M. L. H. Arnold Snow, M.D.
General Physiological Effects of Mechanical
MASSAGE AND MECHANO-EXERCISE have been investigated
for many years, and of late vibration, manual and mechanical,
has received attention. As certain facts and principles
have been considered by Ling, Maggiora, Colombo, Mezger, Sargent,
Kellgren, Cyriax, Savage, Taylor, Graham, Kellogg, Fleisch, v.
Marxow, Buchheim, Saquet, Meltzer, Lagrange, Bechterew and Tschigajew,
Langendorff, Axenfeld, Lange, Mesnard, Lavalette, Hasebroek, Winternitz,
Kumpf, Ewer, Bjorksten, Zander, Abrams, Ledermann, Nebel, Granville,
Charcot, and others, it is fitting to recognize their efforts.
Beginning with the work heretofore accomplished, it will be possible
to approach a more complete system. For a full appreciation
of the subject it is necessary to recall certain anatomical and
MECHANICAL -VIBRATION when applied
in accordance with varying rapidity of speed, length of stroke,
degree of pressure - light, moderate or heavy - is capable of
affecting every tissue and organ in the body, with varying degrees
of intensity. The EFFECTS may be classified as follows:
1. MECHANICAL - It induces the removal of extravasations,
lymph, exudations and transudations, breaks up adhesions and stimulates
the circulatory and lymphatic systems. It improves respiration,
stimulates excretion and secretion, relaxes over contracted parts,
and contracts relaxed parts.
2. CHEMICAL - It assists in the interchange of oxygen
and CO2 and in the increase of certain waste products such as
3. THERMAL - It causes the generation of heat; vibratory
friction increases heat elimination, and deep interrupted vibration-with
moderate or heavy pressure by acting on muscles increases heat
production. Cutaneous and vaso-motor stimulation affect
the storage of heat, for contraction of the skin and its blood-vessels
diminishes the heat evolved. If they dilate it is increased.
If stimulation [Landois and Stirling. Text Book of Human
Physiology, 4th edition, page 410] of sensory nerves causes the
circulation to, be accelerated, the respiration to be increased,
the skeletal muscles to be relaxed, "the temperature of the interior
of the body and rectum is increased." If stimulation of
sensory nerves causes the circulation to be retarded, respiration
to be decreased, and the skeletal muscles to be contracted reflexly,
"the temperature of the interior of the body and rectum is diminished."
"External parts [Landois and Stirling. Text Book of Human
Physiology, 4th edition, page 411] give off more heat than they
produce, so that they become cooler the more slowly new blood
flows into them, and warmer the greater the rapidity of the blood
stream through them." The temperature of internal parts
falls" when the blood stream through them is accelerated and it
is raised when the blood stream is retarded." An increased
temperature means an increase in the number of heart beats, according
to Liebermeister [Landois and Stirling. Text Book of Human
Physiology, 4th edition, page 419].
"Pulse beats per minute....... 78.6
91.2 99.8 108.5
Temperature in C.............
4. PHYSICAL - It assists endosmosis of the lymphatics
and the physical action of respiration.
5. METABOLIC - It induces anabolic or katabolic
changes affecting the functional activity of a part as in the
removal of stasis and an increase in the nutrition of a poorly
6. REFLEX - It induces activities and changes in
related parts through the nerve stimulation of the central and
peripheral parts of the cerebro-spinal and sympathetic systems,
as in its action as a sedative.
The following, by Taylor [Massage],
is of interest: "The analysis of transmitted motion into its factors,
and the discrimination of the separate, distinct effects of these,
is of direct consequence for estimating the influence of different
rates of rhythm or length of motion-waves transmitted.
"We may presume that the heat
evolved must pretty closely correspond with the rectilinear extent
of the motion and the accompanying pressure whatsoever the length
of the waves. On the other hand, the chemical products are
in proportion to the number of changes of direction into which
this imaginary direct line of motion is broken up, for every concussion
which accompanies change of direction throws off energy in the
chemical form, doubtless increasing the oxidation and other chemical
changes to which all constituents of the organism are by nature
destined, and the promotion of which all curative processes must
"But the evidences derived from
chemical analogies and chemical facts are by no means the conclusion
of the array available. Those ordinarily satisfactory are
abundant. These are clinical tests. The peculiarity
of this class of evidence of chemical effects consists in removing
obstinate local and general manifestations of disease, for which
the most potent chemical remedies are commonly employed with far
less conclusive success. This effect of rapid wave or vibratory
motion shows that profound chemical changes are superinduced by
the means used, which in this case can only be liberation of chemical
energy in contact with material having unstable equilibrium -
the non-vital suboxides."
THE EFFECTS OF MECHANICAL VIBRATION are as follows:
1. Cardiac activity is regulated. Blood pressure
may be lowered reflexly. It may be raised also.
2. Contracts arterial blood vessels. If prolonged,
dilatation results. Pulse rate may be lowered.
3. It induces many reflex effects as well as motor,
sensory, secretary and vaso-motor effects. It lessens and
removes hyperactivity of nerves. It diminishes pain and
relieves congestion not due to organic conditions.
4. Diminishes and relieves muscular pain and stiffness.
It can relax tense muscles and cause relaxed and atrophied muscles
to become firm and increase in size. It tones up cardiac
5. Reflexly induces contraction of the lungs.
Relieves pain and dyspnoea. Improves respiration.
6. Diminishes size of glands, directly and reflexly.
7. Contracts or dilates the liver, stomach and spleen.
8. Diminishes irritability of the bladder when not
due to organic conditions.
9. Induces peristalsis.
10. Increases or diminishes lymphatic circulation
according to the vibratory friction given, centripetal or centrifugal.
11. Assists in diminishing intraocular tension.
12. Lessens nasal hyperemia.
13. Suction vibrations are valuable in removing
pus from a boil, etc.
Vibration, having a marked
effect on respiration, digestion, absorption, heat, secretion,
excretion, the nervous system, the muscular system and all physiological
processes which are affected by active change, it is necessary
that the anatomical relations, the physiological function, the
blood, nerve and lymph supply of each organ or part of the human
body be thoroughly understood in order to more fully appreciate
faulty technique, for too often vibratory work is misdirected,
energy is misspent, and mechano-vibration or the particular vibrator
used, is condemned.
THE PHYSIOLOGICAL EFFECT OF VIBRATION,
according to Reich, is to increase "the excitability as well in
the motor as in the sensory nerves if the excitation continues
for a short period, but to lessen the excitability if the time
given for the vibration or concussion is prolonged. Therefore
we have reason to believe that small excitations of long duration
have the same effect upon the nerves as strong applications which
only work once, according to Pfluger-Arndt's law.
The skin will be pale after a
short application of vibration (high frequency), but will redden
after a longer application. Therefore a contraction will
be at the beginning sometimes even contraction of muscles of the
skin, while vaso-dilatation will ensue in the further application."
He believes that general vibration increases the blood pressure,
accelerates the circulation, increases absorption and the secretory
power of glands. Mechanically it can favor the expulsion
of gall and kidney stones. Reflexly when vibration is applied
"in the region of the roots of the spinal cord, especially of
the neck a general sense of cold results." The writer has noted
this when the vibratode is applied over the exit of the second
cervical nerve. If applied to the spinal cord in the interscapular
region a decrease in heart rhythm ensues. "Manipulations
of short duration will have a stimulating and tonic effect while
prolonged vibration will have a quieting, analgesic, sedative
effect; therefore use short but often repeated vibrations in cases
of paresis, cutaneous anesthesia and when used as an analgesic.
"In relaxations of contractile
tissue, in weakness of the heart, in floating kidney, in relaxations
of the uterus, in hemorrhoids and prostatic hypertrophy, for the
sensations of lassitude of neurasthenic patients - in all these
conditions use short but often repeated vibration.
"The prolonged vibration should
be used in neuralgia, hyperaesthesia, spasms, tremor, paralysis
agitans, insomnia and all conditions of general excitability.
Also use prolonged vibration for the mechanical effect; for instance,
for the expulsion of kidney and gall stones. Sometimes the
treatment may be given for as long a period as one-half hour.
Throughout this work the word
"vibration" is used to include vibration of all frequencies.
Some writers prefer to call vibration of low frequency concussion."
THE FOLLOWING DEDUCTIONS WHEN
SPINAL CONCUSSION or vibration was employed, have been noted by
Abrams [Spondylotherapy] and the author.
1. Contraction of the myocardium associated with
the heart reflex of contraction. It increases pulse volume
and diminishes frequency.
2. If the heart is weak and blood-pressure is high,
a strengthening of the heart will cause fall of pressure by vibration
of 7th cervical spine. Concussion properly applied can cause
fall of blood pressure. Vaso-dilators in drugs reduce blood-pressure
by "paralyzing the vaso-constrictor mechanism."
3. If the heart is weak and vaso-motors do not compensate
the failing heart, a strengthening of the heart causes rise of
blood pressure by vibration of 7th cervical spine. Concussion
selectively applied can raise blood pressure.
4. Heart reflex of dilatation increases area of
cardiac dullness associated with no increase in diameters of heart
as "heart muscle can increase the size of its cavities without
any corresponding augmentation of tension of its walls."
5. The aortic reflex of contraction is associated
with stimulation "of the vaso-constrictor nerves or their centers
in the cord. They emerge with the anterior roots as preganglionic
6. The aortic reflex of dilatation is associated
with stimulation of the vaso-dilator nerves or their centers in
the cord. They emerge with the posterior spinal nerves.
7. Stimulation of the longitudinal muscular fibres
of intestine occurs in intestinal reflex of dilatation.
8. Induction of contraction of circular fibres occurs
in intestinal reflex of contraction.
9. The excretion of indican is promoted after 15
minutes' concussion of first three lumbar vertebrae or corresponding
intervertebral vibration between the 1st and 2nd and 2nd and 3rd
10. An increase in volume of liver occurs in liver
reflex of dilatation by concussion of llth dorsal vertebra.
11. Depletion of liver induced by liver reflex of
12. It augments the tone of the splanchnic vasomotor
mechanism by expressing the blood from the abdominal vessels to
the right heart, by concussion of the spines of 2nd, 3rd, 4th,
5th, 6th, 7th and 8th dorsal vertebrae which correspond to splanchnic
nerves from the 5th, 6th, 7th, 8th, 9th, 10th, 11th and 12th dorsal
nerves or by corresponding intervertebral vibration.
13. It has a mechanical effect on the spleen by
concussion of first three lumbar spines or corresponding intervertebral
vibration causing a reflex contraction of the spleen.
14. It induces dilatation as well as contraction
of kidney thus varying its volume which depends on structural
distension and amount of lymph, and blood in its vessels.
15. Concussion or vibration "stimulates the motor
component of a spinal segment and subdues its sensory constituent."
The effect of vibration has been
appreciated for a long time, as noted by Snow in his work, "Static
Electricity and the Uses of the Roentgen Ray," as follows:
"The action upon metabolism of
vibratory influences has long been recognized by physiologists
such as that attributed to the heart's impulse. Dubois-Reymond
taught 'That the nutritional effects depend not on the quantity
of the electricity but upon the variations in the quantity,
and the suddenness of these variations,'" which is true as applied
to vibration, but requires qualification in various features of
1. The vibration should possess the necessary rapidity
and length of stroke. Exerted pressure should be painless
or according to tolerance.
2. The rapidity, stroke, pressure or non-pressure
should be governed by the indications and the patient's reactionary
3. The interruptions when using interrupted vibration
should be limited in number to avoid exhaustion in nerve power.
4. The intervals of rest should be as long or twice
as long as the period of impulse contact to assist in the perpetuity
and fixedness of the effect.
5. The stroke should be adapted to the density of
the part treated, and the speed to the condition.
6. Vibratory effects should be applied to aid or
promote functional activity of a part without altering the integrity
or unfavorably affecting, the normal activity of the part.
7. The effect directly or indirectly will vary with
the duration, speed, direction and pressure used in the treatment.
Cyriax ["Vibrations and Their
Effects." Lecture given before the Ling Association, London,
on Jan. 5, 1900, by Edgar F. Ciriax, M. D., G. D.] summarized
an exhaustive study of the effect of vibration in which he considered
both manual and mechanical vibration. The following is a
brief summary of his observations.
"The great majority of the conclusions
quoted are obtained from experiments with machine vibrations."
1. "EFFECT ON THE CELLS of the human body.
Fleisch V. Marxow set up the theory that the (vibrations) minute
shocks imparted to the cells of the lungs by the heart beat were
necessary for the gaseous interchange, that these were in fact
a sine qua non for actual existence. Other observers have
concurred in this.
2. "EFFECT ON BACILLI. Saquet found no change
in the growth and characteristics of bacilli after eight days'
continued vibration, whereas Meltzer found destructive effect
with shorter time of vibration.
3. "EFFECT ON THE TEMPERATURE. Taylor, Lagrange,
Saquet found a rise of temperature after using vibrating machines.
Bechterew and Tschigajew, using vibration of the whole body, found
a rise in the internal temperature and a fall in the skin and
4. "RELATION BETWEEN SPEED AND EFFECT. Langendorff,
using a tuning fork on a nerve, found the maximum result with
4800 oscillations per minute. Axenfeld with the same kind
of apparatus considered that up to a certain point the slower
the rate the better, as the amplitude of the movements of the
tuning fork was then greater. Lange concluded that a rate
of 1100 to 1200 per minute produced the greatest effect."
Mesnard caused muscular tetanus with 15,000 vibrations per minute.
5. ON THE MUSCLES. Muscular contraction was
induced. (Rood, Lavalette.) Mesnard used "very rapid vibrations"
to cause contractions. Ewer "states that vibrations can
sometimes cause contraction in muscles which will not react to
6. ON THE HEART. It diminishes excited cardiac
action (Winternitz, Levin, Hasebroek, Nebel, Ziegelroth).
"Achert and Siegfried found very little effect, and Bechterew
and Tschigajew a varying one. Heitler found that vibration
of the heart set up by the so called hacking over it raised the
tone of the cardiac muscle and diminished the size of the organ.
A strong manual vibration on the heart is one of the best methods
of causing it to beat again" when the heart ceases to beat (Strassmann,
Korte and Kurnpf). Some consider that heart vibration acts
reflexly and others that it acts directly. On the blood
vessels it causes contraction and rise of blood-pressure according
to Bjorksten, Zander, Bechterew, and Colombo, which according
to some is followed by a dilatation and fall of blood pressure.
The writer finds that it may raise or lower blood-pressure.
7. EFFECTS ON NERVES. Bechterew and Tschigajew
by vibrating the whole body induced sleepiness in about a quarter
of an hour. The vibrating casque of Charcot has been extensively
used in France to promote sleep. Vibration diminishes pain.
"Buchheim obtained stimulatory effects on the sympathetic and
vagus in the neck according to the site of application."
8. IT IMPROVES RESPIRATION (Hasebroek).
9. GLANDULAR CONSTITUENTS, solid and liquid, of
liver, stomach, etc., are increased by "a combination of petrissage,
friction and vibration." (Colombo.)
10. IT PROBABLY INCREASES OR DIMINISHES THE FLOW
OF LYMPH according to the direction of the running vibrations
used, - centripetal or centrifugal.
11. CONTRACTIONS OF UTERUS. (Kumpf.)
12.CONTRACTIONS OF OESOPHAGUS. (Lange.)
Cyriax has probably compiled
the most exhaustive summary extant on the effects of the Kellgren
method of manual vibration. The same effects have been verified
in many instances by the writer with mechanical vibration.