The new V-ACTOR »HF« handpiece with extended frequency spectrum – A field report by Prof. Dr. Karsten Knobloch, FACS


My practice started using the V-ACTOR® handpiece in 2012, adding vibration therapy to the focused and radial shock wave therapies that we offer. Vibration therapy is the final stage that I apply when treating myofascial issues, lymphoedema and cellulite with radial shock waves.

My initial observations were that patients undergoing cellulite treatment responded very positively to vibration therapy. When treating tendon disorders, however, I also saw that vibration therapy was an excellent addition to combined shock wave therapy: epicondylitis in the forearm extensor musculature, calcaneal spurs and achillodynia in the gastrocnemius musculature are all examples of disorders that responded well.

What are the benefits of the V-ACTOR® »HF« handpiece?
The new V-ACTOR® »HF« handpiece extends the previous frequency spectrum from 1–35 Hz to 1–50 Hz, which means that we can now use frequencies between 36 and 50 Hz at the higher end. In my experience, the 36 to 50 Hz frequency range is suitable for creating deep myofascial stimulation by means of interaction with muscle receptors such as muscle spindles and the Golgi tendon apparatus, relaxing the musculature and improving lymph flow.

How is vibration therapy incorporated into the treatment protocol?
I use the V-ACTOR® »HF« handpiece at the end of each session. I’ve found that it’s more beneficial to use a combination of frequencies rather than just a single one, so I apply a ramp-based model that allows me to increase the frequency gradually (35/40/45/50 Hz).

Ramp-based model used with the V-ACTOR »HF«

 Left: Ramp-based model used with the V-ACTOR® »HF«, featuring equally sized steps (example based on a total of 6000 V-ACTOR pulses), as used by Prof. Dr. Karsten Knobloch, FACS / Right: V-ACTOR® »HF« handpiece

How does vibration therapy work?
The main indication is increased tension affecting myofascial muscle structures as a result of pain, spasticity following a stroke or delayed onset muscle soreness (DOMS) felt after playing sports. Muscle tone is generally controlled by a range of mechanoreceptors in muscles and tendons. Like focused and radial shock wave therapy, vibration therapy is able to respond to these receptors in a way that, in my experience, varies according to the frequency, muscle and localisation.

In pain treatment, the aim of vibration therapy is to stimulate mechanoreceptors in order to stop pain from being transmitted. This relates to the neurophysiological gate control theory, developed by two pioneers in pain research: Ronald Melzack and Patrick D. Wall. It is based on the finding that pain signals being sent to the brain can be inhibited by a special mechanism that involves closing what is known as the “pain gate”. As a result, either the pain is significantly weakened or the patient does not feel it at all.

 Treatment with V-ACTOR handpiece

Left: Vibration therapy being applied to epicondylitis / Right: Vibration therapy being applied to the quadratus lumborum

To sum up, I would say that the V-ACTOR® »HF« handpiece and its extended frequency spectrum of 1 to 50 Hz have enriched the range of treatments I am able to offer day to day, and provide a much better form of therapy for treating patients with myofascial issues, lymphoedema and cellulite.

At a glance

  • Vibration therapy with extended frequency spectrum (50 Hz)

  • More intensive deep stimulation and improved lymph flow

  • Designed to complement radial and focused shock wave therapy

  • Can be combined with the radial »ultra« generation of devices