Meet Mark

Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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December 05, 2016

Dear Mark: Vibration Training, Missing Meniscus, and Neuromuscular Electrical Stimulation

By Mark Sisson

SONY DSCFor today’s edition of Dear Mark, I’m answering three questions. First, do those whole body vibration training plates provide the kind of instability that I suggest promotes good cartilage function? Second, what can a person with degenerated or missing menisci do about it? What kind of training can work with knees that are missing cartilage? And finally, what’s my opinion of neuromuscular electric stimulation—does it work?

Let’s go:

Mark – wondering if a whole body vibration plate qualifies for unpredictable movement? I’m finding it useful for balance and rattling my lymph system loose, any impact on cartilage and tendons?

Nothing like a good lymphatic rattle, am I right?

As to your question, yes. A study from 2011 tested the effect of vibration training on cartilage in people on 14 days of full immobilization. The control group, who were immobile but did not do vibration training, lost 8% of the articular cartilage thickness at the weight-bearing part of the tibia (shin) in just 14 days. That’s scary. Meanwhile, the vibration group gained an average of 22% more cartilage thickness after 14 days.

This is remarkable. They did nothing but vibration training—literally, didn’t move their legs, just had them jiggled around a bit—and gained cartilage.

Vibration plate training also has beneficial effects on bone density and muscle strength and stability in older women. It seems legit. Maybe a larger post is in order.

But for now, it seems to work.

Mark, what about people who are missing cartilage. I am missing 75% of the meniscus in my right knee (ACL repaired) and 25% of the meniscus in my left knee.

First of all, don’t stop moving, training, and playing. Pretty much every study with people who’ve had parts of their menisci removed confirms that sticking with exercise and rehab improves outcomes.

  • One study found a 12-week exercise rehab program immediately after surgery has beneficial effects at a 1-year followup.
  • Another found that a 12-week exercise rehab program after surgery beats none at all.
  • Still another confirms that “high repetitive, high dosage” post-op rehab is efficient and effective compared to none at all.

What kind of training should you do?

This may not apply to your specific situation, but for people who are approaching surgery or just finishing it, your doctor will likely assign a physical therapy program. Just start with it. In my experience, they tend to be quite good.

Training the gluteus medius (the “outer” glute that controls hip abduction) has particularly impressive effects on post-meniscectomy knee health. Based on EMG studies (where they measure the “activity” of the muscles in response to different activities), side-lying hip abductions (think raising your leg in a side plank position), single leg squats, lateral band walk (resistance band around your ankles, walk side ways), and single leg deadlifts are the best exercises for the gluteus medius.

Do these knee circles every single day for three sets of 50-100 circles in each direction. They don’t take that long. Just do them. Go as deep as you comfortably can.

Try front squats instead of back squats. Front squats produce fewer compressive forces and knee extensor moments on both the front and back of the knee than back squats while activating just as much musculature.

Strenuous, pounding exercise may not be helpful. Research in rats with osteoarthritis finds that damaged cartilage has an imbalanced response to strenuous exercise. Whereas moderate bathes the damaged joint in both anti-inflammatory and inflammatory cytokines, strenuous exercise produces the inflammatory cytokines without enough anti-inflammatory cytokines.

A friend of mine with some missing meniscus has found that uphill sprints are both easy on the joints and more effective than flat sprints. Cycling, swimming, and rowing are other ways to get some high intensity activity without pounding the knees.

Discomfort is expected. Effort is required. Pain should be avoided. You don’t want your knee to “hurt.” That’s a sign that you’re doing something counterproductive to your ultimate goal: having healthier knees. If you can go hard and heavy without pain, keep it low volume. Think heavy singles, doubles, or triples instead of high-rep stuff.

Good luck! You can have plenty of success. And hey, there’s some cool medical tech coming down the pipeline.

There’s an active indiegogo campaign for a device called “bionic gym” that is basically a device that stimulates muscle shivering using electrical muscle stimulation (EMS) to help burn calories… genius or snake oil? I’m thinking if the science is valid, it can help many especially those who are injured or too sick to work out. If coupled with MAF method, it sounds like it’s possible to improve the base aerobic capability of a bunch of people and hopefully reduce the risk of cardiovascular disease. What do you think, too good to be true?

The Bionic Gym is a neuromuscular electrical stimulation (NMES) device.

NMES is a legitimate piece of technology. Past studies have found it can be effective in a number of capacities:

It can prevent muscle wasting in critically-ill bedridden patients and during immobilization.

It can increase muscle protein synthesis in older men with type 2 diabetes (something resistance training famously increases).

It can improve muscle thickness in older women with knee osteoarthritis.

It can improve muscle activation and reduce pain during normal physical tasks (squatting, stepping, etc) in women with knee pain.

It can improve knee flexor strength slightly more than resistance training in patients with knee osteoarthritis. No word on what that “resistance training” actually consisted of, though.

It can activate and strengthen deep abdominal stabilizers. It also works for lumbar stabilizers.

It can even coax paralyzed muscles into lifting weights.

Those are mostly patients who can’t train “normally,” though. NMES is clearly better than doing nothing at all. What about in healthy, fully-able adults?

Well, one recent study found that NMES certainly “activates” the muscle comparably to resistance training. But except for torque, which did improve, they didn’t look at many outcomes—strength gained or lost, hypertrophy, etc. On paper, it should work, but we don’t know for sure yet.

The authors of another study where NMES improved strength over resistance training concluded that healthy muscles will have the best gains with both NMES and “voluntary exercise” because they do different things. The NMES hits the largest motor units first, while voluntary exercise recruits the smaller ones first. Do both, and you theoretically have the best of both worlds.

The allure of NMES is obvious. It works to some extent, and it does the work for you. You just sit there and take it. Meanwhile, adherents to “voluntary exercise” know they have to expend effort to get results. Not everyone likes to give effort. That’s why so many people fail in the gym—they’re not willing to work hard, or they have wrong information and make poor training decisions. That’s probably why NMES compares so favorably to “exercise” in a lot of studies.

I suspect the average person loitering in the gym, puttering around with machines, watching CNN as they mindlessly cycle or row or walk without the desire to do better is the perfect candidate for NMES. They’ll see real results because their muscles will be seriously contracting, finally.

On the other hand, I suspect the average person reading this blog, doing compound exercises, running sprints, lifting heavy things, doing CrossFit, performing all the right moves doesn’t need NMES as much. But it wouldn’t surprise me if adding some NMES on top of smart training had a compound effect. That will be cool to see.

One interesting possibility is the use of NMES to target smaller muscles that people typically have trouble targeting or activating. In that study mentioned above, they used NMES to strengthen the vastus medialis, a small and oft-ignored but very important extensor muscle in the thigh. Voluntary exercise (step downs) wasn’t very effective compared to NMES. It’s just a tough muscle to hit.

I can see that kind of application working well—real training and NMES.

Anyway, that’s what I’ve got for today. Thanks for reading and be sure to chime in down below.



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13 Comments on "Dear Mark: Vibration Training, Missing Meniscus, and Neuromuscular Electrical Stimulation"


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8 months 17 days ago

Thanks for the reminder about the knee circles exercise Mark … adding them back into to my exercise routine!

8 months 17 days ago
My gym got a power plate about a year ago. My observations: 1. At the higher settings, or for an extended time, any benefits would be overwhelmed by the costs. Above a 2.4 setting i can feel feel my eyes shaking, and that can’t be good. Also, internal organs! 2. After using it at low setting, I’ve learned that foot placement matters tremendously. Also you’ve got the learn to “fight” the vibrations to hit the muscles. Very different when you are being active and fighting the vibrations rather than just standing on the machine. No question that the “Fighting’ mode… Read more »
8 months 17 days ago

I’ve seen hundreds of patients with knee arthritis or following meniscectomy that have dramatically improved strength and function following, basically, the protocol you’ve outlined above. Pain avoidance is critical but movement is medicine.

8 months 17 days ago

Slightly off topic, but DMSO (the cream) has been an absolute miracle for me for pain reduction for my knees. I strongly recommend it (after doing your own research) for those with chronic knee pain.

Norbert Keuler
Norbert Keuler
8 months 16 days ago

Where can we buy DMSO?

8 months 16 days ago


8 months 17 days ago

Love that exercise video about circles with the knees. Thank you for sharing that.

Elizabeth Resnick
8 months 16 days ago

I’m fascinated by the vibration training. Hearing the results on people that were immobile makes me think it could really be amazing for people that are already fit and active. Think this is the same thing I first heard Dr. Terry Wahls speak about a few years ago as part of her MS treatment.

8 months 16 days ago

Yes, Terry Wahls did electrical stimulation when she was confined to a tilt reclined wheel chair. She said it was painful but helpful.

8 months 16 days ago

So, would a vibrating adjustable bed have similar beneficial effects?

8 months 15 days ago
I tore my medial posterior horn of my meniscus 4 years ago. I had no surgery. I have a DIRECT correlation between quad muscle growth and strength to minimal knee pain and increased range of motion/athletic capability. For the first year or so I never really committed to heavier squats, but in the past three I have. I went from pain and swellingwith lateral movement exercises, sprinting, and jumping to now I have zero pain or swelling, and I do whatever I want. I routinely do high box jumps, play soccer with my son, sprint, and play handball. The only… Read more »
8 months 15 days ago

You have enlivened such a large number of Herbal Tips! Continue doing the Benefits Tips LLL Care things that you generally do!

29 days 8 hours ago

Please do a full post on full-body vibration plates. I’m intrigued by the claims, but with prices running from $150 to $3,000 or more, I have no idea how to evaluate the claims of manufacturers. Thanks in advance!