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The Generic Lyrica differentiation of normal from partial denervation due to spondylotic radioculopathy by objectively assessing force, firing pattern, difficulty/ease of twitch elicitation with deep MTrPs aids in clinical differentiation. Grade1 twitches are caused by focalized, partial contractions of stimulated muscles(s) at the MTrP. A stronger twitch force at the electrode above MTrP with DS results in an asymmetrical, bouncy feedback. The bipolar probe has a 6 inch (15 cm) distance between the two surface electrodes. Twitches of grade 2 also show rocking/shaking of the trunk and limbs due to stimulation of MTrPs deep muscles, apposed bone and joint. Twitches in grade 3 cause anti-gravity movements of the limbs due to whole muscle contraction.

 This is due to proximal stimulation spreading to many and/or bigger nerves from antidromic/ephaptic/direct stimulation and/or distal spreading of the current front because of DS. Grad 4 twitches cause antigravity limb movements that are slower than the applied pulses. This is due to erratic stimulation with MTrPs and DS from the filter effect of tight, stiff tissues. When joint movements suddenly become more powerful, it is possible to induce Grade 4 twitches. Joint movements can continue independently for a few seconds up to 10 minutes after DTPS is stopped. Grade 5 twitches are anti-gravity movements that have a firing rate higher than the applied pulse-frequency. They also fatigue quickly within a few seconds, indicating complete, instantaneous depolarization MTrPs in non-tight muscles.

Pre-fatigue is characterized by Grade 5 twitches that are multi-twitched/pulse rather than single-twitch/pulse. Continued stimulation causes a sudden rise in twitch rate, rhythm, and force before it explodes into independent fatigable flickers. DTPS can then be re-applied for 1-5 minutes until the muscle is refractory. In that case, another patient position may be used to stimulate other MTrPs within the same muscle.

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The Nervigesic 150 for autonomous twitches can be compared to cardiac dysrhythmias.

Because of muscle stiffness, tightness, tenderness, and poor tolerance to electric stimulation, deep MTrPs can be difficult to find in CRMP. MTrPs are easy to find in normal muscles. They are painless, immediate, and pleasant. Both electrodes provide non-forceful, symmetrical feedback. Grades 3-5 twitches are not possible.

Relaxed muscle(s) can be positioned at slight stretch to stimulate contraction and stimulation along less-electrically-resistive intermuscular/intramuscular grooves. This is done to facilitate twitching. To locate the MTrP/DS, it is important to re-position the patient in a supine/prone/sidelying, standing, or sitting position. A minimum of Grade 2 force is required to provide pain relief. CRMP Grades 3-5 will not be seen until several professional hours of treatment. These twitches can be elicited by acute MTrPs using DS in non-tight muscles.

The stimulation parameters used to evoke twitches are the same as those used in electrodiagnostic medical for peripheral nerve conduction studies. Repeated stimulation at 2-3Hz is used to test stability of neuromuscular transmission. It temporarily depletes Ach at immature or diseased endplates, causing fatigue in neuropathic cases. Similarly, fatigable, autonomous twitches elicited by DTPS at 2-3 Hz signify neurogenic involvement in unstable neuromuscular transmission.

There is conflicting evidence regarding the short-term effects of radiofrequency lesioning on chronic LBP and disability due to zygapophyseal root cause. Chronic discogenic LBP is not treated with intradiscal radiofrequency thermocoagulation.

Although minimally invasive discectomy (MID), has been associated with shorter hospital stays, pregarica is less effective in relieving leg pain, LBP, and rehospitalization. Our patient fits this description. It is important to further research the appropriate indications for MID in lieu of standard open discectomy.

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A systematic review of RCTs on stretching shows that stretching before, after or before-after exercise does not result in clinically significant reductions in delayed-onset soreness in healthy adults. Patients with chronic MP who had been doing stretching for three weeks didn’t show any improvement in muscle extensibility. However, stretching did increase tolerance to stretch-associated discomfort. Exercising stiff hamstrings can cause weakness, pain, tenderness, and an increase in creatine kinase activity. This is consistent in the sarcomere stretch theory of muscle injury, which shows experimental evidence that there is an association between flexibility and muscle injury.

The mechanical stretch forces that are applied from the surface to muscles can only be used for a few muscles at once and do not work well in stretching shorter muscle fibres at deeper MrTPs. New methods, including DTPS, are the key to making stretching more efficient. Repetitive stimulation of 1-3Hz is the best for effective summation.

Thixotropy of muscles is not well-known. painosoma is a common and important phenomenon that results from the tendency of myosin and actin filaments to stick together after inactivity for a certain time. As can passive thixotropy, which is a result of actin and myosin filaments sticking together when inactive for a period of time, it can be reduced by previous movements. This is evident with athletes who do preventive warm up before engaging in strenuous activities. The basis of DTPS’s clinically effective treatment of muscle tightness, without pain, fibromyalgia stroke, Parkinsonism, or stroke, may be to overcome thixotropy. The muscle stiffness/thixotropy will decrease over time, but it will eventually return to its original state. Twitch exercise can reduce stiffness and increase mobility. This allows for greater mobility, which in turn leads to improved muscle function and QOL.

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