VibroAcoustic therapy

VibroAcoustic therapy is a technology that uses acoustic (sound) energy in the form of micro-vibrations to reduce pain. The development of this technology is based on the recognition that external vibrations can influence how the human body functions. Vibroacoustic therapy involves applying acoustic energy that is heard, as well as felt by the human body. It is used now primarily in the form of music therapy to reduce stress and promote relaxation, and to a lesser extent for acute and/or chronic pain reduction. Music therapy with the most commonly used design is full-frequency music (FFM) models that use a single sound source to provide the music in a wide range of frequencies. It applies VibroAcoustic stimulation (VS) to the whole body as opposed to local areas on the body, and no specific frequencies are targeted. The sound power is low because simple speakers deliver the sound rather than special audio transducers.
In any rapidly developing art such as VibroAcoustic medicine, treatment methods and approaches are in constant flux. Novel approach advances VibroAcoustic therapy by producing acoustic energy and using audio transducers to transmit this energy directly to the painful area/s. Thus VS applied in close proximity to pain source with final goal to achieve pain reduction.
VS (VibroAcoustic stimulation or application of micro vibration in sound frequency) is one such CAM (Complimentary and Alternative Medicine) modality that has been shown to be effective as a pain reduction therapy for acute and chronic musculoskeletal pain (Hansson 19, Lundberg at al. 23 Lundberg at al., 24, Lundberg at al. 25). Studies show that VS increases the pain threshold in response to electrical stimulation on human teeth and skin when applied to the painful area (Ekblom at al. 9 Lundberg at al. 10) VS reduced the report of pain in patients suffering pain from phantom limb when investigators applied VS to the skin over the area of pain or antagonistic muscle (Lundberg 15, Guieu at al.16)
Available data show VS has been more effective than placebo in the alleviation of chronic pain syndromes. Best pain reduction effect was obtained when VS was applied with moderate pressure (1.0 kg) for 25-45 minutes over the skin at the point of pain. Long-term results (12 to 18 months) of VS use as a pain reducing measure for chronic pain has shown 59% success rate in patients studied with 50% or greater pain relief as measured by visual analog and adjectival scales. Seventy-two percent of these patients reported increased social activity and more than half of the patients reduced analgesic drugs use 50% after 12 months of home treatment using VS. (Lundberg at al. 4, Lundberg at al.5)
VS will reduce joint pain There are three major mechanisms which can produce such effect: 1) Direct vibratory analgesic action; 2) Higher temperature in application area creates increased blood flow, an anti-inflammatory effect and improved joint flexibility; 3) Enhance synovial fluid production and cartilage regeneration.
1) Direct vibratory analgesic action. While the exact mechanism of action of VS remains unclear, researchers theorized that the reduction in report of pain that follows its use may potentially result from stimulation of the Pacinian corpuscles, large mechanoreceptors located in the subcutaneous and connective tissues surrounding visceral organs and joints. These bulb-like structures surrounding nerve endings are sensitive to pressure. For example, Chesky and Michel 6 report that the Pacinian corpuscle can react to VS in the range of 60 to 600 Hz. When stimulated the Pacinian corpuscle sends neurological non-pain messages to the brain that appear to inhibit the pain impulse. Other researchers too, have documented the effects of stimulation of Pacinian corpuscles at these frequencies (Quillian and Sato7, Hubbard8). Likewise, VS elevates the pain threshold in response to electrical stimulation when applied on or close to the painful area over muscle (Pantaleo at al.11). These investigators were able to prevent this effect when either tonic vibration reflex of adjacent muscle was elicited or the skin underlying the vibrator was anesthetized. The local analgesic effect that results from the application of VS is thought to be caused by Pacinian corpuscles, and potentially at spinal segmental levels by volleys in myelinated afferent fibers.
Other potential mechanism of vibratory analgesia is sensory input mediated by unmyelinated and myelinated fibers. Roy et al 43 showed VS relieved pain in chronic TMD (Temporo-Mandibular Joint Disorder) pain conditions. This finding cannot be attributed to a mechanism involving Pacinian corpuscles since these receptors are lacking in the skin of the orofacial region. Kakigi and Shibasaki 44 showed pain inhibition by large myelinated fibers during VS application. Hollins at al 45 performed vibratory antinociception trial and concluded that signals in multiple vibrotactile channels are able to modulate nociception. No one mechanoreceptive channel appears to have a privileged role.
Researchers do not believe that the met-enkephalin and beta-endorphins are involved in the analgesic action of VS for patients who suffer from acute or chronic pain. Guieu at al.12 confirmed this premise when injected naloxone, a morphine antagonist, in patients who achieved analgesia after an application of VS. The naloxone injections did not have any effect on the pain relief achieved by VS. Guieu at al. 12, Hansson t al. 13, Lundberg 14 has shown that CSF levels of met-enkephalin and beta-endorphins do not change with the application of VS, although persons reported analgesic action occurred with VS. Substance P-like immunoreactivity levels (a major pain mediator) were decreased in the CSF of patients who had 30 minutes sessions of vibratory stimulation, but this drop was too small to account for the level of pain relief the patients reported (Guieu at al.15).
VS was applied to the toes and caused inhibition of nociceptive dorsal horn neurons of the cat spinal cord which was unaffected by strychnine or naloxone but was blocked by P1-purinogenic receptor antagonist (Dekoninck Y and Henry JL 46). Possibility exists that VS has direct inhibitory effect on nociceptive neurons in spinal cord.
2) Higher temperature in application area creates increased blood flow, an anti-inflammatory effect and improved joint flexibility. Olivery at al17 showed that VS at 100 Hz increases temperature more than 4 degrees and cause erythema at the application area, lower frequencies did not produce similar effect. “Heat increases blood flow and the extensibility of connective tissue; decreases joint stiffness, pain; and helps resolve inflammation”. (Merck Manual 47) Sands WA at al 48 observed that vibration could be promising means of increasing range of motion beyond that obtained with static stretching. These effects of VS are beneficial to the patients suffering from OA and contribute to pain reduction.
3) Enhanced synovial fluid production and cartilage regeneration: Sah Rl at al49 studied cartilage biosynthetic response to dynamic compression and found that it can modulate chondrocyte biosynthesis. Takeuchi R at al 50 investigated the effects of vibration at 100 Hz and hyaluronic acid on 3-dimentional cartilages and observed the activation of the proteoglycan production (Chondroitin 6-sulfate and Chondroitin 4- sulfate). They concluded that some mechanoreceptors for vibration exist on the plasma membrane of chondrocyte and activate the intracellular signal transduction system. Mechanical load to the joint is an important regulator of chondrocyte metabolic activity (Urban 51). Investigators believe that that sound energy in form of VS can stimulate chondrocyte leading to enhanced proteoglycan synthesis and as result augment synovial fluid production and cartilage repair. “Chondrocyte proliferation is enhanced by mechanical stresses in vivo, especially those with oscillatory waveform. Analysis of these data suggests that genetically coded chondral growth is up-regulated by mechanical signals” (Wang and Mao 52).
VS action is similar to the Transcutaneous Electrical Nerve Stimulator (TENS) except for the type of energy used. TENS uses electrical energy while VS uses acoustic energy. When compared to high or low frequency TENS, VS at 20Hz, 100 Hz, 200Hz, investigators found VS to be just as effective or, in some patients, to be more effective than TENS in reducing chronic musculoskeletal or orofacial pain in 731 patients (135 suffering from acute musculoskeletal or orofacial pain and 596 patients suffering from chronic musculoskeletal or orofacial pain (Lundberg.20). Investigators reported a relationship between the degree of pain reduction and the individuals’ pain intensity before treatment. Dual stimulation (TENS and VS combined) alleviated pain in more cases than TENS or VS alone, and had a more long-lasting effect (Guieu at al. 21).
As pain suppressive interventions, researchers have found VS and TENS used separately in patients suffering from myofascial or musculoskeletal pain to be just as efficient and, in some patients, even more efficient than aspirin (Lundberg. 22). In addition, researchers have studied the pain reducing effect of TENS, VS at 100Hz, and electro acupuncture at 2 Hz as compared to placebo in 36 patients with myalgia revealing that VS, TENS and electro acupuncture are each efficient pain suppressive measures that are superior to placebo (Lundberg 5).
VS possess analgesic effect compatible with TENS plus it has unique actions such as temperature, blood circulation increase in area of application and direct stimulation of chondrocyte.

Literature sited:

Preventing Chronic Disease: Investing Wisely in Health. CDC revised July 2005
1. Hootman JM, Helmick CG. Projections of U.S. Prevalence of Arthritis and Associated Activity Limitations. Arthritis and Rheumatism 2006;54(1):226–9.
2. National Institutes of Health., National Institute of Arthritis and Musculoskeletal and Skin Disease. Handout on Health: Osteoarthritis 2001. Retrieved June 17, 2001
3. Sharma, L., Epidemiology of osteoarthritis. In R. W. Moskowitz, Os. Howel, R.D, Altman, J.A. Buckwalter, & V.M. Goldber (Eds) Osteoarthritis: Diagnosis and medical/surgical management 2001. (3rd ed., pp.3-17). Philadelphia: W. B. Saunders.
4. American Pain Society., Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis, 2002. Glenview, IL. APS. http://www.guideline.gov/summary/summary.aspx?doc_id3691&nbr2917 - s23
5. Lundeberg T, Abrahamsson P, Bondeson L, Haker E., Vibratory stimulation compared to placebo in alleviation of pain. 1987. Scand J Rehabil Med. 19(4): 153-8.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?dbpubmed&cmdRetrieve&doptAbstractPlus&list_uids3438712&query_hl15&itoolpubmed_docsum
6. Lundeberg T, A comparative study of pain alleviating effect of vibratory stimulation, transcutaneous nerve stimulation, electroacupuncture and placebo. Am J Chin Med.1984. Summer; 12(1-4): 72- http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids6208773&doptAbstract
7. Chesky K, and Michel K., The music vibration table (MVT): a developing and conceptual model for pain relief. Music Ther Perspect.1991: 9:32-37 http://music.utsa.edu/tdml/conf-II/II-Chesky&Kondraske/II-Chesky&Kondraske.html
8. Quillian T, Sato M., The distribution of myelin and nerve fibers from Pacinian corpuscles. J Physiol.1955. 129:167-176. http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid1365924&pageindex1
9. Hubbard S, A study of rapid mechanical l events in a mechanoreceptor. J Physiol.1958.141:198-218.
http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid1358795&pageindex1
10. Ekblom A, and Hansson P., Effects of conditioning vibratory stimulation on pain threshold of human tooth. Acta Physiol Scand.1982. Apr: 114(4): 601-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?dbpubmed&cmdRetrieve&doptAbstractPlus&list_uids6182753&query_hl2&itoolpubmed_docsum
11. Lundeberg T, Abrahamsson P, Bondeson L, Haker E. Effect of vibratory stimulation on experimental and clinical pain. Scand J Rehabil Med. 1988. 20(4): 149-159. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?dbpubmed&cmdRetrieve&doptAbstractPlus&list_uids3266033&query_hl16&itoolpubmed_docsum
12. Pantaleo T, Duranti R, Bellini F., Effects of vibratory stimulation on muscular pain threshold and blink response in human subjects. Pain.1986. Feb: 24(2): 239-250. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbpubmed&doptAbstract&list_uids3960570&query_hl=1
13. Guieu R, Tardy-Gervet M, Giraud P., Met-enkephalin and beta-endorphin are not involved in the analgesic action of transcutaneous vibratory stimulation. Pain 1992. Jan: 48(1): 83-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?dbpubmed&cmdRetrieve&doptAbstractPlus&list_uids1738578&query_hl25&itoolpubmed_docsum
14. Hansson P, Ekblom A. Thompsson M, Fjeellner B., Influence of naloxone on relief of acute oro-facial pain by transcutaneous electrical nerve stimulation or vibration. Pain 1986. Mar: 24(3): 323-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?dbpubmed&cmdRetrieve&doptAbstractPlus&list_uids3515293&query_hl38&itoolpubmed_docsum
15. Lundberg T., Naloxone does not reverse the pain-reducing effect of vibratory stimulation. Acta Physiol Scand.1985. Feb: 29(2): 212-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbpubmed&doptAbstract&list_uids3976336&query_hl=2
16. Guieu R, Tardy-Gervet M, Giraud P., Substance P-like immunoreactivity and analgesic effect of vibratory stimulation on patients suffering from chronic pain. Can J Neurol Sci.1993. May: 20(2): 138-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbpubmed&doptAbstract&list_uids7687513&query_hl15&itoolpubmed_docsum.
17. Lundberg T., Relief of pain from a phantom limb by peripheral stimulation. J Neurol. 1995. 232(2): 79-82. http://www.springerlink.com/content/w2066k813k495516/
18. Olivery DJ, Lynn K, Hong CZ., Increased skin temperature after vibratory stimulation. Am J Phys Med Rehabil. 1989. Apr: 68(2): 81-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids2930643&doptAbstract
19. Doering, Thorsten J. MD 2; Fieguth, Hans G. MD; Steuernagel, Birgit MD; Brix, Jurgen MD; Konitzer, Martin MD; Schneider, Berthold PhD; Fischer, Gisela C. PhD. External stimuli in form of vibratory massage after heart or lung transplantation. Am J of Phys Med & Rehab 1999. Mar/Apr 78(2):108-110. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids10088583&doptAbstract
20. Hansson P, Ekblom A., Exrtasegmental transcutaneous electrical nerve stimulation and mechanical vibratory stimulation as compared to placebo for the relief of acute oro-facial pain. Pain 1985. Nov: 23(3): 223-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?dbpubmed&cmdRetrieve&doptAbstractPlus&list_uids3877900&query_hl57&itoolpubmed_docsum
21. Lundeberg T., Vibratory stimulation for the alleviation of chronic pain. Acta Physiol Scand Suppl.1983. 523:01-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbpubmed&doptAbstract&list_uids6609524&query_hl4onclick
22. Guieu R, Tardy-Gervet MF, Roll JP., Analgesic effects of vibration and transcutaneous electrical nerve stimulation applied separately and simultaneously to patients with chronic pain. Can J Neurol Sci. 1991. May 18(2):113-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids1712660&doptAbstract
23. Lundberg T, The pain suppressive effect of vibratory stimulation and transcutaneous electrical nerve stimulation as compared to aspirin. Brain Res. 1984. Mar 5:294(2): 201-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids6608397&doptAbstract
24. Lundeberg T, Abrahamsson P, Bondesson L, Haker E, Vibratory stimulation for the alleviation of pain. Am J Chin Med 1984. Summer: 12(1-4): 60-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbpubmed&doptAbstract&list_uids3438712&query_hl3&itoolpubmed_docsum
25. Lundeberg T. Nordemar R, Ottoson D. Pain alleviation by vibratory stimulation. Pain. 1984. Sep: 20(1): 25-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbpubmed&doptAbstract&list_uids6333660&itooliconabstr&query_hl1
26. Lundeberg T., Long-term results of vibratory stimulation as a pain relieving measure for chronic pain. Pain 1984. Sep; 20(1) 13-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbpubmed&doptAbstract&list_uids6436774&itooliconabstr&query_hl2
27. Osiri M, Brosseau L, McGowan J, Shea BJ, Tugwell P, Wells G., Trancutaneous electrical nerve stimulation for knee osteoarthritis. The Cockrane Database of Systematic Reviews, 2000. Issue Art. No. CD002823. DOI: 10.1002/14651858.CD002823. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids11034768&doptCitation
28. Bellamy, N., et al., Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol, 1988. 15(12): p. 1833-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids3068365&doptCitation
28. Bellamy, N., et al., Double blind randomized controlled trial of sodium meclofenamate (Meclomen) and diclofenac sodium (Voltaren): post validation reapplication of the WOMAC Osteoarthritis Index. JRheumatol, 1992. 19(1): p. 153-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids1556679&doptCitation
29. Gentelle-Bonnassies, S., et al., Comparison of the responsiveness of symptomatic outcome measures in knee osteoarthritis. Arthritis Care Res, 2000. 13(5): p. 280-5. http://www3.interscience.wiley.com/cgi-bin/abstract/81502420/ABSTRACT?CRETRY1&SRETRY0 - relatedArticles
30. Theiler, R., et al., Superior responsiveness of the pain and function sections of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as compared to the Lequesne-Algofunctional Index in patients with osteoarthritis of the lower extremities. Osteoarthritis Cartilage,1999. 7(6):p. 515-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids10558848&doptCitation31. Angst, F., et al., Responsiveness of the WOMAC osteoarthritis index as compared with the SF-36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention. Ann Rheum Dis, 2001. 60(9): p. 834-40. http://ard.bmjjournals.com/cgi/content/abstract/60/9/834
32. Altman, R., et al., Design and conduct of clinical trials in patients with osteoarthritis: recommendations from a task force of the Osteoarthritis Research Society. Results from a workshop. Osteoarthritis Cartilage, 1996. 4(4): p. 217-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itoolabstractplus&dbpubmed&cmdRetrieve&doptabstractplus&list_uids=2137644
33. Dieppe, P.A., Recommended methodology for assessing the progression of osteoarthritis of the hip and knee joints. Osteoarthritis Cartilage, 1995. 3(2): p. 73-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?dbpubmed&cmdRetrieve&doptAbstractPlus&list_uids7584320&itooliconnoabstr&query_hl26&itool=pubmed_DocSum
34. Gentelle-Bonnassies, S., et al., Comparison of the responsiveness of symptomatic outcome measures in knee osteoarthritis. Arthritis Care Res, 2000. 13(5): p. 280-5. http://www3.interscience.wiley.com/cgi-bin/abstract/81502420/ABSTRACT
35. Beaton, D.E. and E. Schemitsch, Measures of health-related quality of life and physical function. Clin Orthop, 2003(413): p. 90-105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids12897600&doptCitation
36. Brazier, J.E., et al., Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ, 1992. 305(6846): p. 160-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&doptAbstract&list_uids1285753
37. McHorney, C.A., J.E. Ware, Jr., and A.E. Raczek, The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care, 1993. 31(3): p. 247-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids8450681&doptAbstract
38. Ware, J., Snow KK, Kosinski M, SF-36 Health Survey: Manual and Interpretation Guide. 1993, 2000, Lincoln, RI: QualityMetric Incorporated. http://www.cinahl.com/common/sample_recs/research.htm
39. McHorney, C.A., et al., The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care, 1994. 32(1): p. 40-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids8277801&doptCitation
40. Kosinski, M., et al., The SF-36 Health Survey as a generic outcome measure in clinical trials of patients with osteoarthritis and rheumatoid arthritis: relative validity of scales in relation to clinical measures of arthritis severity. Med Care, 1999. 37(5 Suppl): p. MS23-39. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids10335741&doptCitation
41.Kosinski, M., et al., The SF-36 Health Survey as a generic outcome measure in clinical trials of patients with osteoarthritis and rheumatoid arthritis: tests of data quality, scaling assumptions and score reliability. Med Care, 1999. 37(5 Suppl): p. MS10-22. http://www.lww-medicalcare.com/pt/re/medcare/abstract.00005650-199905001-00002.htm;jsessionid=FL8L0ntG1vkfMDCbgK1wJndSVGLdJ2qtDbpg5dSMnxXGvgNFkpPw!65971010!-949856144!8091!-1?index1&databaseppvovft&results1&count10&searchid1&navsearch
42. Felson DT The sources of pain in knee osteoarthritis. Curr Opin Rheumatol-01-Sep-2005: 17(5): 624-8 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids16093843&doptAbstract
43. Roy EA, Hollins M, Maixner W. Reduction of TMD pain by high frequency vibration: a spatial and temporal analysis. Pain- 01-Feb 2003: 101(3): 267-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids12583869&doptBooks
44. Kakigi R, Shibasaki H. Mechanisms of pain relief by vibration and movement. Journal of Neurology, Neurosurgery & Psychiatry. 1992 Apr. 55(4): 282-6. http://jnnp.bmjjournals.com/cgi/content/abstract/55/4/282
45 HollinsM, Roy EA, Crane SA. Vibratory antinociception: effects of vibration amplitude and frequency. Journal of Pain. Sep 2003, 4(7):381-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids14622680&doptAbstract
46. Dekoninck Y and Henry JL. Peripheral vibration causes an adenosine-mediated polysynaptic inhibitory potential in dorsal horn neurons of the cat spinal cord. Neuroscience Sep 1992. 50(2): 435-43 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?dbpubmed&cmdRetrieve&doptAbstractPlus&list_uids1436497&query_hl11&itoolpubmed_docsum
47. Merck Manual http://www.merck.com/mrkshared/mmanual/section21/chapter291/291d.jsp)
48. Sands WA, Mc Neal JR, Stone JR, Russel MH, Monem, Jemni EM. Flexibility enhancement with vibration: Acute and long-term. Medicine&Science in Sports&Exercise Mar 2006 38(4): 720-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids16679989&doptCitation
49. Sah Rl, Kim YJ, Doong JY, Grodzinsky AJ, Plaas AH, SndyJD.Biosynthetic response of cartilage explants to dynamic compession. J Orthop Res 1989: 7(5): 615-36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdRetrieve&dbPubMed&list_uids2760736&doptCitation
50. Takeuchi R, Saito T, Ishikawa H, Takigam H, Dezawa M, Ide C, Itokazu Y, Ikeda M, Shiraishi T, Morishita S. Effects of vibration and hyaluronic acid on activation of three-dimentional cultured chondocytes. Arthritis&rheumatism. 54(6):1897-905, 2006 Jun. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmdSearch&dbpubmed&term=effects+of+vibration+and+hyaluronic+acid+on+activation+of+three+dimensional+cultured+chondrocytes&toolfuzzy&otEffects+of+vibration+and+hyaluronic+acid+on+activation+of+three
51. Urban JP. The chondrocyte: a cell under pressure. Br J Rheumatol 1994 Oct: 33(10): 901-8. http://rheumatology.oxfordjournals.org/cgi/content/abstract/33/10/901
52. Wang X, Mao JJ. Chondrocyte proliferation of cranial base cartilage upon in vivo mechanical stresses.J Dent Res 81(10): 701-5, 2002. http://jdr.iadrjournals.org/cgi/content/full/81/10/701
53. “General Considerations in the Design of Clinical Studies For Pain-Alleviating Devices” published by FDA in May 1998. (page 4)
http://google2.fda.gov/search?clientFDA&siteFDA&oe&lr&proxystylesheetFDA&outputxml_no_dtd&getfields=*&q=%93General+Considerations+in+the+Design+of+Clinical+Studies+For+Pain-Alleviating+Devices%94+&as=GO

Main Menu

See Also

Main Menu