July 3, 2010

Many methods do exist for treating acute trigger points (neuromuscular junctions) which is the root source of ischemic neuromuscular or myofascial pain.  Tendinitis starts when the muscle is chronically tight and shortened and pulls on its own tendon.  The tendon then pulls on underlying bone and joints.  Over a course of time, the tendon becomes thick and swollen.  Treating the tendon alone is not sufficient.  Treatments have to be directed to the trigger points in the muscles associated with these tendons.

eToims is state-of-art non-invasive electrical stimulation that can be applied to trigger points in the deepest muscle layers apposed to bone and joints where the most pain arises due to the significant traction on underlying pain sensitive receptors in bone and joints together with the vice-like compression of intramuscular nerves and blood vessels.

eToims provides real time diagnosis and prognosis in addition to simultaneous therapeutic pain/discomfort relief.

1. Diagnosis: Smaller twitch forces and slower twitches are found in tight muscles, chronically involved muscles or weak muscles.  Larger twitch forces with rapid rates that can fatigue the trigger point are found with acute nerve irritation before the muscle has become tight. Such acute trigger points are also present in chronic pain but are more difficult to find and significant clinical skill is needed to be able to locate and stimulate these points.
2. The therapeutic effect and hence diagnosis and prognosis for pain/discomfort relief is directly dependent on twitch force, ease in eliciting large force twitches and ability of trigger points to fatigue.

eToims treatments need to be directed to:

1. Both sides of the body.
2.  To the muscles on both sides of the joint because the eccentric muscles at the back are weak from chronic injury making the muscles on the other side of the joint in the front to become very tight.

Since most patients and athletes and even asymptomatic individuals have very tight and/or stiff muscles, the clinician may not be able to bring the trigger point to fatigue.  However, if that trigger point can fatigue, you will notice that suddenly the twitches will become more forceful and more rapid termed the pre-fatigue phenomenon. The trigger point will then suddenly fatigue abruptly so that the clinician will not be able to elicit such twitches at the same point.

It is very important to find as many active trigger points/unit time as possible to provide the patient with optimal pain/discomfort relieving results.

The best time to treat any individual especially athletes is when they have little to no pain since the muscle tissue is softer and the electrical stimulation is able to reach the deep trigger points easily without pain. eToims treatments have to be titrated well to be painless and will give pleasure on stimulation at the trigger points.

eToims results will be invaluable for any individual to perform at their peak. Since eToims is noninvasive and is a localized exercise to individual muscles, it can be used daily and even multiple times in the same day. The importance of eToims is in the ability to prevent injuries by increasing the margin of safety for neuromuscular tissues and to reduce the healing time when injuries do occur.

Please click on this link to see how eToims is actually performed.

http://www.youtube.com/watch?v=5vpFK1zAKvI

]]> http://www.etoims.com/blogs/?feed=rss2&p=338 http://www.etoims.com/blogs/?p=333 http://www.etoims.com/blogs/?p=333#comments Sat, 12 Jun 2010 04:28:14 +0000 etoims http://www.etoims.com/blogs/?p=333 Who does not enjoy a relaxing massage? Massage is used in many cultures across the world in many types of painful and non-painful body conditions associated muscle tightness. It has been used in individuals with neck and low back pain, chronic fatigue, anxiety, and depression.

The National Center for Complementary and Alternative Medicine (NCCAM) considers massage therapy to be a manipulative and body-based method of complementary and alternative medicine.

Massage provides relief of muscle tension through tissue mobilization that stimulates nerves and through increasing blood flow. Generally, massage is considered safe but must be applied by trained and certified practitioners.

There are many types of massage and it can be applied superficially or deep. Superficial massage consists of gentle stroking, or light circular movements. Neuromuscular massage is used for reaching deeper tissues and is not benign. Deep tissue massages can result in the individual experiencing more pain after the therapy. Exciting deep neuromuscular tissues with manual stimulation is not sufficient to depolarize the nerve and may result in more muscular tension and hence more pain. There may also be more tissue tightness due to muscle spasms induced by the massage itself especially in patients with preexistent muscle pain and tightness. The optimal way to stimulate deep neuromuscular tissues resulting in deep tissue relaxation is to apply electrical excitation at neuromuscular junctions by individuals well-trained in the eToims technique.

The complications of manual massage include increased pain and spasm, dizziness and lightheaded and fainting from stimulating the carotid sinus. Massage has also been reported as a cause of rhabdomyolysis-induced acute renal failure. It has also been reported to cause inflammatory myositis and prolonged myopathy (Tanriover MD. Guven GS. Topeli A: An unusual complication: prolonged myopathy due to an alternative medical therapy with heat and massage. Southern Medical Journal. 102(9):966-8, 2009).

As compared with their prevalence in the general population, left-handers are overrepresented in the expert domain of many interactive sports. This study examined to what extent this is due to negative perceptual frequency effects–that is, whether the greater frequency of tennis matches with right-handed opponents makes it possible to discriminate the stroke movements of right-handed players more precisely. Fifty-four right-handed and 54 left-handed males in three equal-sized groups of varying levels of tennis expertise (national league experts, local league intermediates, and novices) completed a tennis anticipation test in which they had to predict the subsequent direction of an opponent’s temporally occluded tennis strokes on a computer screen. The results showed that all three groups were better at predicting the direction of strokes by right-handed players. This supports the hypothesis that the overrepresentation of left-handers in the expert domain is partly due to perceptual frequency effects. (

Demographic and clinical characteristics were assessed at diagnosis, affective and cognitive variables at 6 months after diagnosis, and QOL at 12 months after diagnosis.

Multiple-group analyses showed that among younger patients (< or =68 years old, n = 199), lower levels of decisional regret were associated with better functional QOL, and lower Gleason scores and PSA levels were associated with lower levels of distress and longer expected survival time, respectively. Being employed was related to higher levels of functional QOL and frequent worries about recurrence.

Among older patients (>68 years old, n = 192), lower levels of distress were associated with higher levels of functional QOL, and longer expected survival time was associated with better functional and physical QOL. (Diefenbach M, Mohamed NE, Horwitz E, Pollack A: Longitudinal associations among quality of life and its predictors in patients treated for prostate cancer: the moderating role of age.Psychology Health & Medicine. 13(2):146-61, 2008)

He is basically in good functional status although he has a multitude of other chronic medical problems. Presently able to be useful to himself, his ailing wife and community.

Oncologist wanted him to enjoy the holidays and wait for the chemotherapy to start on 1/7/10.

Should he have chemotherapy? That is what has been suggested to halt the rapid rise of PSA. Has been going up by almost 90 points every month for the past 3 months.

Have taught father-in-law how to self treat with eToims since 12/6/09. Cancer is due to lack of oxygen, therefore, he should be given the chance of improving oxygenation by better perfusion and circulation through the exercise effects of the twitches.

When prostate cancer returns, a new study offers insight as to why treatment isn’t effective.

The study - a collaboration between researchers at the Josephine Ford Cancer Center at Henry Ford Hospital and Fox Chase Cancer Center - shows that men with a low oxygen supply to their tumor have a higher chance of the prostate cancer returning, as found by increasing prostate-specific antigen (PSA) levels following treatment.

“After several years of research, we were able to show that low levels of oxygen to the tumor are highly related to a patient’s outcome. Those with lower oxygen levels to the prostate cancer did not respond as well to radiation therapy, and the cancer returned more often,” says Benjamin Movsas, M.D., senior study author and chair of the Department of Radiation Oncology at Henry Ford Hospital. Moreover, recent studies suggest the same finding also appears to apply to patients treated with surgery.

Results from the study will be presented May 31 at the American Society of Clinical Oncology (ASCO) annual meeting in Orlando.

Prostate cancer affects one in six men in the United States, but according to the American Cancer Society only one in 35 will die of it. The majority of all prostate cancer are diagnosed in men older than 65.

According to Dr. Movsas, oxygen being delivered to a tumor is critical to the treatment for many cancers. Radiation therapy, for example, creates free radicals that damage DNA in tumors, and oxygen acts as the mediator that perpetuates the free radicals.

That’s why Dr. Movsas began his work nearly a decade ago to investigate low oxygen levels - also known as tumor hypoxia - in prostate cancer tumors while working at Fox Chase.

To measure the amount of oxygen being delivered to the tumors and surrounding areas, Dr. Movsas and his colleagues at Fox Chase used custom-made oxygen probes to test 57 patients with low or immediate risk of cancer prior to radiation therapy. The probe was used prior to “radioactive seeds” which were implanted in the prostate.

Dr. Movsas’ initial research found that it is possible for prostate cancer tumors to have low oxygen levels. The next step was for the team to track the long-term correlation between low oxygen levels and PSA levels following treatment.

These new findings, being presented at ASCO, ultimately reveal that a tumor’s oxygen supply can significantly predict a patient’s outcome following treatment, independent from tumor stage or Gleason score, a classification of the grade of prostate cancer. Of the 57 patients, the study found that eight experienced an increase in their PSA levels about eight years following treatment.

“By identifying patients at risk with low oxygen levels in prostate tumors, we’re now able to build on this research and begin to explore novel treatment options for this small subset of patients. It’s possible we’ll find that these patients will do best with a combination of radiation therapy and other novel approaches, such as angiogenesis therapy (targeting blood vessels) or possibly even gene therapy. That’s where our research is taking us next,” says Dr. Movsas. “Non-invasive methods to detect oxygen levels in tumors are also very important.”

Reference: “Hypoxic Prostate/Muscle pO2 (P/M pO2) Ratio Predicts for Biochemical Failure in Patients with Localized Prostate Cancer: Long-term Result.” Abstract # 5136. ASCO 2009.

Those who exercise regularly, even just walking as an aerobic exercise tend to maintain their muscle strength.   Exercise is important not only for cardiovascular effects and preventing osteoporosis but now recent reserach has found that those who do not have enough exercise lose muscle strength and have a higher incidence of Alzheimers.

Of all types of exercises, nothing is easier to start and maintain than walking.

Itching is defined as an unpleasant cutaneous sensation leading to the desire to scratch. It serves as a physiological self-protective mechanism as do other cutaneous sensations like pain, touch, vibration, cold, and heat to help defend the skin against harmful external agents.

Itching can be evoked in the skin directly by mechanical and heat stimuli or indirectly through chemicals. It may also be generated in the central nervous system independently of peripheral stimulation.

Histamine-evoked itch is transmitted by selective slow-conducting subpopulations of unmyelinated C-polymodal neurons. Chemical itch mediators that can cause itch on C-fibers are histamine, neuropeptides, prostaglandins, serotonin, acetylcholine, or bradykinin.

Targets for therapy against itching can be directed to new receptor systems such as vanilloid, opioid, and cannabinoid receptors on cutaneous sensory nerve fibers that may modulate itch. (Stander S, Steinhoff M, Schmelz M, Weisshaar E, Metze D, Luger T: Neurophysiology of pruritus: cutaneous elicitation of itch.Archives of Dermatology. 139(11):1463-70, 2003 Nov.

Therapy such as massage whether done mechanically or electrically to mobilize tissues locally and improve circulation could also be helpful.

Wonder if there were sex differences in consequences of musculoskeletal pain in terms of limitation of function, work leave or disability, and healthcare use?

The following are data of a Dutch population-based study, limited to persons 25 to 64 years of age (n = 2517). Data were collected by a postal questionnaire.

Results showed:

Women with any musculoskeletal pain report more healthcare use, i.e., contact with a medical caregiver and use of medicines than men. Older age and those who lived alone had more limited functioning and more health care use.

Men report more work disability due to low back pain only, irrespective of work status. Older age males had more disability than younger males and had more health care use and those who lived alone used more medicines.

Men with low educational level was associated with limited functioning, work leave, and more contact with a medical caregiver.

Both men and women with low educational level had more work disability.

Smoking was associated with limited functioning (men), work leave (women), and healthcare use (women).

Physical inactivity was associated with limited functioning due to musculoskeletal pain in women. Pain catastrophizing was associated with limited functioning, work leave, and healthcare use (men and women) and work disability (men).

(Wijnhoven HA, de Vet HC, Picavet HS: Sex differences in consequences of musculoskeletal pain. Spine. 32(12):1360-7, 2007).

Hamstring strains represent up to 15% of all injuries sustained during participation in running sports and most of the football codes, making them a costly injury due to the high frequency in injuries. Inadequate neuromuscular control may have contributed to the original injury, and that it remains as a risk factor for further injury.

Misjudgement in movement with errors occurring when the hamstring muscle group is strongly and rapidly contracting, as it is during late swing phase through ground contact to the mid-stance phase, may increase the muscle length and torque demands, and alter the length-tension relationship of the hamstring muscle group in a way that cannot be resisted without injury. Thus, any method of improving the performance of the sensorimotor system could have possible benefits for hamstring and other lower limb injury prevention.

This study examined the effect of the HamSprint Drills training programme and conventional football practice warm-up on lower limb neuromuscular control in 29 footballers from one professional Australian Football League club. Without vision of the contact point, participants performed 40 backward swing movement trials with each leg and made a judgment of the magnitude of each movement.

Participants were randomized to either an intervention or control group that performed different procedures in the warm-up prior to football practice sessions over a 6-week period, and then were re-tested. The intervention group performed the HamSprint programme-drills specific to the improvement of running technique, co-ordination and hamstring function. HamSprint programme-drills consisted of six sessions of three drills of increasing difficulty, repeated three times over a 30 m interval, performed twice per week after a 10 min warm-up that comprised stretching, jogging and the practice of 2–3 drills from the previous session.The control group performed their usual warm-up of stretching, running, and increasingly intense football drills.

Backward leg swing extent discrimination was significantly better in players following the 6-week HamSprint programme when compared to discrimination scores of players who performed their usual practice warm-up only. Significant improvement was observed in lower limb neuromuscular control in movements similar to the late-swing early stance phase of running. The HamSprint program can therefore improve control in a specific aspect of sensorimotor system performance, and this may be useful particularly in athletes who have lower function levels or those deemed at risk of hamstring injury. (Cameron ML, Adams RD, Maher CG, Misson D: Effect of the HamSprint Drills training programme on lower limb neuromuscular control in Australian football players. Journal of Science & Medicine in Sport. 12(1):24-30, 2009).