M. L. H. Arnold Snow, M.D.
Systems of Vibration Therapy
There are various methods of applying mechanical vibration,
but up to the present too little attention has been given to the determination
of scientific modes of application, Two methods in general are in vogue, one
having central nerve stimulation as its basis, the other being founded on manual
massage including friction particularly.
THE APPLICATION OF MECHANICAL VIBRATION is subject
to great latitude, varying from the employment of a portable machine operated
by hand power to an elaborate apparatus whose motor power is electricity.
The average physician has little time for manual massage, which naturally
falls to a trained masseur; and as this is written for physicians and not
for masseurs, the application of the various hand devices for administering
mechanical vibration by percussion, concussion or tapping will not be considered.
In order to familiarize the reader with what has thus far been accomplished,
a few methods will be included.
THE BASIS FOR TREATMENT for the application of mechanical
vibration as treated by Pilgrim [Mechanical Vibratory Stimulation]
- based on central nerve stimulation is as follows:
The spinal cord is
(1) "The principal seat of reflex nerve-action.
(2) It is the center of the vaso-motor system.
(3) It exercises an automatic action over the arterial tone and various
(4) It is the index of abnormal action in many parts of the body."
From this standpoint, vibratory treatment for the
relief of pain may be applied in three ways, as summarized by the same
(1) "Application of the inhibitory stroke to the spinal nerve centers,
supplying sensory fibres to the affected part.
(2) Stimulation of the vaso-motor centers.
(3) Inhibition of the peripheral termination of the sensory
"Affected nerve centers are evidenced by the presence
of muscles in a state of contraction, atrophy of muscle or muscles overlying
the posterior primary divisions of the spinal nerves, and vertebral spreading
Although the patient may be treated in a sitting
posture those who use machines generally prefer to have him lie on a narrow
hard-cushioned table. The table should be about six feet long and
twenty inches wide in order that the operator may easily reach across during
the administration. For spinal treatment the prone position is assumed
with the face down and the arms hanging loosely over each side of the table.
When the thorax is to be treated a pillow may be placed beneath the posterior
portion of the chest.
When mechanical vibration is to be applied to the
region of the neck with the patient lying, the patient's head should be
turned on the pillow so as to provide a resisting surface, or in some cases
no pillow need be used. It is a recognized fact that an opposing
resistance increases the value and efficacy of vibratory treatment.
It is best that ladies remove their corsets, in fact
all clothing about the waist but the undervest, and that a man should remove
his vest, coat, suspenders, and stiff-bosomed shirt.
The following relative to vibratory technique as
outlined by Pilgrim may be of interest
THE DURATION OF TREATMENT is usually from two to
four or five minutes and each - individual part should not be treated for
a longer time than five or eight seconds for stimulation, or ten to twenty
seconds for inhibition - bearing in mind that stimulation, vibratory stimulation,
or inhibition depend relatively upon pressure and length of stroke as well
as time. If what is termed stimulation be desired, the brush (multiple
point vibratode) should be applied for a few seconds, using light pressure
and medium stroke; if vibratory stimulation is desired, a slightly longer
application according to Pilgrim, "eight to twelve seconds," with tolerably
deep pressure is necessary, and actual inhibition is brought about in from
a quarter of a minute to a minute or more, employing deep pressure with
the ball. The writer believes that the condition under treatment
the immediate response of the patient to treatment during previous administrations
and the after effects must be the guide as to length of time requisite
to obtain the effect desired. Great care must betaken not to make
the treatment too long, or, what is a matter of the utmost importance in
the writer's judgment, to exert too great pressure, as the treatment might
be followed by a sense of great weariness or lassitude.
IN THE TREATMENT OF PATHOLOGICAL CONDITIONS affecting
the organs of special sense the following general plan is adopted.
First, consider the nervous supply of the organ and its general relationship.
If it is indicated to treat the superior cervical ganglion, apply vibration
to the upper part of the anterior, border of the sternocleido-mastoid muscle,
or if lower in the neck it may be treated indirectly through the other
cervical ganglia, applying the vibratode in front of the transverse processes.
IN VENEREAL DISEASES, according to instructions,
based on central nerve stimulation, developed by Dr. Pilgrim, the treatment
should be as follows:
(1) " Stimulate with the rubber ball the proper vaso-motor area for
the purpose of inducing a more efficient blood flow, and the nerve area
in the spine, which controls the nutrition of the genital or other affected
organs' which, under such conditions, are quite sensitive to deep pressure.
(2) Stimulate with the brush the lymphatics generally, but especially
those along the sides of the penis and in the inguinal region, in order
to secure the best drainage possible, relaxing at the same time all contiguous
(3) Stimulate at their nerve connections at the spine (with the ball),
and also directly over the organs, with the brush, the liver, kidneys,
spleen and bowels, with a view of accelerating their eliminative action.
(4) Place the patient in the 'Sim's' POSITION, with knees well elevated,
shorten the stroke of the vibrator arm and apply a mild treatment to the
prostate gland per rectum, using for this purpose the special rectal attachment.
WHEN TREATING THE AFFECTED SPINAL CENTERS treatment
should be applied just inside of the tuberosities of the ischium, deeply,
immediately behind the attachments of the perinaeum, using the ball and
IF THE STIMULATION BE SPINAL, the ball attachment
is applied between the transverse processes. Great care must be exercised
to avoid the spinous processes. This treatment is based on the idea that
pain is of nervous origin and by treating the centers of such nerves we
can act upon the affected part.
OTHER SPECIAL CONDITIONS are treated in accordance
with the theories on which the above line of treatment is based.
One very unique method was recommended by Pilgrim [Mechanical Vibratory
Stimulation] for flushing the mesenteric glands in cases of alcoholism
or morphinism as follows: "The patient should drink a pint at least of
water (hot if for the former condition, and hot or cold for the latter)
and then lie on his right side with the knees well elevated. Vibratory
stimulation with the ball should then be applied to the spine between the
fourth and fifth dorsal vertebrae, using firm and tolerably deep pressure."
This should be continued for one minute and is done to relax the pylorus.
"Next place the hand over the abdomen, just below the stomach, and exert
heavy upward pressure with a view to elevating the stomach. When
this is accomplished, the contents of the stomach will rapidly discharge
into the abdomen without much absorption taking place through the gastric
After this stimulate the splanchnic nerves to hasten
absorption by means of the mesenteric glands.
The above is only a brief outline of the method employed
by many advocates of vibration.
THE METHODS that have been followed by other advocates
of vibration more closely follow the forms of manual massage. As
an example the following is noted in respect to neuralgia. One writer
states that the best way "of treating neuralgia with vibratory massage,
is to 'coup' the pain by immediate application of very powerful vibrations
for a short period, one-quarter to one-half minute, and then continue with
milder, but increasing vibrations over the pain points and along the course
of the nerve, up and down and then finish with vibrations of the initial
strength and duration. There is however one obstacle to the successful
carrying out of the above treatment, viz., the inability of most patients
to withstand the shock of the 'couping.' Therefore, one must mostly
resort at the beginning to moderately strong vibrations and then increase
until the limit, to be determined by the patient. Milder vibrations
will cure but not so rapidly. The element of time varies" from two
to twenty minutes, and two treatments per day have been necessary in some
THE ACTION OF THE TISSUE OSCILLATOR is somewhat different
from that of a mechanical vibrator. By some its action is regarded
as closely resembling that of a mechanical exerciser, such as some of the
apparatus of Zander and Taylor.
In using this apparatus the patient sits or stands,
or he may recline when the hand piece is applied to the back or when the
new additional vibratory attachment is used. If the patient applies
the hand piece, a chair with arms is desirable, otherwise the chair without
arms is to be preferred. Chairs should be firmly fastened to the
floor. The patient may under certain conditions remove nothing but
the hat, in others, as for throat applications, the collar, or for foot
applications, the shoes must be removed. If a woman is to be treated,
corsets or tight clothing should be discarded. In the case of a man,
suspenders and stiff-bosomed shirt should be removed. Of course an
application to the exposed skin is oftentimes desirable in order to secure
the full effects, in which the clothing to be removed will be determined
by the judgment of the operator.
IF A BODY TREATMENT IS INDICATED the wide belt should
be used and the administration made with the patient standing. Usually
abdominal or spinal treatments are best given with the patient standing,
as he can more easily hold the belt taut. In almost all other cases
sitting is advised. An application as a whole may last from a few
to seven or eight minutes, although some employ it for a longer period
when treating exceptionally vigorous patients. Usually the effect
produced instead of the time will best serve as a guide, but it is well
under no conditions to make the treatment exceptionally long. The
same rule obtains as with all cases under mechanical vibratory treatment,
viz., the first administration should be made shorter and milder than those
THE FREQUENCY OF TREATMENT is left mostly to the
judgment of the operator. Daily treatments at first followed by treatments
three times a week is the general rule, but the rule of electro-therapeutics
is applicable to oscillation; a daily treatment unless otherwise indicated
is best at first, to be followed later by one on alternate days, every
third day, or two or three times weekly, according as the relief can be
"bridged over" - that is, the effect produced should last until or almost
until the following treatment until the conditions are finally relieved.
This machine affords a vigorous means of massaging
the abdomen. Observe the law of exercise - do not exercise on a full
stomach or immediately following other exercise or exertion. The
dosage should be regulated according to the effect sought, based upon its
use according to Monell [A Pictorial System of Instruction, page
611] as follows, to " (1) Accelerate the general or local circulation.
(2) Determine an increased supply of blood to a part. (3) Increase
under-nutrition. (4) Excite over-oxidation. (5) Relieve pain or muscular
stiffness. (6) Stimulate internal organs to improve functions. (7) Tone
up atonic muscle fibres. (8) Increase secretion, especially of the liver
and digestive apparatus. (9) Increase peristaltic action of the intestinal
tract. (10) Secure the effects of fine rapid vibration."
TO REGULATE THE LENGTH OF STROKE an eccentric provided
for the purpose should be adjusted to one or one and one-half millimeters
for a fine stroke. A stroke of one and one-half millimeters is best
adapted for work about the neck when the smaller belt is used. The
use of over two and one-half millimeters is not advisable when the hand
piece is employed. With the large belt a stroke of from three to
eight or nine millimeters may be used according to the size and tolerance
of the patient, as well as the condition of the part treated. Beyond
this limit the strokes become actual muscle and body exercisers.
THE EMPLOYMENT OF SPECIAL APPLICATORS will be considered
in connection with the treatment of particular parts. The use of
the hand applicator with this apparatus is illustrated in the treatment
of the ear. Remove the distal end portion of one handle and lock
the eccentric on the same side at zero, then unscrew the set screw of the
other eccentric and adjust it so as to secure a stroke of about one millimeter
and in place of the lower part of the other handle attach the hand applicator.
One eccentric being locked, vibrations instead of oscillations occur.
The operator should strap his hand to the applicator and use his finger
tips or thumb tip in making the applications, the vibrations being transmitted
through the hand of the operator to the patient. The handle bar should
always be rigid during administrations as a deviation affects the vibrations.
It is desirable in the writer's opinion to start the vibrations before
applying the hand to the region to be treated and thereby avoid shock and
discomfort. With one finger tip, using well regulated pressure, treatment
may be given over an area where administration is indicated, as the Eustachian
tube, larynx, or pharynx.
THE TREATMENT OF MYALGIA OF THE NECK has been followed
by good results by the use of the narrow belt in the writer's experience,
employing the apparatus as follows: Adjust each eccentric so the stroke
will be about one and one-half millimeters and tighten the set screw.
To the lower part of each handle hook on the narrow belt. Have the
patient remove her hat and collar and adjust the belt. She should
sit in the chair at such a distance as to bring the belt taut, and the
handles must be in line. Start the motor at a rapid rate of speed.
At the end of five minutes the patient under such treatment was able to
move her neck freely. When the large belt is used the patient should
stand in such a position as to throw a weight of about twenty-five pounds
upon the belt in order to keep it taut.
IN RESPECT TO THE TREATMENT OF THE EXTREMITIES, taking
the foot as an example, as it will also demonstrate the method of using
the foot rest, the method is as follows: Seat the patient facing the apparatus
with legs extended. It is best, although not absolutely necessary,
that the shoes be removed. Hook the foot rest to each handle bar.
The patient should then place her feet in the foot rest and hold the belt
in her hands, or have it fastened around her body, or around the chair,
as it must be held taut. Three or four millimeters as indicated on
the eccentric of this apparatus will usually give a stroke of sufficient
length for this administration. The treatment should be continued
for about five minutes, unless existing conditions indicate otherwise,
and a short rest should follow before the patient leaves the office.
This treatment is adapted to patients suffering from poor circulation and
Electricity can be administered during the treatment
with the applicators, but is not considered a valuable combination.
A vibratory attachment also increases the usefulness of the apparatus.
Dr. Morse [Journal of Advanced Therapeutics], of Boston, describes
a practical method of treating auto-intoxication as follows: "My first
treatment consisted of a gastric lavage, not by the usual method of swallowing
a tube, but by having the, patient drink half pint of a solution of sodium
phosphate and sodium salicylate, followed by one or two glasses of Poland
water, shaking him vigorously by placing the band of the oscillator over
and around the stomach, after which having him lie for five minutes on
his right side that the solution might gravitate into the duodenum."
This procedure was followed by "a sinusoidal surging current through the
duodenum for five minutes and the static wave current over the parts for
five minutes." This treatment caused a marked elimination of toxic
material resulting in a rise of temperature, quickened pulse and slightly
swollen and tender joints. An active cathartic was then given to
eliminate the toxic material.
In the adaptation of all machines to therapeutics, the operator
must consider many features other than the directions generally given, for the
relative strokes, speed, and pressure of and with different machines vary.
He should always test the application of each particular vibratode with varying
degrees of speed and stroke and pressure on himself at the same site he is to
treat the patient; for without so doing he cannot rightly appreciate effects
or obtain the best results.