M. L. H. Arnold Snow, M.D.
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
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
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
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
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
prescribed in the seventeenth century by Paullini. Massage rollers
and muscle beaters applied in many ways by changing their shapes were primitive
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
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
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
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
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.