I have clients with multiple sclerosis. One of them asked me whether the Power-Plate would be a good thing to use. I didn't really know what to say as I have not used it and did not know what effect it would have on them. Do you have any information on this?
Vibration Training (VT) can be used on people living with multiple sclerosis (MS). While there is not a large body of published literature specific to VT and MS, there is some interesting pilot data as well as a good body of clinical data. In other words, while few studies have been performed, many healthcare and clinical settings use it safely and effectively.
One published study, from The Medical University of Vienna, found that VT may positively influence the postural control and mobility of people living with MS. However, a small pilot study in Glasgow of 16 people with MS over a three month period that compared an exercise program with the same exercises done on a vibrating platform failed to demonstrate that VT provided any additional benefit. A further pilot study from the Sweden and the Netherlands concluded that VT positively influenced postural control, balance, mobility, strength and endurance. In particular, this paper found that in short tasks in which explosive strength and coordination was required, the greatest gains were made. The mixed reports are the result of several factors including loss ‘n’ sizes, variability of the disease state and the “newness” of this technology. Yet clinically, we are seeing some very exciting and positive outcomes.
So where does this leave you?? It is my opinion that it comes down to two simple factors.
- Is your client cleared for acceleration-based resistance training?
- What are the secondary impairments associated with the primary condition (in this case, MS)?
VT is no more than the application of acceleration forces (gravity) to the body undergoing movement. Force = Mass x Acceleration, thus VT manipulates the “A” factor in this equation and applied forces TO the body. If your clients are ready, willing and able to perform gravity-based resistance training, there is a VERY good chance that VT is right for them. However, the answer to the second question will have the greatest determination on 1) if VT is safe for your clients and 2) how to use it for optimal effectiveness/results.
MS, as you know, has many stages (classifications). Each stage will have different degrees and nature of secondary impairments. One person with MS may have only a slight loss in sensorimotor function, while another has cardiovascular dysautonomia, incontinence and spasticity. It is these impairments that dictate usage and guidelines. Ultimately, your client will be exposed to the same responses and adaptations as “traditional” resistance training, and you must ensure that any/all secondary impairments can tolerate these. You then adjust your guidelines to match their needs. The greatest ones to consider with VT and MS are the following:
- Cardiovascular Dysautonomia: Irregular function of the autonomic nervous system (ANS) leads to a blunted heart rate and decreased blood pressure in response to exercise. If this condition is present, heart rate and blood pressure must be monitored throughout the exercise program, and intensity might need to be decreased.
- Heat Sensitivity: This can include fatigue, loss of balance and visual changes. Create a cool environment with fans, air temperature between 72 and 76 degrees Fahrenheit. Wear clothing that breathes (i.e., cotton), and use cooling aids as needed. To counter dehydration, experiment with using sports drinks instead of water, depending on problems with incontinence.
- Incontinence: Void bladder before exercise and monitor urinary cycle.
- Balance and Coordination
- Medication: Be aware of side effects of medication you are taking and how this will affect your exercise program. Medication can affect energy level, muscle coordination and muscle strength.
Therefore, you now choose the training components that address these impairments. If you have attended the Power-Plate Certifications, you will have detailed guidelines for each training component. If not, I will summate here some simple but effective guidelines. Given that I don’t know your clients or their level of function, please accept these are just “generic” guidelines:
- Movement Preparation
- 30s/30 Hz/Low Amplitude (training Matt on)/1-2 sets (per movement)/Passive – Active execution
- Focus on major complexes/segments that have imbalances and/or asymmetries.
- Stability and Coordination
- 30s/30 Hz/Low Amplitude (training Matt on)/1-2 sets (per movement)/Static execution/W: R 1: 2
- Focus on training from the ground up. Do not fatigue! This is about high quality/low quantity to re-educate efficient movement patterns.
- 10-30s/30 Hz/Low Amplitude (training Matt on)/1-2 sets (per movement)/Static execution/W: R 1: 1 or 2
- Progressions; volume of work – skill of movement – frequency – amplitude
- You may well need to start with VERY low volume and intensity. Some clinicians have found higher frequencies and amplitudes to be most effective. However, this is only after a significant acclimation phase AND if they can tolerate it.
- Recovery and Regeneration
- 60s/35-40 Hz/High Amplitude (training Matt on)/1-2 sets (per movement)/Massage
- Focus on areas that may have hypertonicity (spasticity tremors).
The single biggest concern here is the effect of neural fatigue. MS is very predisposed to this. Start conservatively. Build tolerance, then volume, then skill and then intensity. Most importantly, take into consideration the daily variations of secondary impairments (thoughts, hydration, sleep, nutrition, etc… all affect these). If your clients recover between sessions well, then do not be scared to progress them accordingly.
I hope this helps.
- Schuhfried O, et al. Effects of whole-body vibration in patients with multiple sclerosis: a pilot study. Clinical Rehabilitation 2005;19 (8):834-842.
- Ohlin, S, et al. Whole body vibration training in multiple sclerosis patients – a pilot study. Dept of Neurological Physiotherapy, Malmo, Sweden.
- Oakes, PhD CASE HISTORIES—MULTIPLE SCLEROSIS. An Aggressive Functional Capacity Training with Whole Body Vibration.