Percussion & Vibration

As is often the case, I began this post having no idea all it would entail. Researching any topic I end up going down all kinds of interesting rabbit holes. I hope reading this helps you learn more about using percussion and vibration to your best advantage!

• History
• Differences Between Percussion & Vibration
• Effects
• Choosing Devices
• Using Devices

History of Percussion & Vibration

I had no idea percussion and vibration devices went back so far in history – some records mention evidence of Cleopatra having used a form of vibration with bees in a dried gourd (no, I don’t know her purpose or chosen site of said bees). Motives for using these historical devices varied extensively: beauty treatments, pain, “hysteria,” and, of course, sexual stimulation. As is often the case, popular “historical” perspectives can circulate for years only to be later shown to have no basis. So gleaning the truth can be challenging. Suffice it to say that the application of percussive and vibratory forces to the human body is not new.

My internet search of the history of the vibration device yields all kinds of information, some of it kind of kinky (be careful where you go!). As far as I have seen and generally speaking, vibration devices precede percussive. Perhaps this is due to the fact that the piston, an essential component in percussive devices, was not invented until long after Cleopatra and her bees. In specifically researching the history of percussion, the name Josef Leopold Auenbrugger surfaces recurrently as being the father of the concept. He “tapped” into it by wrapping on wine kegs to discern how full they were, and went on to apply his methods to identifying fluid in the lungs. His work went unheralded and was plagierized by others for many years, prompting this brutally honest comment from him which still holds true today.

“I have not been unconscious of the dangers I must encounter, since it has always been the fate of those who have illustrated or improved the arts and sciences by their discovery, to be beset by envy, malice, hatred, detraction, and calumny.“

Josef Leopold Auenbrugger 1807

At the prompting of my dear husband, Bill, I’ve included the vintage vibrating belt machines. For years I have talked about these and wondered why they aren’t around anymore. Bill says it’s because they didn’t work. Maybe they didn’t work the way people expected them to as as a magic fat buster that melted pounds away effortlessly. Dream on. But in light of all that’s known about percussion and vibration I have to wonder if these machines have potential when used in conjunction with other measures. I have a future post planned on exploring adipose and metabolic problems, and I foresee it including vibration as well as cupping.

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Differences between Percussion & Vibration

People frequently blur the difference between the forces of percussion and vibration, so it can be difficult to know from a picture which action a device truly imparts even though it’s labeled as a percussor or vibrator. Adding to the confusion is that both are often labeled simply as “massage tools.” Perhaps a few definitions will help to clarify:

• Percussion: bypassing the musical instrument definition, in this case we are talking about the striking of one solid object with or against another with some degree of force.
• Vibration: an oscillation of the parts of a fluid or an elastic solid whose equilibrium has been disturbed, or of an electromagnetic wave.

As you might perceive, there is potential for some overlap in these definitions, perhaps owing to the smudging of precision in use of terminology. Both percussion and vibration forces require the input of energy to operate (be it muscle, battery, or electricity). Yet the resultant output differs greatly. The key difference may boil down to the words striking versus oscillation in the above definitions. Percussion involves the movement of a pistoning head, while vibration does not. This pistoning action causes a fluctuation in the force imparted to the tissue, whereas there is far less fluctuation involved with vibration. Percussion typically involves a very targeted spot, while vibration can be more global and impact a larger area.

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Effects of Percussion & Vibration

There are multiple tissues impacted by percussive and vibratory forces: skin, superficial and deep fascia, fat, lymphatics, nerves, muscles, blood vessels, bones, and organs. The power of the force imparted may certainly play a role in the tissue influenced. For instance, a gentle vibration force is more likely to impact the more superficial structures (skin, fat, superficial fascia, vessels, superficial nerves) than the deeper structures (muscle, deep fascia, organs). Reaching these deeper tissues may understandably require a bit more power from the chosen device, as well as a strategy for which device to choose. If my empirical evidence is worth anything (please tell me it is), I will say that when I want to impact the more superficial hypodermis I tend to migrate toward the oscillatory effects of vibration. When my target is the deep fascia, I look to the percussion tools more. Having said that, it’s worth pointing out that you can’t get to the deep structures without impacting the more superficial, so they always need to be considered. In other words, perhaps there’s an order to all this that necessitates consideration of the outermost tissue layers in treatment before blasting past them to get to the deep stuff. In cases where the superficial tissues harbor significant dysfunction it may be good to consider cupping.

The mechanisms for the impact of percussion and vibration on the tissues are thought to be multi-modal:

1. Thermal – the transfer of kinetic energy from the percussive/vibratory device to the tissues layers creates friction, stimulating a tissue temperature rise. This is evidenced by a palpable warmth in the area targeted, as well as reddening of the tissue which signals increased circulation/vasodilation. It’s kind of like clapping or rubbing your hands for an extended period.
2. Biochemical – the low level trauma introduced by percussion/vibration stimulates a localized inflammatory process. This ushers in the release of a host of biochemicals including histamine (causing temporary localized itching), and hyaluronan (also known as hyaluronic acid) which promotes tissue lubrication.
3. Biomechanical – the percussive/vibratory action begins to break up the dysfunctional bonds adhering tissue layers, nerves, and other structures (like adipose cells) together, promoting lubrication and slide.
4. Neurological – percussion stimulates proprioceptors (nerves that detect motion) which can override nociceptors (nerves that transmit signals to the brain that may provoke pain). Percussion/vibration can also serve to free up nociceptors trapped in adherent tissue layers as mentioned in #3 above.

So there are many reasons for using percussion and vibration. Within the realm of rehabilitation, evidence shows benefits such as muscle relaxation/facilitation, wound and fracture healing, improved circulation, nervous system inhibition/facilitation, pain control, and improved flexibility. The effects vary according to the power of the device used, frequently measured in hertz (Hz), as well as amplitude and torque. Studies show varying effects on parameters such as blood flow according to the power of the device, as well as the length of time applied. While there is wide variability in protocols, there seems to be some agreement that 30-50 Hz applied for five or more minutes generates positive therapeutic effects. In other words, that little AA battery-operated buzzing child’s toy is not going to give you the same effect as a more powerful unit.

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Choosing Percussion & Vibration Devices

As I write this in 2021, percussion and vibration devices are all over the internet especially in the last few years. The first percussion device I recall being on the market years ago was the Theragun® which is the brainchild of chiropractor Dr. Jason Wersland. He was involved in a motorcycle collision which left him in disabling pain. He repurposed some power tools he had and redirected their percussive force to his painful sites with good results. (I love these kinds of stories – good coming from something bad!) He was certainly an early innovator in the introduction of percussion devices in the treatment of soft tissue pain, and has created an impressive line of products.

I was shamefully tardy to embrace the use of percussion and vibration in the clinic, even though several colleagues touted the benefits to me. Finally conceding to give it a try, I borrowed a Hypervolt® from one of them, which is another brand of percussion device that is a little less aggressive than the Theragun®. I remember holding it over the bony sacrum of a patient, and it started bouncing all over like a runaway jackhammer which startled me and turned me off to it for another year. (I should have been using a different head on the Hypervolt® for that bony site but I didn’t know better.) Eventually I gave it another chance, and I now own three of them! I also have a vibrating roller and vibrating sphere, both from Hyperice. I use these devices every day in the clinic on nearly every patient at least for some part of treatment.

Percussion and vibration devices are easily accessible, making self-treatment very appealing and relatively safe. In an effort to optimize safety and results, consider these tips when choosing your device:

1. IDENTIFY YOUR NEEDS: Percussion or Vibration? Percussion tools are very versatile in terms of ability to be used on multiple body parts. The changeable heads also broaden the options for treatment locations. I use the percussion devices far more in treatment than vibration, which is why I typically suggest people go with the percussion gun because of its broader application. Vibration is lovely when oscillation is more ideal, such as when I’m trying to cover a broader site or use a gentler tissue prep. I use the vibration roller most often on the abdomen or the back of the leg. Other than that it is awkward to position on many other sites, limiting its use. The vibration ball is very gentle, so I may use it on the face, neck, head, or even on the abdomen when working with children.
2. IDENTIFY YOUR BUDGET. When I purchased my Hypervolt® units in 2019 they ran ~ $299 on sale. My vibration roller from the same company, Hyperice, was $199, although we have a second less expensive one from another company that no longer offers it. I have been very pleased with the performance of both of these devices, especially considering they only have a 1 year warranty. But the average person is not going to use a device as much as I do (every day for extended periods). So it’s fair to question whether you really need to spend that much to acquire a product that suits your needs. I have seen some very nice, less expensive devices on the market that patients purchased both off the internet and in local stores. Some were very good, some were not. I think there is a point where if you try to get the cheapest device available, be it percussion or vibration, you may be wasting what little money you spend. As mentioned earlier, I have been less pleased with the vibrating mini-sphere from Hyperice due to fragility and cost. Since I would not purchase it again I don’t recommend it to others.
3. RESEARCH YOUR DEVICE OPTIONS. There’s a lot to choose from! I can’t possibly review all the devices now available. Internet searching will reveal sites that rate products, but I’m not so sure how unbiased they are as it’s not always clear who’s doing the reviewing. Ultimately customer reviews may be the most honest source. Here are some of my favorite devices, in alphabetical order:

Bob and Brad – Nice little percussion devices that seem to perform well, have power output similar to the Hypervolt, and costs less. I like that they give you the squishy head for use on bony places. They also make a mini that is nice for travel, small hands, or anyone who has difficulty holding onto the heavier guns.

Costco Sharper Image Percussion Massager – Reasonably priced, comparable power to the other devices listed here, and available online or at most Costco stores. One negative aspect of this device is that they do not provide a soft head for bony sites. But you can always ad some padding from a towel or something similar, and make do. They also have a compact version that would be nice for travel or keeping with you, but I have not felt the power of this one.

Hyperice – the parent company that makes the Hypervolt which is a good, all around percussion device that also has the squishy head for bony places. A bit heavy, so something to consider. Their Vyper vibration roller is also nice, I use it often. As mentioned above, I am less thrilled with the minisphere as it seems overpriced and I also had one to quit working in warranty. They replaced it no questions, but it just does not seem to be built to last. I believe a cheap vibration device could do just as well.

Lifepro – the fact that their equipment comes with a lifetime warranty absolutely gets my attention. My husband, Bill, and I kid about this and say if it breaks they show up and bump you off. Hopefully not. But one must consider that the company may not be around for your lifetime. You can view their percussion and vibration devices under the RECOVERY tab. They have several models, I always try to encourage people to get a device that has the squishy, accordian-like head. They keep changing what comes with what unit, but at this moment I only see that one with the Sonic LX. It gives you more options for treating bony anatomical sites.

Pado – I used to recommend this more in the past, so it’s been a while since I’ve actually held one. This is different than most percussion devices on the market in that instead of looking something like a hairdryer it reminds me of a back-scratcher of sorts. It’s not as heavy as most other units, which can be an advantage. It has a long handle on it, which could help with reaching places on the back that could be hard with the other models. It’s also a little gentler and less powerful than the hairdryer units. I have recommended this in the past to people who I thought needed more help with reaching the back, a lighter device, and something not so aggressive.

Therabody – parent company making Theragun. They have multiple percussion devices in their product line, and I really can’t direct you deeper as I have not used them. If I was working largely with a young, muscular, athletic population I might consider this as my impression is they are a bit more aggressive. They also have a vibration roller which I have never tested.

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Using Percussion & Vibration Devices

Typically these devices are demonstrated by people moving the percussion gun around like they are sanding or painting, or rolling the body part being treated over the roller or sphere. To each his own, but that’s not how I use them. I apply the chosen device to the fascial densification points I determine to be in need of treatment in the Fascial Manipulation method. The device serves to prep the tissue in a relatively pain free manner – the relatively is in comparison to my elbow or knuckle. Percussion and vibration hurt the patient much less than my elbow, and also save me from having to do so much manual work: a win-win for both of us. Sometimes I’ll also use vibration after treatment to mitigate soreness.

While percussion and vibration are incredibly helpful, research supports that percussive and vibratory forces do not fully resolve fascial densifications. The manual component is still needed for maximal therapeutic benefit. This is perhaps due to the fact that neither percussive nor vibratory forces can impart the essential vertical shear component integral in the manual element with the elbow and knuckle. While more intense and uncomfortable, the manual element is also more effective. No machine currently existing can replicate this shear force and still leave the skin intact – yes, we like our patients leaving with their skin on. Guess I’ll always have a job.

The use of percussion versus vibration, as well as which percussion head to use, is determined by the anatomy and the patient. The percussion guns are very versatile and can be used on most body parts. If it’s a bony place (like that sacrum!) I may use the soft squishy head (many percussion devices do not have this head so please read carefully, and check out my recommended devices below). If it’s a fleshy place like a hip I often use the ball head (looks like Mickey Mouse’s nose). I like using the vibrating roller for prepping fascial densifications in the abdomen or back of the leg before applying a manual shear force to them. The small sphere is very gentle, and I’ll use it on a head, neck, ribs, or other sensitive areas. It’s also nice for older adults or young children who can’t tolerate or are concerned about the more aggressive percussion/vibration devices.

4. CHOOSE THE MOST APPROPRIATE SITES TO TREAT. This is the number one question I encounter: “How do I know where to treat?” It’s not feasible for me to teach everyone the Fascial Manipulation (FM) methodology behind my choice of points, so let’s just let that one go. Recall me saying that I do not tend to move the device around much in treatment since I am targeting a specific point. Most videos show moving the percussion device or roller all around the area of problem. Since you don’t know the methodology used in FM, then moving around where it hurts may be your best bet. Do whatever works for you. Here are some guidelines you can try:

• Treat where you hurt. Simple, straightforward. If it helps great, if it doesn’t then it may be because the problem causing your pain is remote. In other words, where it hurts isn’t always where the problem is. Try checking tissues a little further out from where you hurt and see if it helps.
• Listen to your body. If working a sites is extremely painful and/or makes your condition worse, then it’s likely not the best choice.
• Treat where I direct you to treat. Of course, this only works if I am currently working with you. I like doing this for stubborn points that need additional care, or for those who want to accelerate progress between visits.
• Not all pains and problems are appropriate for percussion and vibration. I never use percussion or vibration on the fascial points around the eyes (yes, there really are several). I typically don’t use percussion on the skull, but I have used the vibration ball here. It depends on the person and the problem. See below for additional precautions.

5. CHOOSE THE MOST APPROPRIATE PERCUSSION HEAD. There are no absolutes here, and multiple different heads may be suited for the same part of the body. Generally speaking on fleshy areas I use the round ball, like on the buttock, thigh, low back, or back of the calf. For smaller muscles (arm, leg) I may use the flat head. For bony places (hand, foot, shoulder, elbow) I typically use the soft squishy head. As mentioned earlier, many devices do not have this head. In that case I would use some type of cloth padding between the bony site and the head of the device, and probably go with the round one. Generally the head that looks like one finger I don’t use as much, as well as the one that has two projections. These are fairly aggressive, but in some cases and with some patients it’s the right choice.

6. DETERMINE APPROPRIATE DOSING OF TREATMENT. This is very individual, as people are very different in pain perception and tolerance. There can also be great variability according to the problem being addressed. Acute or newer problems may respond very differently than chronic or well established ones. Just because some is good does not mean more is better. If you bruise easily then you may need to lighten up, or try a gentler head or even device. I am not aware of scientifically proven protocols for every problem – this stuff is relatively new. Here are some guidelines to consider:

• Frequency of treatment – consider that giving an area at least 1-2 days before returning to it will allow for healing. If you have to keep retreating the same points then it may mean you are not at the source of the problem and you need help.
• Intensity – I typically use my 3-speed Hypervolt on medium as it seems to work fine and be tolerated. All units are different, so listen to your body.
• Duration – I tend to not run the percussion device on a point any more than five minutes, and often less. Then I work the site manually for a few minutes, and then often repeat the cycle of percussion/manual. Since most people will not be working on themselves manually, then a longer period of time with the percussion device may be warranted. Just keep in mind that it’s a motor, and motors can burn out. I thought I fried one once but fortunately it revived after several days rest. Since that episode I do not let the percussion guns run longer than 10 consecutive minutes. I also check to see how hot they are by removing the head and inserting my finger where the head goes. If it’s pretty hot then I give it a break. The vibration rollers cut off after a 10 minute cycle, and I have had no issues running them for a second cycle.

7. DON’T TREAT STUFF YOU SHOULDN’T, AND GET HELP WHEN APPROPRIATE. These devices are great but certainly have their limitations. Our bodies are also very complicated structures, and respond best when handled with care. Please be reasonable and understand that not all problems can be helped with these devices, and seek competent help when necessary. A few contraindications/precautions that I can think of are listed below. This listing can’t possibly be all inclusive so when in doubt get competent help.

• DO NOT: treat over an open wound, fresh surgical site, broken bone, snake/dog/whatever bite, cancer site, any area that is warm/red/swollen and such.
• MAYBE DO NOT: treat over a fresh bruise, area with significant swelling/edema, extremely painful area when the cause is unknown.

The internet is loaded with videos and tutorials on treating lots of diagnoses and body parts. Just remember that getting at the source may necessitate a more global approach, so don’t hesitate to seek guidance.

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In summary, there are multiple advantages to using these devices:

1. They reduce the manual work needing to be done. (But manual work or application of a shear force to the site is still necessary.)
2. They prep sites of connective tissue dysfunction by beginning to break bonds holding connective tissue layers abnormally adhered.
3. They help reduce the pain associated with fascial dysfunction as well as the pain of working manually / applying a shear stress to the tissue. I believe they can also help mitigate pain by serving as a distraction at one point while working on another site.
4. For me they allow me to work multiple fascial points simultaneously, which can help tremendously with time management.
5. They can facilitate a patient actively participating in a treatment session, such as when they hold the device. I find this strategy works especially well with children and teens to remove anxiety and apprehension associated with treatment.
6. They pave the way for self-management, independence, and implementing a home maintenance program.

So don’t be afraid to give it a try! Percussion and vibration are fairly user friendly and can be a tremendous help with addressing and managing issues related to the soft tissues.

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