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Shoulder Dykinesis|Muscles|Rehabilitation

In my professional experience, the most common cause of shoulder dykinesis is underlying cervical radiculopathies precipitated by acute or chronic repetitive trauma.  eToims can treat hyperactivity as well as hypoactivity of muscles.  I have found that upper trapezius is usually hyperactive while the mid and lower trap and latts dorsi are hypoactive and that there is weakness also in the whole kinetic chain with hip/leg and trunk weakness.  Advantages of eToims is that it can quickly diagnose and treat the muscles that are weak and hypoactive as well as those that are hyperactive throughout the whole body and both sides in a safe and efficacious manner in one session.  There are only arbitrary standards in exercises proposed by clinicians  as regards dose and duration of these exercises.  eToims  starts off the twitch induced exercise in the hyperactive muscles such as upper trapezius and adductor magnus and all muscles where trigger points are easily found.  This is followed by treatments to the hypoactive muscles such as the core spinal muscles and the Latissimus Dorsi and Gluteus maximus muscles. In addition, eToims it can be done repetitively throughout the day and every day to the same muscles without side effects.  The trigger points can be fatigued within a few seconds with acute problems.  With chronic problems, since the tissues are so tight that the electricity is unable to reach the trigger points well enough to fatigue, the exercise session can be as short as 10 minutes to the trigger points zone of a muscle or the entire treatment session for many muscles can be done over several hours if need be and the exercises can be repeated daily.

The following is excerpted from

Rehabilitation of Shoulder Dyskinesias

Many authors have suggested that forward head posture and increased thoracic kyphosis may contribute to scapular protraction and lead to adaptive shortening of postural muscles or muscular strength imbalances. A protracted scapular position may be associated with a narrowed subacromial space upright posture with increased subacromial space and a flexed thoracic spine and forward shoulder position alters scapular motion and results in diminished force output with elevation. Adaptive shortening of the pectoralis minor muscle has been identified as a contributor to abnormal scapular kinematics and implicated as a factor that may contribute to shoulder impingement syndrome.

What is Known and What is Not Known

Optimal rehabilitation of scapular dyskinesis requires addressing all of the causative factors that can create the dyskinesis and then restoring the balance of muscle forces that allow scapular position and motion.[30] Causative factors can be grouped into: (1) neurological factors include long thoracic, spinal accessory and dorsal scapular nerve palsies, evaluated by appropriate muscle testing, typical scapular position and diagnostic electromyography studies; (2) joint derangement factors include labral injury, glenohumeral instability, biceps tendinitis and A-C separations; (3) bone factors include clavicle and scapular fractures; (4) inflexibility factors include shoulder rotation tightness (GIRD and Total Range of Motion Deficit) and pectoralis minor inflexibility; muscular factors include lower trapezius and serratus anterior weakness, upper trapezius hyperactivity or scapular muscle detachment and  kinetic chain factors include hip/leg weakness and core weakness. The bone and joint internal derangement factors may require surgical repair before rehabilitation may be maximally effective. They may have to be healed before restoration of muscle performance.

Restoration of the scapular muscle force couples requires core strength and facilitation by kinetic chain activation. This establishes the proximal stability to prevent postural perturbation and force generation and maximises activation sequencing for the scapular retraction muscles. Once the stable proximal base is established, scapular rehabilitation can proceed along specific guidelines. An algorithm guideline has been proposed that is based on restoration of soft tissue inflexibilities and maximising muscle performance.

Several principles guide the progression through the algorithm. Acquisition of flexibility in the muscles and joints is usually required first because the tight muscles and capsule can inhibit strength activation. Also, muscles should be trained in sport or activity specific patterns. Research has demonstrated maximal scapular muscle activation when muscles are activated in functional patterns (vs isolated), when the muscles are activated in specific diagonal patterns using kinetic chain sequencing. Also, the activation is facilitated when the scapula is placed in a retracted position, thus increasing serratus anterior and lower trapezius activation as stabilisers in retraction Exercises should also emphasise lower trapezius and serratus anterior activation and reduce upper trapezius activation.

Using these principles, many rehabilitation interventions can be considered. A reasonable programme could start with standing low-load/low-activation exercises with the arm below shoulder level, to meaningfully activate the scapular retractors (>20% maximal voluntary isometric contraction) without putting the arm in an impingement position. It could then progress to prone and side-lying exercises that increase the load, but still emphasise lower trapezius and serratus anterior activation over upper trapezius activation. Additional loads and activations can be stimulated by integrating ipsilateral and contralateral kinetic chain activation and adding distal resistance. Final optimisation of activation can occur through weight training emphasising proper retraction and stabilisation.

Although the guidelines, principles and protocols may appear to be straightforward, the actual rehabilitation process is frequently complicated and prolonged. Many patients come into rehabilitation with well-established flexibility deficits, muscle activation patterns and compensatory motions so that overcoming these obstacles requires a prolonged rehabilitation course. The lower trapezius is frequently inhibited in activation, and specific effort may be required to ‘jump start’ it. Tightness, spasm and hyperactivity in the upper trapezius, pectoralis minor and latissimus dorsi are frequently associated with lower trapezius inhibition, and specific therapy should address these muscles. Finally, special attention should be paid to the glenohumeral joint because internal derangements can inhibit scapular muscle activation that may not correct until the internal derangement is corrected.

Biomechanical and clinical knowledge regarding the role of the scapula in shoulder function and dysfunction is growing, and the concepts regarding how to evaluate and treat scapular dyskinesis are evolving. There is enough information to emphasise the clinical implications for treating shoulder patients.

This consensus conference revealed that scapular involvement in almost all types of shoulder pathology may play an important, but as of now not a completely understood role in creating or exacerbating the shoulder dysfunction. Shoulder impingement symptoms in particular appear to be affected by scapular position and motion. Scapular dyskinesis is probably most aptly viewed as a potential impairment to optimum shoulder function and shoulder be evaluated and treated as part of the comprehensive treatment protocol.

Evaluation for scapular dyskinesis is primarily by clinical observation. A specific methodology has been identified with the tests showing to be reliable, but not specific. It can provide a good picture of the variety of alterations that can be associated with scapular dyskinesis.

Scapular rehabilitation protocols have been developed that have the potential to improve scapular muscle strength, alter scapular position and alter shoulder symptoms. They are best utilised within a comprehensive programme and should be implemented when all of the causative factors for scapular dyskinesis have been identified and addressed.

Limited Range of Motion |Contractures| Exercise

Limited Range of Motion |Contractures| Exercise

Limitation in range of motion of the neck and lower back, shoulders and hips start at a very early age and becomes more prominent as we age and and the limitation of range of motion spreads more to the distal joints.  All this can occur silently without symptoms of pain from muscle tightness due to motor spinal nerve root irritation.  We accommodate and compensate for our limitation of neck range of motion by turning the body to face the left if there is tightness on the left side of the neck.  If there is tightness in the lower back, we accommodate for that by keeping the trunk bent forward since standing up to be straight with an erect posture uses too much energy from work performed by the spine extensor muscles.  Therefore individuals stay in a position of comfort which is usually a forward flexed posture of the neck and back.  Limitation of motion of the big joints or any joint for that matter is compensated by less use of the joint as well as performing of motion only within the free range.  This disuse of muscles make them more tight since they are not exercised through the full range of motion.

Normally, to stand needs very little energy expenditure since no muscles need to contract except for the calf muscles.  Normally, the line of gravity passes behind the neck and trunk and through the sacrum, behind the hips and in front of the knees and ankles.  With an abnormal forward flexed posture, the line of gravity falls too much forward of the spine and hips but behind the knees such that many muscle contractions are now needed to allow the individual to stand.  These individuals also are prone to falls with serious injury to the spine and hips sustaining fractures.  Even though you may have only a slight flexion contracture at the lower back and hips, you will notice that you cannot stand long enough comfortably and wants to sit down frequently to rest.  When you have such symptoms, the earlier it is worked upon by clinicians knowledgeable in neuromuscular health, the better the end results so that progressive contractures will not occur.

As the muscles become tighter, very little in insidious trauma or acute trauma is needed to bring about pain.

eToims has a major role in exercising single muscles to improve range of motion as well as to provide relief of pain by surface electrical stimulation of the trigger points in individual muscles, working first on the muscles that perform lengthening eccentric contractions such as the spinal extensor muscles at the back of the body.  These exercises are followed by the isolated exercises from trigger point stimulation of strong muscles that perform shortening concentric contractions in the front of the body.  The more involved the contractures, the treatment applied exercises will be needed regularly as an ongoing basis.


When we see a person and try to guess their age, we look at the face first.  Therefore, individuals concerned with the effects of aging are always interested in improving their youthful appearance since it is the face that others first notice.  Therefore, much of the efforts have been toward facial rejuvenation beginning with external application of creams and lotions to control the aging of the skin.  Once the wrinkles are set, we will use much more dramatic efforts and will consider exposing the skin to more invasive methods such as peeling of the skin, laser therapy, botox injections and eventually to plastic surgery of the face and neck.

However, even if the face looks youthful, if the individual has an obvious head forward position and stooped posture or rounded shoulders and trunk with unsteady gait, stiffness during standing or sitting,then observers will notice  these much more than the face.  Posture and ambulation abnormalities are much more glaring signs of aging compared to the face.  The biggest giveaway of aging of course is the hands.  You can barely hide the hands!  Esp when you are sitting when gait and ambulation is not in evidence.

Due to a constant use and exposure to weather, the hand ages very quickly.  The presence of skin wrinkling, taut tendons and tortuous veins on the dorsal and ventral aspects of the hand is common.  The finger joints also enlarge due to the presence of degenerative arthritis.  The joints also more conspicuous because of laxity of the skin from atrophy of the subcutaneous tissues as well as the muscles.  I’m amazed to find out that there are hand rejuvenation surgeries that will restore the skin surface, resection of redundant skin and tissue augmentation.

If one considers that the taut and thickened tendons are secondary to presence of tight and shortened muscles from spondylotic radiculopathy due to aging, how does one prevent them from making the hand look senile even after hand rejuvenation surgeries?  Between the tight tendons and the tortouse veins, the age give away will still be there.

Will the veins be as tortuose if they were able to empty well into the deeper veins?  So should we not consider means of relieving the tightness of the muscles so that the veins can empty well?  Apart from loss of subcutaneous tissue where not much can be done and since not everyone is a candidate for tissue augmentation surgeries to hide the veins, other means of providing less resistance to venous return should be considered.  This can be as simple as manually massaging the muscles to keep them soft and limber or using electrical stimulation at the trigger points to actively contract and stretch the intramuscular tightness of the muscles.

Compare your own hands as it looks through the ages.  How come that your hands still ages even though you may not be actively over using your muscles after you have retired and not using the hands as much?

The hands, the spine, the limb joints are sure tell tale signs of aging.  You got to start now to know what muscles can do to make you age.  After all 40% of the body mass is muscle, so when they do not function well, you will not age well.  Neuromuscular health is the key to control aging.

Osteoarthritis|Youthful Aging|eToims Exercise

As we age, our muscles and joints become tight and stiff. However, we accept these symptoms as part of normal aging. If aging is defined as being of advanced years, especially past middle age, how is it that we resign ourselves to also accept that it is OK to be tight and stiff? What does the passage of time has to do with symptom development? What if a younger person has these symptoms? Does chronological age has an important role in symptom development?

Is this acceptable to feel discomfort from the movements of tight muscles and joints? Can we age without feeling such discomfort? Or prevent pain from developing? How do we slow down the pathophysiological process of aging since we cannot slow down chronological aging? Can there be an opportunity to youthfully age and enjoy freedom of mobility, function and have quality of life comparable to that of a younger person though one has “aged” ?

Symptoms of osteoarthritis most often develop gradually and include

· Joint aching and soreness, especially with movement

· Pain after overuse or after long periods of inactivity

· Stiffness after periods of rest

· Bony enlargements in the middle and end joints of the fingers (which may or may not be painful)

· Joint swelling

The first three symptoms truly mimic that of myofascial pain/discomfort due to spinal nerve irritation that produces trigger points. Could it be that if muscles symptoms can be controlled, that arthritic symptoms can be controlled? If muscle tightness and stiffness can be controlled, possibly that the last two objectives signs in the list above may not even occur? If the condition is diagnosed later, we may not be able to reverse the arthritic process. In that case, we should be able to decelerate the aging process?

Regular light to moderate physical activity has both preventive and therapeutic benefits for individuals with knee osteoarthritis. When these regimens fail, apart from blaming genetic makeup and having to resort to just taking medications and looking forward to eventual joint deformities leading to joint repair/replacement surgeries can anything be done at all before that happens to slow down this down-hill trajectory and the complications associated with such procedures? What if all these procedures have already been performed to the individual and the person still remains in discomfort and worse yet, in pain?

Exercise is important to maintain joint health. However, routine exercises as well as movements that occur during activities of daily living result from the contractions of multiple muscles that cross the joints and produce movements of multiple joints. It is not suprising that patients with osteoarthritis feel painful to move their joints or have more pain after the exercise. So when exercises fail to relieve pain and or discomfort and yet because exercise is therapeutic, one should consider exercises that can actually isolate movements to only one muscle at a time. This can be done through twitch contractions by electrical stimulation of trigger points zones of individual muscles so that isolated active contractions can occur for individual muscles.

Twitch contractions produce the ultimate aerobic and active exercise since this occurs from nerve-muscle transmission and activation of the neuromuscular junction (trigger points) as it normally occurs with electrical impulses coming from the brain and spinal cord. However, when the muscles become very tight due to nerve irritation or nerve death at these trigger points, the tight muscles due to muscle spasm or intramuscular fibrosis act as a local constrictor force on the intramuscular nerves and blood vessels. The tight muscles also produce a traction force on underlying bone and joints.

The most effective way to unfurl these muscle knots and spasms is to locally excite the entrapped intramuscular nerves with deep but painless, local electrical stimulation with eToims. These twitch muscle contractions are the most effective method of sending fresh oxygenated blood to these injured trigger point areas especially in the deepest portions of the muscles where the pain/discomfort is concentrated.

The local muscular pump effect created by the twitch contractions which mimic in rhythm to that of cardiac contractions can most effectively improve the circulation of blood to the sites where it needs the most blood supply. This can occur since the freshly injured trigger point is very electrically sensitive. On the other hand, twitches are difficult to elicit in chronically tight muscles or when the pain is very strong since the muscles tighten up more.

The twitch contractions also perform an intramuscular stretch to these tight spasmed muscles thus relieving pain by reduction of the traction force on the underlying bone and joint. In this manner, we can use localized and focalized active twitch contractions to not only reduce the pain and discomfort of the osteoarthritis but also to prevent its progression. It also simulates normal exercise since the individual can twitch contract his own muscles with the eToims Twitch Method to feel physically rejuvenated and feel and look young. eToims done on a daily basis can provide blessings to have youthful aging. Correction of pathophysiology and treating the ischemic and traction effects of tight muscles on bones and joints is the answer to prevent or slow down osteoarthritis. Yes, this is important to youthfully age and feel and even look young. Anyone game for forever 18 years of age?

Massage| Trigger Points| Pain

Massage is available all over the world  denoting its popularity with the public at large.  You’re one of the lucky ones if you had a massage and truly enjoyed the effects.

Do you know that massage can be used as a test for neuromuscular health?

There are points within the muscles where the massage feels exceptionally good and enjoyable.  These areas are points where the intramuscular nerve has early irritation at the trigger point (nerve muscle meeting point).   These feel-good points are latent trigger points  Manual movements in that area causes the muscles to twitch causing muscle relaxation and relieving tension.

When you do not like massage, it indicates that the muscles are very tight and tender. Do not massage this area aggressively since the massage can cause the muscle to go into spasm  giving you pain after the massage session.

Tenderness of the muscles is a cardinal sign of neuromuscular ischemia.  This usually means that you have active trigger points with nerve and muscle ischemia.

Always feel around in your muscles.  The points that you do not like are the troublesome areas.  Cut down on your activities so that the trigger points do not flareup more which will happen if the muscles are continued to be abused.

The areas in the muscles that feel so good to be massaged  can be massaged frequently so that the latent trigger point can come out of spasm.

Repetitive stress injury| Pain| Deep Massage

The rise of software programmers for computers and mobile apps and the users of computers, smart phones, smart pads and game boxes worldwide, will give rise to more individuals suffering from repetitive stress injury.  Overuse of the hand muscles and overuse movements of the wrist to stabilize the hand movements usually results in pain and/or discomfort in the hands, wrists, forearms and elbow.  The natural tendency is to protect the painful areas with wrist splints, forearms stabilizers and elbow splints.  Although the pain may somewhat feel better from using the joint stabilizers, as one uses the same muscles again and again repetitively to type, the pain will not only recur but remain even though the hands are not in use.  Medications may blunt the pain but are unable to relax the deep muscle spasms that have already formed. The pain will then become chronic and constant such that the individual can become totally disabled from pain.

The hallmark of nerve related muscle pain is pain aggravated by movements accompanied by stiff, swollen and sore muscles.  There is also tenderness, tightness and taut muscles with a deep ache.  This usually occurs because of a vice-like effect of the muscles on vein, arteries and nerves inside the muscles especially in the most terminal portions of these blood vessels where the nerves meets the muscle fiber.  Also, the tight and stiff muscles will pull on underlying bone and joints increasing the pain resulting from poor circulation. The area becomes very tender to touch and a hard node, nodule or muscle band will form.  When you flick or massage the area, a twitch response may occur.  Deep pressure on this point may reproduce your own pain.  This area is called a trigger point.

As the nerve is also involved, there will be sharp shooting pains with tingling and numbness.  The pain may awaken you from sleep.  If this occurs in the first three and ½ digits (thumb, index, middle and half of the ring finger), you will usually get a diagnosis of carpal tunnel syndrome after undergoing some nerve conduction tests.  This is from irritation or entrapment of the median nerve at the wrist level. If the tingling and numbness is in the last 1 1/2 digits (the ring and little fingers), with tenderness of the nerve that gives rise to the crazy bone feeling on hitting the elbow, you may get a diagnosis of ulnar nerve problem at the elbow.

The best treatment is to treat it conservatively and not rush into getting local treatments to these areas with injections or even surgery.  These procedures may resolve the symptoms temporarily but will recur again with repetitive use of the hands.

Compounding the overuse of the muscles is working with a poor posture.  Most people work with a head forward position, rounded shoulders, unsupported forearms and wrists.  One must type by aligning the head over the shoulders and sitting back in the chair so that back can be supported.  Always keep the arms close to the side of the body, elbows slightly bent and wrists in alignment with the hands.  Forearms and wrists need to be supported.  Never work with the arms outstretched in space since this posture will overwork the neck and shoulder girdle muscles.  As you age, the nerve roots in your spine are very vulnerable to injury and will get irritated more when the neck and shoulder muscles are overworked and will not only increase the pain but make the pain chronic and long-standing.

Heat, massage and stretching can be used on the hand and forearm muscles and the massage must include muscles of the neck and shoulder girdle. It is important that massage relaxes your muscles rather than aggravate the pain which can happen if the massage is deep and aggressive causing the muscle to spasm even more.  Electrical Twitch-Obtaining Inramuscular Simulation (eToims) is state of the art deep massage therapy specifically designed for healing nerve related deep muscle pain due to trigger points.

Overuse Injuries| Bicycling

Overuse injuries are common in bicycling.  In a study of professional elite road cyclists (94%, 109 of 116 cyclists) had overuse injuries experienced in the previous 12 months. A total of 94 injuries were registered involving the back, knee and legs.

Lower back pain (58%) and anterior knee pain (57%) are the most prevalent overuse injuries, with knee injuries most likely to cause time loss and lower back pain causing the highest rates of functional impairment and medical attention causing even missing the chance to compete.

If one already has chronic pain, the problem is compounded from the inability of pelvic girdle muscles and thigh muscles to contract and relax in coordination.  The repetitive motion activities that actively engage in eccentric (lengthening) contractions cause most damage to muscles.  Since the hip and knee are consistently flexed, lengthening injuries primarily involve the gluteus maximus, adductor magnus, hamstrings, tensor fascia lata, quadriceps, ankle dorsiflexors and calf muscles.

Additionally entire trunk and neck muscles are kept flexed in a position of the eccentric contractions.  Eccentric contractions of the muscles of the shoulder girdle also occur causing pain not only of the trunk and neck but also the upper limbs.

Not uncommonly entrapment neuropathies also occur due to pressure on the wrist and hand with injuries to the deep ulnar nerve and/or median nerve producing tingling and numbness in the fingers.  If significant damage occurs, there can be even be atrophy of the hand muscles.  Similarly, injury to the peroneal nerves at the knee level or ankle level can occur.

The incidence and magnitude of back pain in cyclists can be reduced by appropriate adjustment of the angle of the saddle.

Often it is necessary to relieve the rider’s extended position by using handlebars with less drop, using a stem with a shorter extension, raising the stem, or moving the seat forward. Changing hand positions on the handlebars frequently, riding with the elbows “unlocked,” varying head position, using padded gloves and handlebars, and riding on wider tires all reduce the effects of road shock.

Often, delayed responses to pain development will occur depending on physical reserves.  Those with little to no physical reserves will have pain very soon after exercise involved with the cycling activities.  The degree of preexistent tightness of the muscles determine the onset of pain aggravation after cessation of the activity.

Treatments involve pain control relating to the primary neuropathic pain problem with additional supportive measures that facilitate healing of muscles and nerves.

Muscles that are in intense pain are so stiff and tight that stimulation of the trigger points with eToims cannot be performed since trigger points cannot be found.  Those muscles suffering from ischemic myofascial pain however will respond with large force twitches to eToims with good response to treatment.  The response to trigger point treatments with eToims will therefore depend on the electrical reactivity of the trigger points.

Falls| Muscles| Balance

Many falls are preventable, with exercise playing a crucial role in prevention.  Deficits in postural control and muscle strength are important intrinsic fall risk factors.  Both fatigue and load carriage compromise gait.

To decrease the falling risk and hence the risk of fractures especially in the frail and elderly, , exercises must be done to increase lower and upper extremity muscle strength, aerobic endurance and especially that of agility and dynamic balance performance.  Of particular importance is lower limb muscle strength, gait and balance, especially that of calf muscle strength.

Exercises that challenge balance are more effective in preventing falls than those which do not challenge balance.  The ability to regain balance during the forward falls is important.

A major focus on maintaining or increasing muscle strength instead of muscle size.  Strengthening the calf  musculature aiming to reestablish the function and stability of gait can  possibly avoid falls.

Leaning how to keep balance while standing on one leg and trying to stand on the toes is a useful exercise.  If balance is very bad, hold on to something to prevent loss of balance.  You will quickly find out the the weaker leg through  loss of balance to the weak side and the rapidity of fatigue of calf muscles on the weak side.

Many people have co-morbid diseases and conditions such as joint pain, muscle stiffness, rigidity and joint deformities, use of multiple medications, alcohol, vestibular dysfuction causing vertigo and dizziness, which contributes to the fall.

All  who know they have have a weak bladder should restrict fluids in the evenings to prevent hasty movements to the bathroom, often a cause of falls in the night.

Falls are frankly dangerous and cause early disability and death.

Twitches| Massage|Muscle Pain Relief

eToims ET127 device is the only evoked response stimulator that can stimulate nerve-muscle meeting points commonly known as trigger points.  This electrical stimulation will excite the nerve to produce a brisk muscle contraction and relaxation called a twitch.  The device is used to seek and search the most excitable trigger points to produce the desired deep twitch that is essential for relieving nerve-related muscle pain and/or discomfort.

eToims is basically active deep tissue mobilization that is painless, pleasant, pleasing with the ability to produce pain relieving exercise to individual muscles throughout the body.  Unlike a massager, TENS or electrical muscle stimulators, eToims device empowers the individual to actively exercise individual muscles.

The individual is able to actively exercise his total body with self treatments similar to getting a total body self massage and feel physically rejuvenated immediately.

eToims does this without causing pain or discomfort compared to active exercise in which multiple joints move because of simultaneous contraction of multiple muscles that can aggravate the underlying muscle pain.

Electrical muscle stimulators, TENS units, self massagers or manual therapies can produce only mechanical excitation, and although pleasing and pleasant, the effects do not last since they are unable to elicit these deep twitches that are critical to achieve deep pain/discomfort relief. Also if electrical or mechanical stimulation is done too aggressively there can be aggravation of pain since there are no guidelines as to when a treatment is too much.

In eToims, the twitches can provide simultaneous diagnosis, therapy and prognosis in nerve related muscle pain/discomfort.

There are five grades of twitches and I will explain how we differentiate twitches in normal muscles from that associated with acute and chronic pain. eToims is always done with the least stimulus parameters to obtain the desired twitch and can be carefully titrated not only to be painless during treatment but not to cause pain after treatment.

Grade 1: Good brisk thumping twitches that produce a recoil effect on the hand holding the probe are easily found. This indicates that the motor endplates under the electrodes are firing. This “thumping” twitch is probably from depolarization of minimally dysfunctional endplates (latent trigger points).

In chronically tight muscles, it is very difficult to find any trigger point. Also due to the filtering effect of the tight tissues, the twitches tend to be small without force enough to produce a recoil effect. This is the most basic twitch force needed to get the most basic therapeutic eToims effect.

Grade 2: Joints to move in a shaking or rocking manner.

In the normal situation, when the stimulus parameters are increased to deliver maximal stimulation to the motor endplates zone, the stimulus will reach the deeper muscle fibers. The contraction of the deeper muscle fibers will produce movements of the bone and joints. This is a minimum requirement to get reasonable eToims therapy effect. Once this effect is attained, further increase in stimulation will not produce stronger twitches.

In acute nerve irritation, the twitches will be strong enough to produce vigorous joint movements and the movements may be strong enough to lift the joint against gravity.

However if the overlying tissues are very tight, one will get only joint rocking or shaking movements. If one increases the stimulus, one can get stronger twitches.

In the very chronic situation, due to the tissue filtering effects, even grade 2 movements are difficult to obtain and the movements may be that of shaking or rocking of the joint, rather than true movement.

When the muscles are very tight, the treatment goal is to aim for grade 2 therapy which is some joint play with shaking or rocking of the joint.

Grade 3: The limb and even the trunk can move anti-gravity.

These twitch forces are due to depolarization of acutely dysfunctional endplates (acute trigger points). In all cases of chronic pain, these acutely dysfunctional endplates are present and must be searched for to get good pain relieving results. However it is very difficult to find these acutely dysfunctional endplates and to depolarize them since the electricity is unable to penetrate deep since the muscle tissues are so tight.

In the normal situation, as one increases the stimulus parameters the twitch force will not become stronger since the motor end plate zone is discharged fully already. The antigravity movements will not occur in the normal situation since the motor end plate is completely depolarized already and further increase in stimulus parameters will not improve the strength of the twitches.

In acute situations, twitch forces will be large and forceful enough to get antigravity movements.

In chronic situations, antigravity movements do not occur due to the tightness of the tissues that prevent the electricity from reaching the acutely irritable motor endplates zones.

Grade 4: The limb and even the trunk can move anti-gravity with slow fatigue (takes many twitches, usually more than 4 twitches to fatigue and the movements are slow). This is because the tight tissues prevent the stimulation to effectively reach the motor end plate to stimulate with maximal stimulus strength.

Grade 4 twitches always indicate that the stimulus is able to penetrate better to reach to the acutely irritable motor endplates zones but the fatigue occurs slowly since the tight tissues give resistance that prevents the electricity from reaching fast to the nerve.

Grade 5: Muscle fatigue occurs very fast with rapid twitches. The twitches will go on even without ongoing electrical stimulation. If very acute, the fatigue will be occur by 4-9 twitches. Acute on chronic or sub-acute condition, the fatigue may not occur until 20 twitches.

and these are the Twitches of Choice:

Positive Emotions| Happiness|Longevity

I write this blog in honor of the sudden passing of a dearly loved centenarian, a very positive person, physically able and mentally clear to the end. Without a high school or college degree, Du was my role model in the 30 years I knew her well. She always dressed warmly, ate lightly and yet kept a steady weight, faithfully did self massage, read a lot and slept well.   I have never seen her arrogant, sad, angry, bitter, spiteful, depressed or blaming others.  On the contrary, my constant vision of her is that of kindness, gentleness, warmth, love, care and a delight to be around. It was a privilege to know her.  We were fortunate to have received so much love and care from her and we thank her very much.  She had lots of friends and family and was a leader in her circle because she read well and could discuss present day situations of current and past important local and world news.  She was still able to play board games, walked with a walker, cooked for self and others, lived independently and offered love, time and attention to all of us.  She was a vision of life and vitality.

I did a literature search on positive emotions in elders and let me share this with you since Du practiced these all her life which I am sure played major roles in her longevity.

Behavioral, neuroendocrine, and immune pathways have now been identified that help explain how negative emotions affect the physical health of older persons. Positive emotions, however, have been a relatively unexplored terrain for medical and social scientists.


“Having reviewed research involving representative samples of several hundred thousand people from all over the world, psychologists Myers and Diener describe the correlates and consequences of happiness, concluding that people who are happy tend to be less self-focused, less hostile, friendlier and more outgoing. Another important discovery of theirs - one that is particularly relevant to the topic we are discussing - is that happiness does not seem to be highly dependent on external circumstances such as the degree of wealth.

According to Myers and Diener, four traits characterize happy people: (1) high self-esteem - they believe themselves to be more ethical, more intelligent, less prejudiced, and better able to get along with others; (2) feeling in control - they believe that they have personal control over their lives and futures; (3) optimistic and hopeful - they often see the best in people and circumstances; and (4) extroverted and outgoing - although they are happy whether alone or with others.

Another correlate of happiness is having close, supportive personal relationships. Numerous studies document a positive relationship between social support, happiness, and life satisfaction in later life and an inverse relationship between social support and depression or other negative emotions. High social support, in turn, also predicts better physical health and lower mortality, even in studies that have controlled for depression and psychological stress.

Physical health is one of the strongest correlates of happiness, particularly among older adults. Physical disability often has an enormous impact on the determinants of happiness, including self-esteem, sense of personal control, optimism about the future, and desire to interact with others.

Finally, Myers and Diener note that religiously active people report greater happiness. Controlling for social support, depression, and stressful life events does not explain this association, leaving open the possibility that positive emotions play a role”.

Harold G. Koenig MD: Positive Emotions, Physical Disability, and Mortality in Older Adults  Journal of the American Geriatrics Society - Volume 48, Issue 11 (November 2000)