Mechanical Vibration
M. L. H. Arnold Snow, M.D.
Chapter 1

History and Development of Mechanical Vibration Therapy

    MECHANICAL VIBRATION or vibra-massage which has become generally recognized by the profession, is the outgrowth of a subject which dates back to ancient times, - one which has been maturing for centuries, and which has been practiced by many nationalities in various ways, to wit, massage.  Until recently, however, massage has not received the recognition it so richly deserves, for in the hands of charlatans and quacks - non-professional masseurs - it has principally become known, and not favorably known.  It required such men as Mezger, Zabludowski, Bunge, Graham, Seguin, Weir-Mitchell, Playfair, and Kellogg to give it scientific recognition and establish a technique that could be therapeutically employed.

    THE HISTORY OF MECHANICAL VIBRATION is brief, but as much can be learned from its development in its relation to massage it is well to consider it in that connection.

    THE WORD MASSAGE is from the Greek to knead; Sanskrit, Masch, to strike to press, to condense, and according to Graham [Massage: Reference Handbook of the Medical Sciences], includes "friction, kneading, manipulating, rolling, and percussion of the external tissues of the body in a variety of ways, either with a curative, palliative, or hygienic object in view."  Friction, rolling, a form of deep kneading, and percussion, are produced by the action of many of the mechanical vibratodes.

    ACCORDING TO THE SWEDISH MOVEMENT CURE, massage should be combined with various forms of exercise suited to the case - passive, assistive, resistive, or active movements.  Such combination with vibration greatly enhances its field of usefulness, and increases its therapeutic value.  It is believed that the "Shoshruta" of the Hindoos, used also by the Brahmins,  is the oldest work on the subject.  It was probably followed later by the Chinese book, Cong-Fou of the Tao-Sse which was written hundreds of years before Christ.  Some believe that the Greeks probably got their knowledge from the Hindoos and Chinese.

    Homer, about 1000 B. C., in his masterpiece, the "Odyssey," notes that rubbing and anointing were used for their invigorating effects.  The ancient Greeks and Romans of all classes used massage as a luxury, to hasten recovery from sickness, or to increase their agility and powers of endurance.  After gymnastic exercises, it was used in the treatment of pains and as an invigorator, marking its early recognition as a therapeutic agent.

    Its place, however, today can be far more ably filled by properly applied mechanical vibration, due regard being given to rate, stroke, mode of application, and applied technique.  At that time, it was in the hands of priests, trainers (aliptae), and slaves as well as medical men.  This is one reason for the slow development of scientific massage.  When a subject is taken up by a body of learned men, investigation is thorough, improvements are suggested, and progress results, but when it falls into the hands of charlatans and quacks, the avenue of progress is blocked.  For this reason mechanical vibration as a science did not develop until massage had been established on a physiological and well defined basis.

    IN THE 5TH CENTURY HERODICUS  advocated exercise for the treatment of disease and compelled his patients to have their bodies rubbed, he being a firm believer in the efficacy of massage.

    JOSEPH SCHREIBER, M. D., author of "Treatment of Massage and Exercise," translated by Walter Mendelson, M. D., of New York, claims that Herodicus first laid down principles for rational, mechanical methods of treatment.

    HERODICUS, 484 B. C., was one of the first to refer to the manner of giving massage.  He said friction should be gentle and slow at first, then rapid in combination with pressure, which was to be followed by gentle friction.  Other advocates were Plato, Socrates, and Hippocrates, who said "rubbing can bind a joint that is too loose, and loosen a joint that is too rigid. Hard rubbing binds, soft rubbing loosens, much rubbing causes parts to waste, moderate rubbing makes them grow." This is the earliest definite information relative to the effect of variations in the application of massage.  These maxims should be remembered by those who use mechanical vibration for they well define its general therapeutic application.  Hipppocrates also suggested the direction in which to apply massage the art of rubbing up, thereby assisting mechanical and physical processes, aiding circulation, relieving stasis and consequently quickening metabolic processes.

    ASCLEPIADES, 128-56 B. C., USED MASSAGE in conjunction with active and passive movements.  Cicero and Julius Caesar were also advocates, the latter even allowing himself to be pinched daily as a treatment for neuralgia.

    Celsus believed most firmly in rubbing, advocating it for chronic pains of the head and for strengthening a paralyzed part.  He mentions general treatment and also speaks of localization, but adds that sometimes treatment is necessary in a part other than the seat of pain which is along the same line of thought as vibratory treatment applied to "referred pain."  He also mentioned the length of treatment, saying that a general treatment if weakness be present should be shorter and gentler than a local treatment - an important consideration in vibratory treatment.

    HADRIAN, PLINY, AND MARTIALIS were also earnest advocates of massage.  Galen, A. D. 130-200, recognized friction usually as an adjunct - to other measures.  He said that if friction be used before exercise for the purpose of rendering the parts supple and less liable to injury, "the middle quality between hard and soft" should be used, and this is the keynote to mechanical stimulation.  Even at that early date there were advocates of various modes of rubbing.  Some taught that tranverse rubbing, known as "circular rubbing, hardens and condenses and contracts, and binds the body, but that perpendicular rubbing rarifies and dilates, and softens and unbinds."  Galen, however, was eclectic in his views and favored variations in application, advocating nine different ways of employing massage.

    ARRIAN advised stretching in connection with massage, which in conjunction with relaxation induced activity of the lymph current.  This should be borne in mind when using mechanical vibration, particularly when treating local stasis.  Stretching is also useful when applied to affections in which it is desirable to increase the joint nutrition

    ORIBASIUS, a Greek, speaks of the "apotheapeia," a method which included bathing, friction, and inunction.  A new feature mentioned by him was that of extension and holding the breath.  Extension assists also in the treatment of selected cases when using mechanical vibration; for example, in tendosynovitis.  The patient, should not hold his breath during a vibratory treatment, but take deep inhalations followed by slowly forced exhalations.  This enables the operator to administer deeper vibratory treatment over deep structures, as the solar plexus, and is a great assistance when giving passive exercise as an adjunct to vibration.  Greater tension can be made during the period of forced exhalation.

    AN ANCIENT METHOD mentioned by Blumenthal was one used by the Greeks, which consisted of wrapping one end of a saw in cotton fabric and applying it to the part to be treated while on the uncovered part of the saw a piece of wood was sawed; thus mechanical vibration was transmitted to the part requiring treatment.

    THE SCOURGE was also used in cases of impotence.  The back was rubbed to cure sterility in ancient times, and "Roman ladies allowed themselves to be whipped with strips of leather" for the cure of the same condition.

    PARACELSUS, 1492-1541 A. D., Professor of Surgery at Basle, in 1526 wrote "Liber de Vita Longa," in which the effects of friction are extolled, indicating the early recognition of its therapeutic value.

    In the sixteenth century, a Japanese book, "Sau-Tsai-Tou-Hoei," demonstrated the use of percussion, vibration, and pressure, as well as passive motion.  These methods were used by the Japs for many years.  They were applied for relaxing "rigid muscles" and spasmodic contractions, for the relief of rheumatic pains, and after the union of fractures, conditions amenable to mechanical vibratory treatment.

    AMBROISE PARE, 1517-1590 A. D., noted for introducing the ligation of arteries, described and advocated that three modifications of friction - gentle, medium, and vigorous - be employed, and demonstrated the effects of each, showing that some attention was then given to technique and its results.

    IN 1573, MERCURIALIS published "De Arte Gymnastica," treating of the beneficial effects of movements.  Fabricius ab Aquapendente of Padua, author of "De Motu Locali Secundum Totum," Guyon, author of "Miroir de la Beute," Sydenham, and Hoffman, who wrote "Dissertationes Physico Medical" in 1708, believed in massage.  Francis Fuller in 1740 wrote "Medical Gymnastique" in which, he treated of the "influence of motion" and its therapeutic value.  Flagellation, percussion and slapping were prescribed in the seventeenth century by Paullini.  Massage rollers and muscle beaters applied in many ways by changing their shapes were primitive vibrators.

    ABBE ST.  PIERRE, in the early part of the eighteenth century, invented the tremoussoir.

    Three systems relative to motion followed the medieval period: the Stahl or iatro-mechanical, the Boehaave or iatro-dynamical, and Hoffman's or the mechanico-dynamical.

    AN OLD BOOK of special interest to the mechano-therapist is "A Full Account of the System of Friction as Adopted and Pursued with the Greatest Success in Cases of Contracted Joints and Lameness from Various Causes" by John Grosvenor, the celebrated English surgeon.  He did not consider it a cure-all.  He said it was not applicable "in all cases of inflammation, in scrofulous cases tending to suppuration, in cases of inflammatory gout and rheumatism" and was "useless in cases of true ankylosis.  "He found it valuable in "contractions of the joints attended with languid circulation, and thickening of the ligaments," where there was "too great secretion of the synovial fluid in the joints, after wounds in ligamentous, tendinous or muscular parts when the function of the limb is impaired; after violent strains of the joints; in incipient cases of white swelling; after fractures of the articulating extremities of the joints when stiffness remains after union; in cases of dislocation of the joint when the motion is impaired some time after reduction; in case of paralysis; in case of chorea combined with attention to the system; and in weakly people where the circulation is languid.  "His selection of cases was certainly apt, and the line of division will follow about the same course when mechanical vibration is used, particularly vibratory friction.

    IN 1808, JOHN BARCLAY WROTE "The Muscular Motion of the Human Body "in which he relates a case of muscular contraction cured by percussion alone.  M. Blacbe in a paper on chorea treated by mechanical means, opened the eyes of the profession in France, but Ling and Mezger probably gave the most marked impetus to the subject.

    In the early part of the nineteenth century, William Balfour wrote on "Illustrations of the Power of Compression and Percussion in the Cure of Rheumatism, Gout and Debility of the Extremities, and in Promoting Health and Longevity."  He says that "Medical practitioners encourage their patients in giving perfect rest to parts affected with rheumatism and gout, till, as often happens, they change their action altogether.  "He claimed in respect to the treatment of gout by percussion that "percussion instead of repelling, creates an afflux of nervous energy and sanguineous fluid to the part.  Vessels in a state of atony are thereby roused to action and circulation is promoted; and bandages support the vessels and enable them to perform their
functions."  This was an attempt at an explanation of the physiological action of percussion, so necessary to thoroughly understand that percussion may be more intelligently used therapeutically.

    IN THE NINETEENTH CENTURY impetus was given to the subject by Ling's "Swedish Movement Cure" which took note of the association of organic disturbances with tenderness of special spinal areas. The Griffins associated symptoms with tenderness of definite spinal areas.  Hall's work called attention to spinal reflexes.  The osteopath believes that diseased organs cause spinal tenderness which may be relieved by manipulations to remove pressure due to displaced vertebrae.

    IN THE MIDDLE OF THE NINETEENTH CENTURY, Zander constructed mechanical motion devices, as his "Headshakes" for neuralgia, etc., and still later Vigoreaux employed a tuning fork in connection with a resounding box for the treatment of contractures locomotor ataxia, etc.

    TAYLOR OF NEW YORK AND KELLOGG OF MICHIGAN were also among the pioneer inventors and users of mechanical apparatus for massage.  Vibrating, shaking, rolling, percussion, compression, and friction can well be done by such apparatus but due regard to careful technique is necessary in their successful manipulation, as much so as in manual massage.  The majority of this apparatus vibrated the subject en masse.  The next advance step was the introduction of vibration apparatus by means of which treatment could be more localized, the apparatus better controlled, and capable of being applied with a greater nicety of technique.

    Peoples of warm countries and cold countries, barbarous and civilized alike, have methods of massage, manual or mechanical.  The Toogi-Toogi, Mili or Tota of the people of Oceanica described by Graham comprises "striking constantly and softly with the fist, rubbing the palm of the hand, and pressing and squeezing the tissues between the fingers and the thumb."  It illustrates combination of effects that can be produced with a vibratode.  The natives used it for fatigue, pain, etc., and curiously enough, if for fatigue, treated only the arms and legs, but if for pain the surrounding area of the particular site was treated, demonstrating that they had an idea of localizing treatment.  The Sandwich Islanders use a mixture of kneading, squeezing, and rubbing called lomi-lomi.

    DURING THE TWENTIETH CENTURY the advancement of the status of exercise by such men as Savage, Kellogg and Sargent, has aided also in advancing massage.  Dr. Joseph Schreiber considers that the first treatise on mechanical manipulation, physiologically considered, "appeared in 1876 by von Mosengeil in Archiv fur Clinische Chirurgie."  He put it on a scientific basis.

    Others adopted it, and now through Cyriax's study and application of manual vibrations and frictions, Abrams' study of spinal therapeutics, Schmidt's study of pain, and Sajous' study of disease, mechanical vibration may be applied more scientifically.

    MASSAGE TODAY IS OF THREE TYPES - massage as used scientifically in connection with drugs or physical therapeutics as exercise, hydrotherapy and electricity; massage in the school of osteopathy which virtually massages and moves joints for the action on nerve centers; and the unfavorably known massage of the charlatan.

    Eventually, massage as a therapeutic measure will be better systematized.  Mechanical vibration should profit by past experience and beginning with the present status of scientific manual massage, build up scientifically, physiologically, and therapeutically.  This must not be done from the mechanical aspect of the subject alone, for not until exercise was placed on a solid physiological basis did it advance, and not until mechanical vibration is studied from a standpoint other than that of empiricism and the commercialism of the manufacturer will it obtain due recognition from the medical profession.

    By recognizing the modes of massage we can more clearly see its relation to mechanical vibration.

    "SLOW AND GENTLE STROKING in a centripetal direction is called effleurage, deep rubbing is massage a friction, deep manipulation without friction is petrissage," and percussion, one of the main features of mechanical vibration, is tapotement.  Dr. Graham [Massage: Reference Handbook of Medical Sciences] makes the subdivisions of "friction, percussion, pressure and movement," and recommends that "all of the single or combined procedures should at first be used moderately, then gradually increased in force and frequency to the fullest extent desirable, and end gradually as begun."  He states the dose is "determined by the force and frequency of the manipulations and the length of time during which they are employed considered with regard to their effect upon the patient," which technique is applicable to vibration therapy.

    The application of manual vibration to the human body therapeutically has been known for many years.  Ling and his advocates had an idea of this mode of treatment of the nerves, and organs, and of its results, as noted in "Georgii Traitement des Maladies par le Mouvement," Paris, 1847. "They observed the effective influences traveling from front to back in the direction of the sinus longitudinalis and of the sinus transversalis, and applied, therefore, vibrations successfully in congestion of the brain.  Heinrich Kellgren developed this method about twenty years ago.  He improved the Ling system and added new features.  "As an example of the new manipulations may be quoted nerve frictions and vibrations, by means of which he was able to treat with remarkable success diseases of the central nervous system, etc., and which, in his hands formed a powerful weapon to combat acute specific infectious diseases." The great value of manual vibration was recognized and probably first demonstrated in this country by Dr. Strensch, who introduced his method in 1891.  Cyriax's studies and work, "The Elements of Kellgren's Manual Treatment" which includes manual vibration is of importance.  Abram's "Spondylotherapy" represents probably the most exhaustive thought on spinal therapeutics.

    Among other contributors are Meltzer;.Tomson, Charcot, Liedbeck, Boudet, Tourette, Godman,  Morselli, Garnault, Granville, Lavalette, Reich, Taylor, Monell, Lucy Hall-Brown, Morse, Wallian, Eberhardt, Gottschalk, Saquet, Bechterew and Tschigajew, Vigoreaux, Axenfeld, Lange, Winternitz, Siegfried, Bjoksten, Colombo, Ledermann, Hasebroek and Ewer.

    It is curious to note that France, the slowest country to adopt massage and yet the one that gave it its name, is the European country that has most extensively employed, mechanical devices for vibration therapy, and as a nation has furnished the most prolific writings on the great sub-division, vibra-massage, except possibly the United States.

    THE SUBJECT OF VIBRATION is growing in favor and embraces not only that of manual and mechanical vibration, but chemical, thermal, and electrical.

    THE WORD VIBRATION [Gage. Elements of Physics] means "a recurrent change of position." Vibrations are movements where the recurrent changes of position occurring at equal intervals of time called periods of vibration, which may be infinitesimally short, or of sufficient duration to be noted in time, give them the character of waves whose amplitude is very small.  Periods of vibration must not be confused with duration of vibrating state relating to the whole. The amplitude of the vibration may vary or be fixed in any given apparatus, and the vibratory movement may be simple as with the pendulum of a clock, or in the unrestricted movement of an ordinary vibratode, or complex as when the vibratode has not a full swing; for example, when it meets the resisting surface of the body of the patient.  The hand may be the motor, or the power may be, liquid air, carbonic acid, gas, or water.

    VIBRATION INDUCED BY CHEMICAL SUBSTANCES is of greatest intensity, as produced by radium and other radioactive substances, thorium, polonium, uranaium, and actinium.  These substances give off ether vibrations without stimulation from any known source of energy, setting gases in vibration, producing varied spectra.  There are three kinds of rays emanating from radium graduated according to their vibratory activity, as a, B and y, the y resembling the X-rays, the B rays of higher vibration resembling the cathode rays, which are of still higher vibratory rate, thereby giving "a more powerful chemical action and profounder physiological effects," and the a rays of still higher vibratory rate.

    ETHERIC VIBRATION INDUCED BY ELECTRIC POWER is of wide range from the vibrations produced by the continuous and induced current batteries to those of the static machine, or coil; varying also from the convective discharges including static electrification, interrupted or constant, the breeze, spray, brush discharge, and high-frequency discharges from the glass vacuum tubes, to the conductive discharges including the static induced current and the wave-current and also the X-rays, as well as the rays produced by modern photo-therapeutic apparatus.

    SELECTIVE, HARMONIC, ELECTRIC VIBRATION, another form or modification of vibration, has recently been scientifically presented by Morris W. Brinkmann, A. B., M. D., of New York.  He considers simple and compound vibrations, but subdivides the simple into slow, moderate and high-frequencv and the multiple into combinations of simple rates, harmoniously or discordantly, and "combination of multiple rates from single blows, 16 to 40000 per second or any multiple rates above this to infinity."  Pitch, intensity, and timbre are characteristic qualities valuable in therapeutics and are closely associated with the physics of sound.  As it is known that hearing depends upon the physiological condition of the organ of Corti, and the optic nerve, and as hearing varies, so do other parts respond differently as their pathological or physiological conditions vary.  Dr. Brinkmann says that the body "attunes itself" to rates below 16 per second, which the ear does not hear, and "general sensation is influenced."  He believes that the "sensory apparatus and muscle sense can estimate and adapt themselves to 3000 vibrations per minute." Thickness, tension, and length he says, may regulate " the particular rate or note to which a muscle, nerve or other tissue" may be attuned or respond.  The theory is that for example, in a striped muscle composed of fibres which are made up of fibrillae of different lengths and tensions, "the concurrent use of several rates of oscillation" is required.  He therefore believed that harmonics would be more useful than single notes, and devised an apparatus which will be considered later.

    This subject in a simple form was recognized by Dr. George H. Taylor and Dr. H. C. Houghton, of New York, and Dr. J. Mortimer Granville, of London, a number of years ago.  Dr. Granville studied and devised an instrument for musical vibra-massage which is said to give from 1000 to 2000 bows per minute.

    The subject of mechano-vibration has been studied by Reich in the "Lexikon der Physikalisfien Therapie.  Diatetic und Krankenflege."  He makes a distinction not as yet recognized in this country, the differentiation of concussion and vibration.  Vibration is of higher frequency and a milder form of movement while concussion is stronger with less frequency, the maximum being from 120 to 150 per minute.  He regards vibration to be high frequency, and concussion low frequency, the body not having time to come to rest before the second tap comes in the first form, results in the summation of stimuli, but in the second form the body has time to come to rest between two single pushes.  He cites the Ewer concussor type of an instrument giving concussion but not vibration.

    VIBRATION IS A SUBJECT OF WIDE RANGE AND CONCEPT, and a brief sketch of it has been given as a whole in order that when we limit ourselves to one small part - mechanical vibration, vibra-massage, or massage, we may bear in mind particularly the import of knowledge gained from experience in other lines of work, the history of massage as it deals with time, frequency, etc., the consideration of vibration, light, heat, and electricity, particularly the static with its most pronounced vibrations, their physiological actions and therapeutic results, and harmonic vibration with its peculiar selectiveness.  Time and energy should not be wasted in trying to build up something entirely new when there is so much that has been, authoritatively demonstrated, but use should be made of all that is applicable and reliable from whatsoever source, building thereon scientifically for the advancement of vibration therapy in the interest of suffering humanity.