkable characteristic of joints is the lubrication with low friction in movement7. Articular cartilage is not innervated with pain fibres8 which implies that the pain is not caused by bone impacting upon bone. The main pain fibres are in the synovium and the surrounding tendons and ligaments9,10.
The association of joint pain and osteoporosis is important for determining how to relieve pain. Bone tends to become thinner because of inflammation as well as disuse11. Bone marrow lesions cause a major portion of arthritis pain and are therefore a critical target for pain relief12. The occurrence of pain in weight-bearing joints supports this as the load affects the nerve fibres around the joint, specifically in the surrounding bone13. This type of pain is most sensitive to the effect of NSAIDs and may explain why some people have a better response to this medication than others.
Vibrocise reduces arthritis pain by combining the science of arthritis with the effective benefit of vibration exercise. It is a programme of exercise which uses the smovey vibration rings, a vibration therapy tool. It stimulates specific neurological pathways that results in a reduction of arthritis pain for the Vibrocise user.
Sympathetic system and stimulation of Osteoblasts
Vibration stimulates the sympathetic autonomic nervous system. A well-known complication of the chronic use of vibration tools is Raynauds type phenomenon14. Vibration white finger has been well described as triggered by excessive stimulation of the sympathetic autonomic nervous system through proprioceptive fibres15. Sympathetic activation, even if located in the upper limbs, can stimulate changes all over the body16. Although stimulation of the sympathetic system as a whole triggers bone resorption17, low frequency vibration has the effect of stimulating osteoblasts to build bone18,19. This knowledge of stimulation of the sympathetic system can now be applied to improve blood pressure when Vibrocise is used in a controlled manner. Vibrocise has the dual effect of improved function while protecting bone through stimulation of the osteoblasts.
Gating theory of pain at spinal level
Vibrocise impacts on joint pain through gating of pain at the spinal level. The pain nerve fibres from the joint synovium, ligaments, tendons, bone and muscle are mainly Type C unmyelinated fibres20. In the case of many forms of arthritis, the associated joint inflammation tends to reduce the nociceptive threshold21. The larger proprioceptive vibration fibres tends to reduce pain by gating at the spinal cord level22. The mechanism is mainly through the blocking effect of interneurons on second order pain pathways. This gating principle results in reduced pain for people involved in physical activity.
Thalamic gating of pain
Vibrocise also has an effect on pain at a central level in the brain. One of the critical regions that modulates pain lies in the thalamus23. Thalamic pain is a well understood complication of thalamic stroke and can be intractable in some patients. The thalamus acts as a relay station, controlling the active pathways going to the sensory cortex in the brain24. The characteristic of chronic pain syndrome associated with arthritis is likely to be operational at this level. Vibrocise impacts on the modulation of pain information through a gating mechanism similarly operational at the spinal cord level25,26. This concept of thalamic gating of pain could explain the phenomenon of morning stiffness as a feature of rheumatoid arthritis. It has been shown that melatonin from the pineal gland has an effect on the symptoms27. It can be inferred that the central effect of the whole body symptoms could be due to increased thalamic tone. Vibrocise has the benefit of reducing this muscle tone and the associated pain28.
Value of Vibrocise in pain reduction and medication relief
The use of anti-inflammatories and immunosuppressants in arthritis represents one of the greatest risks to patients29. There is increased use of opioids in osteoarthritis patients, increasing the risk of falls30. Many people with arthritis have a lower exercise ability which is reflected by the greater risk of cardiovascular complications6.
Vibrocise has the potential to impact on many of these known complications of arthritis by increasing patient activity while reducing pain and medication use. The first principle in medicine is to do no harm. Vibrocise is safe, effective and easy to apply as a technique for any person who suffers with arthritis. There are multiple potential benefits of Vibrocise which far outweigh the worst potential outcome of no impact in a few cases.
- van Vilsteren, Myrthe, et al. "Productivity at work and quality of life in patients with rheumatoid arthritis." BMC musculoskeletal disorders 16.1 (2015): 107.
- Wan, Su Wei, et al. "Health-related quality of life and its predictors among patients with rheumatoid arthritis." Applied Nursing Research 30 (2016): 176-183.
- Veronese, Nicola, et al. "Osteoarthritis and mortality: a prospective cohort study and systematic review with meta-analysis." Seminars in arthritis and rheumatism. Vol. 46. No. 2. WB Saunders, 2016.
- Cooper, Cyrus, et al. "Safety of oral non-selective non-steroidal anti-inflammatory drugs in osteoarthritis: what does the literature say?." Drugs & aging 36.1 (2019): 15-24.
- Visman, I. M., et al. "Cardiovascular disease is associated with activity limitations in osteoarthritis patients." International Journal of Clinical Rheumatology 14.3 (2019): 99.
- Jahn, Sabrina, Jasmine Seror, and Jacob Klein. "Lubrication of articular cartilage." Annual review of biomedical engineering 18 (2016): 235-258.
- O’Neill, Terence W., and David T. Felson. "Mechanisms of osteoarthritis (OA) pain." Current osteoporosis reports 16.5 (2018): 611-616.
- Mathiessen, Alexander, and Philip G. Conaghan. "Synovitis in osteoarthritis: current understanding with therapeutic implications." Arthritis research & therapy 19.1 (2017): 18.
- McDougall, Jason J. "Arthritis and pain. Neurogenic origin of joint pain." Arthritis research & therapy 8.6 (2006): 220.
- Roux, C. "Osteoporosis in inflammatory joint diseases." Osteoporosis International 22.2 (2011): 421-433.
- Sofat, Nidhi, Vivian Ejindu, and Patrick Kiely. "What makes osteoarthritis painful? The evidence for local and central pain processing." Rheumatology 50.12 (2011): 2157-2165.
- Lo, G. H., et al. "Bone marrow lesions and joint effusion are strongly and independently associated with weight-bearing pain in knee osteoarthritis: data from the osteoarthritis initiative." Osteoarthritis and Cartilage 17.12 (2009): 1562-1569.
- Sakakibara, H., and S. Yamada. "Vibration syndrome and autonomic nervous system." Central European journal of public health 3 (1995): 11-14.
- Ekenvall, Lena, and L. E. Lindblad. "Is vibration white finger a primary sympathetic nerve injury?." Occupational and Environmental Medicine 43.10 (1986): 702-706.
- Krajnak, K., et al. "Acute vibration increases α2C-adrenergic smooth muscle constriction and alters thermosensitivity of cutaneous arteries." Journal of Applied Physiology 100.4 (2006): 1230-1237.
- Togari, Akifumi, Michitsugu Arai, and Ayami Kondo. "The role of the sympathetic nervous system in controlling bone metabolism." Expert opinion on therapeutic targets 9.5 (2005): 931-940.
- Kim, I. S., et al. "Human mesenchymal stromal cells are mechanosensitive to vibration stimuli." Journal of dental research 91.12 (2012): 1135-1140
- Kumaoka, M., T. Shiraishi, and S. Morishita. "Effects of Mechanical Vibration on Osteoblast-Like Cell Line." ASME 2005 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers Digital Collection, 2005.
- Felson, David T. "The sources of pain in knee osteoarthritis." Current opinion in rheumatology 17.5 (2005): 624-628.
- Dray, A. "Inflammatory mediators of pain." British journal of anaesthesia 75.2 (1995): 125-131.
- Kakigi, Ryusuke, and Horoshi Shibasaki. "Mechanisms of pain relief by vibration and movement." Journal of Neurology, Neurosurgery & Psychiatry 55.4 (1992): 282-286.
- Dostrovsky, Jonathan O. "Role of thalamus in pain." Progress in brain research. Vol. 129. Elsevier, 2000. 245-257.
- Steeds, Charlotte E. "The anatomy and physiology of pain." Surgery (Oxford) 27.12 (2009): 507-511.
- Zampino, Claudio, et al. "Pain control by proprioceptive and exteroceptive stimulation at the trigeminal level." Frontiers in physiology 9 (2018).
- Ackermann, Paul W. "Neuronal regulation of tendon homoeostasis." International journal of experimental pathology 94.4 (2013): 271-286.
- Cutulo, Maurizio, et al. "Nocturnal hormones and clinical rhythms in rheumatoid arthritis." Annals of the New York Academy of Sciences 1051.1 (2005): 372-381.
- Veqar, Zubia, and Shagufta Imtiyaz. "Effect of vibration in prevention of delayed onset muscle soreness: A recent update." Journal of Physiotherapy & Sports Medicine 1.2 (2012): 75-85.
- Myllykangas-Luosujärvi, R., K. Aho, and H. Isomäki. "Death attributed to antirheumatic medication in a nationwide series of 1666 patients with rheumatoid arthritis who have died." The Journal of rheumatology 22.12 (1995): 2214-2217.
- Lo-Ciganic, W-H., et al. "Analgesic use and risk of recurrent falls in participants with or at risk of knee osteoarthritis: data from the Osteoarthritis Initiative." Osteoarthritis and cartilage 25.9 (2017): 1390-1398.