I was fascinated by vibrating beds in hotel rooms in the 70s and 80s. They were “fun” but puzzling: why was it a thing? Vibration is considered paradoxically both relaxing and/or stimulatory by many people, pleasant at the least, insofar as it is a type of massage, but maybe it’s something a little more “magical” too. There are a few familiar types of common coarse vibrational therapies:
One of many hundreds of similar “massage gun” products.
- Vibrating massage chairs and tools, most notably the “massage gun” devices that have exploded in popularity in the last few years.
- Jacuzzi jets that thoroughly jiggle your soft tissues while you soak.
- Vibrating exercise platforms that shake your whole body as a form of workout.
Whole lotta shakin’ going on! There are all obviously flesh jiggling, physical vibration, and this article is mostly about those macro-scale vibrational therapies, especially massage guns. I will explain the possible biological and neurological effects (some which are intriguing) and especially why it feels so good; give some practical tips and product recommendations; and explore some painful conditions where vibration might be most useful, using frozen shoulder particularly as one of the best-case scenarios for vibration. But first…
“Vibration” and “frequencies” are surprisingly huge themes in both medicine and quackery
Waves and oscillations are an extremely fundamental aspect of nature at all scales.This doesn’t translate into many clear clinical implications, but that hasn’t stopped people from trying! There are several types of subtler vibration therapies, all glowing with the promise of slightly exotic biological benefits and “stimulating” tissue back to full vitality:
- many flavours of ultrasound
- infrared radiation (heat, which is molecular vibration)
- electrical and magnetic stimulation1
- even frickin’ lasers!•pew pew!•
These are mainly microscopic vibrations aimed at your cells and molecules, at a wide range of frequencies and tiny amplitudes, with the idea that cells like to “dance” to certain tunes. But most such methods are not promising, and to date there are no clear examples of a vibrational therapy that truly delivers the goods.
There’s also a whole class of more fanciful claims that overlap with “energy medicine,” most of them cluelessly referencing “frequencies” and quantum physics. Crystal healing is a classic example. Another major one is homeopathy, which depends heavily on the bizarre belief that substances can make a vibrational imprint on water, which is then transmitted to us.
And, finally, there are also a bunch of fairly straightforward mainstream therapeutic applications of high-intensity waves, like smashing kidney stones with sound waves.
Do massage guns work?
There’s a lot in this article, but this is the answer most people come for. Massage guns certainly do vibrate your tissue, for whatever that is worth… which isn’t clear, and almost all of the medical claims are just bullshit. Details…
It’s a little bit of self-serve massage, in the same category as foam rolling. Whatever value massage therapy has, massage guns probably can deliver some of that. I use them — somewhat sheepisly, because I’m not really sure why. I use them for the same (murky) reasons I still pay for massage therapy sometimes: it feels good, it’s a big morale boost, and it seems to have a shot at relieving some stiffness and aching associated with “muscle knots.”2 I don’t expect much else.
The medical benefits of massage therapy are much less clear than most people assume — even the kind that’s delivered by hand, employing many different techniques.3 The profession is riddled with myths, pseudoscience, and unjustified claims.4 For instance, massage cannot significantly relieve soreness from a workout.5
Vibrating massage tools are just one thin slice of the massage therapy pie, with the cherry-on-top idea that there’s something about vibration specifically that is a potent “active ingredient” in massage. Massage guns are being sold with all kinds of alleged benefits — e.g. “stimulates muscle recovery,” “enhances performance” — that are overstated at best, delusional at worst. Almost nothing has ever been “clinically proven” or disproven about any kind of massage at all, let alone this specific sub-type. This is mostly an evidence-free zone, ruled by marketing and not science.
But vibration is interesting, there’s no question it can feel terrific, and on a case-by-case basis it might be worth trying. Just keep your expectations on a short leash.
A few possible biological effects of vibration
Coarse vibrations might have some intriguing neurological effects. The best example I’m aware of: it appears that if you just add some vibration, even already flexible gymnasts can get a surprising boost in flexibility.8910 Clearly that is a neurological effect on flexibility … and a very cool one.
But these are largely uncharted waters, and it’s clear that some popular uses are failing to pass fair scientific tests. For instance, the trendiest application of vibration therapy trying to boost strength training results, which probably doesn’t work, according to a 2014 review.11
A particularly good condition to vibrate: frozen shoulder
Frozen shoulder gives us one of the single best examples of how vibration might be therapeutically useful, but it also very much depends on the particulars. Vibration might be more useful for folks with frozen shoulder (AKA adhesive capsulitis) than many other conditions, if the freezing is “functional.” In some cases, possibly even many cases, the joint may be immobilized because it’s partially or even entirely neurologically inhibited (think “spasm”) rather than physically limited by contracture/adhesion — see The Role of “Spasm” in Frozen Shoulder. Vibration might be quite a good way to disrupt the inhibition.
Even if a case of frozen shoulder is completely dominated by contracture, it’s still a condition that relies heavily on the use-it-or-lose-it principle, and there’s almost always some inhibition piled on top of the contracture. Vibration could help eliminate that, creating a window of opportunity for as much movement as the contracture can possibly allow — and every little bit counts.
There is no evidence that this is the case. This is just a hypothesis. But it’s a really promising one, I think. I’ll explore it a little more below.
Other conditions to vibrate, or not, and why
Other conditions where movement dysfunction might be a significant factor, and a bit of why, and therefore might be helped by vibration:
- low back pain and neck pain, because they have very substantial fear factors
- muscle strain, because it’s a way to physical stimulate tissue without stressing it (assuming an appropriate intensity)
- tennis elbow, because, like frozen shoulder, it’s got a split personality: there are cases that are dominated by tendinitis, and there are cases dominated by muscle pain
Conditions less likely to be helped:
- carpal tunnel syndrome, because it’s caused by a physical entrapment of a nerve, and that probably cannot be altered by vibration
- plantar fasciitis, because the issue with the tissue is usually just overload, and neurological inhibition isn’t a factor
- stress fracture, because it will probably just make it hurt more, and won’t help in any way
Why does vibration feel so good?
Vibration is inherently relaxing for most people, assuming it isn’t applied too suddenly or intensely or in an uncomfortable location. I think there are a couple reasons for this:
Proprioceptive confusion. Proprioception is the sense of position or movement, our under-appreciated “sixth” sense. If you move or shake the body at random, the cerebellum gets a deluge of nonsensical proprioceptive data, sensory information about movements that the brain did not plan. Assuming a safe and healthy emotional context, the nervous system, overwhelmed by the flood of stimuli, willingly “gives up” and stops resisting the movement — an unusual state.
Sensory novelty. Fresh and unusual sensations are the bedrock of massage therapy: when we get a good massage, we experience many sensations that are unique to that context, and that is half the appeal. But vibration delivers especially strong and distinctive sensory novelty: it feels like nothing else, and it feels like the opposite of feeling stuck and stagnant. Like splashing cool water on your face when you’re hot, vibration feels like a natural antidote to the sensation of stiffness.
To a minor extent, these effects might explain why people like the subtler, finer vibration therapies like TENS — but the “confusion” and “novelty” are also subtler, and the relaxation effect are definitely less profound.
More about the relevance to frozen shoulder
The effect of vibration on stretching mentioned above is also quite relevant to frozen shoulder. Flexibility is probably mainly a matter of our “tolerance” of stretch rather than the actual physical looseness of our tissues. In other words, our brains detect excessive stretch and actively block us from going further than it thinks we should. Vibration probably interferes with that, essentially “confusing” the brain about what an acceptable level of stretch is. And if it can interfere there, it might be able to free up a badly inhibited shoulder.
Even if it’s just a temporary, minor effect, it would still be an extremely useful way to faciliate range of motion exercises. My advice is to integrate vibration into your rehab plan, using it as a way to improve the odds that you’ll be able to move further.
Please experiment: try range of motion exercises before vibrating, and then try again after vibrating. Is there an obvious difference?
How to vibrate
The Thumper is a sturdy example of a vibrating massage tool, a class of massage tools that deserves a little more attention. There are many gadgets like the Thumper, and most notably the massage “gun” form factor has exploded in the last few years. But I kick it old school with the Thumper brand: a well-designed device built here in Canada. I’ve had my Thumper for about 15 years now, and it works as well today as it did the day I brought it home. I used it routinely in my clinic for many years (a favourite part of the treatment for many clients), and mainly as a self-massage tool ever since, but it’s also a nice easy way for my wife to give me a quite a bit of massage for minimal effort.12
The “Thumper Maxi Pro” is the thumpingest of all vibrating massage tools. (Except for the one built for horses.)
A Thumper is not cheap, so there ought to be a good reason to get one. Fortunately, it offers a lot of value regardless of therapeutic effect, just as massage does generally, but probably even more so: for those who enjoy them, vibrating massagers can deliver a lot of pleasant stimulation super conveniently for a long time. It may cost up front, but over the long haul it’s quite economical.
- “Windows of Opportunity” in Rehab — The importance of WOO in recovery from injury and chronic pain (using frozen shoulder as an major example)
- The Role of “Spasm” in Frozen Shoulder — How to identify cases of functional frozen shoulder, dominated by muscular inhibition
About Paul Ingraham
I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter.
Related ReadingHere are a few other articles tangentially related to vibration therapy, but there are dozens more therapy and rehab options and concepts reviewed on PainScience.com.
- Does Ultrasound Therapy Work? — Many concerns about the widespread usage of therapeutic ultrasound, especially extracorporeal shockwave therapy (ESWT)
- Quite a Stretch — Stretching science has shown that this extremely popular form of exercise has almost no measurable benefits
- Get in the Pool for Pain — Aquatic therapy, aquajogging, water yoga, floating and other water-based treatment and injury rehab options
- Mobilize! — Dynamic joint mobility drills are an alternative to stretching that “massage with movement”
- Zapped! Does TENS work for pain? — The peculiar popularity of being gently zapped with electrical stimulation therapy
What’s new in this article?
Aug 1, 2020 — “Massage guns” were strangely missing from this article, as well as any discussion of their efficacy, so I corrected that. I also substantially revised everything to make this a more general article about the theme of vibration in both medicine and quackery.
March — Added a couple citations; some editing and clarifications.
March — Publication.
- There are two electrical stimulation therapies that produce vibration-like sensations:
- transcutaneous electrical nerve stimulation (TENS) stimulates finer vibrations with electricity, basically “tingles” that feel somewhat vibratory
- electrical muscle stimulation (EMS) is closely related to TENS, and uses slightly different settings to cause muscles to contract very rapidly
- Most people have sore spots that are associated with sensations of stiffness and aching. The sore spots are known informally as “muscle knots” and more officially as “trigger points,” but they are poorly understood. There is an extremely uncertain explanation for them, and the idea that massage can relieve them is an extremely uncertain solution for them — but trigger points are, nevertheless, the number one reason why massage therapy might be medically helpful. For much more information, start with my self-massage primer, or go straight to an advanced tutorial about trigger point therapy.
Therapeutic massage is expensive but popular and pleasant, with obvious subjective value, and proven benefit for anxiety and depression … but basically no other clearly confirmed biological or medical effects. Most notably, the evidence that massage can help back and neck pain is sketchy, and there is no reason to believe that massage can help much with any other common musculoskeletal pain problem.
And yet some medical benefits are plausible despite the lack of evidence. For instance, many apparently successful treatments may be due to the effects of pressure on “muscle knots,” which are a likely factor in many common pain problems, but poorly understood (and difficult to treat). And regardless, the effects on mood and mental health are so profound that patients can’t really lose — it’s a valuable service whether it “works” for pain or not.
The major myths about massage therapy are:
- Massage increases circulation. Probably not… and definitely not as much as a little exercise.
- “Tightness” matters. The three most common words in massage therapy — “you’re really tight” — are pointless.
- Massage detoxifies. It’s actually the opposite, if anything.
- Massage patients need to drink extra water to “flush” the toxins liberated by massage.
- Massage treats soreness after exercise. Studies have shown only slight effects.
- Massage reduces inflammation. An extremely popular belief based mainly on a single seriously flawed study.
- Fascia matters. The biggest fad in the history of the industry.
- The psoas muscle is a big deal. The most overhyped single muscle.
- Massage stimulates endorphins (natural opioid) and reduces cortisol (stress hormone). They do not.
- “Trigger points” are evidence-based. Actually, the science is seriously half-baked.
- Massage therapists have spooky palpation skills. No, it’s just ordinary expertise… and misleading.
And massage is still awesome! It’s important to understand the myths, but there’s more to massage. Are you an ethical, progressive, science-loving massage therapist? Is all this debunking causing a crisis of faith in your profession? This one’s for you: Reassurance for Massage Therapists: How ethical, progressive, science-respecting massage therapists can thrive in a profession badly polluted with nonsense.
- Guo J, Li L, Gong Y, et al. Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis. Front Physiol. 2017;8:747. PubMed #29021762 ❐ PainSci #52834 ❐ This is a meta-analysis with a technically “positive” conclusion that actually is just damning with faint praise. Garbage in, garbage out, establishing nothing except that there’s obviously no strong benefit to detect. For a much more detailed analysis of this topic, see Post-Exercise, Delayed-Onset Muscle Soreness.
- Germann D, El Bouse A, Shnier J, Abdelkader N, Kazemi M. Effects of local vibration therapy on various performance parameters: a narrative literature review. J Can Chiropr Assoc. 2018 Dec;62(3):170–181. PubMed #30662072 ❐ PainSci #52722 ❐
The Journal of the Canadian Chiropractic Association isn’t exactly The Lancet, but I agree with them that “Most studies found that LMV elicits beneficial changes in the mentioned outcome measures.“ And I also agree that the research is “heterogenous“ — way too many different varieties of vibration — and probably also too shabby to draw any conclusions from.
- Broadbent S, Rousseau JJ, Thorp RM, et al. Vibration therapy reduces plasma IL6 and muscle soreness after downhill running. Br J Sports Med. 2010 Apr. PubMed #18812416 ❐
This is a test of vibration therapy on sore muscles in runners. 29 male creational runners were studied after running a 40-minute downhill run. Half were given “once-daily sessions of vibration-therapy on the upper and lower legs,” and the other received no treatment. Vibrated muscles were less sore and had fewer blood markers associated with soreness
Conclusion: “Vibration therapy reduces muscle soreness and IL6. It may stimulate lymphocyte and neutrophil responses and may be a useful modality in treating muscle inflammation.”
- Issurin VB, Liebermann DG, Tenenbaum G. Effect of vibratory stimulation training on maximal force and flexibility. J Sports Sci. 1994 Dec;12(6):561–6. PubMed #7853452 ❐
In this 1994 experiment, as described by Sands et al, gymnasts “used a vibrating ring suspended by a cable, in which the foot of the subject was placed while they stretched forward over the raised leg, targeting the hamstrings. The resulting increase in ROM was astonishing. These researchers demonstrated that vibration could enhance flexibility.” The results were replicated by Sands et al in 2006, and Kinser et al in 2008.
- Sands WA, McNeal JR, Stone MH, Russell EM, Jemni M. Flexibility enhancement with vibration: Acute and long-term. Med Sci Sports Exerc. 2006 Apr;38(4):720–5. PubMed #16679989 ❐
This experiment replicated the results of an intriguing 1994 experiment by Issurin et al. Ten highly trained gymnasts did forward splits with or without vibration. They stretched to the point of discomfort for 4 minutes, alternating between each leg, 10 seconds of stretching at a time. Flexibility immediately after stretching with vibration was dramatically greater; the long-term results were less striking.
- Kinser AM, Ramsey MW, O’Bryant HS, et al. Vibration and stretching effects on flexibility and explosive strength in young gymnasts. Med Sci Sports Exerc. 2008 Jan;40(1):133–40. PubMed #18091012 ❐
- Anwer S, Alghadir A, Zafar H, Al-Eisa E. Effect of whole body vibration training on quadriceps muscle strength in individuals with knee osteoarthritis: a systematic review and meta-analysis. Physiotherapy. 2016 Jun;102(2):145–51. PubMed #26619822 ❐
- Speaking of my wife, bless her charming idiosyncrasies: she thinks that “Thumper” sounds displeasingly violent for a massage tool, whereas most people seem to think of the Thumper of cute animated-character fame. (Still others imagine summoning enormous sand worms.)