Ultrasound guided Neuromuscular Electrical Stimulation US-NMES


Who needs it?

- Patients experiencing occasional or persistent dull aching pains, burning pains, involving head neck and shoulders, shoulder blades and headaches around the eyes, behind the ears, back and top of head, hip and thigh pains.. - Almost all of such patients present to our clinic, usually with an all clear set of investigations, Laboratory results, MRI and plain X ray images, with no clear diagnosis, or an obvious cause for such symptoms. - We collectively diagnose such conditions, as some form of the evasive, Myofascial Pain Syndrome.

What causes it?

- The pains are attributed to taut bands within the contractured muscle. A contractured muscle is one that got stuck in a state, of almost infinite contraction, failing to achieve full contraction, thus finding it more difficult to fully relax. - Such muscle bands, transform into pain generators, both locally, by compressing neighboring structures as nerves, affecting sensory faculties, causing tingling, numbness, pains, aches,.... As well as motor activities causing weakness and loss of function. - It also leads to an exaggerated state of central brain sensitization, meaning, an increased brain perception, of such type of stimulation, allowing a more intense and chronic form of pain felt by the patients, and lowering of their pain thresholds.

How to treat?

- Utilizing Ultra sound scanning guidance, has transformed locating such damaged bands and their proximity to nerves, from a blinded procedure that used to rely mainly on the palpating skills by the physicians’ fingers, to a far more precise, highly efficient, positive result yielding technique. - Through electrical stimulation to precisely placed dry needles, allowing the achievement of the following: + Immediate disruption of such bands and knots. + Stretching of the muscle filaments and release of protein overlap causing such contracture. + Stretching of the overlying fascia. + Central desensitization, thus reducing the brain’s overreaction to the perceived injury or insult, raising its pain threshold level, breaking a vicious circle that built up over a prolonged period of time.


Does it work?

- Success relies on the collective effect of several factors. The correct diagnosis of the condition, precision of application of the dry needles, dose dependency of the electrical stimulation, being an integrated part within a comprehensive care plan, where all chosen therapeutic techniques, aim at achieving the same goal. This emphasizes the prominent role of the highly skilled physician, working with the patient as a team.


For the more Scientifically oriented:

. Myofascial pain syndrome, is a clinically diagnosed medical condition, where patients suffer a myriad of symptoms such as headaches, that often get diagnosed as migraine or tension type headaches TTH. Neck and shoulder, upper arms, hands, hip and thigh pains, with weakness, and limited ranges of motion.

Such conditions present in the majority of cases, with no valid cause, and usually show lack of evidence on radiographic imaging.

Etiology:

- Repetitive muscle overuse - Acute or sustained overload - Sub-maximal loading of muscles over prolonged periods of time - Psychological stress

All of the above factors cause damage to the sarcoplasmic reticulum, increasing calcium concentration, with increased shortening of Actin and Myosin protein filaments, going along a shortage of ATP and an impaired calcium pump, all leading to an energy crisis at the nerve muscle endplates. It all produces abnormal depolarization of the post-junctional membrane potential of motor end plates with a local energy hypoxic crisis associated with both sensory and autonomic reflex arcs, that all get sustained by sensitization mechanisms.

. Central sensitization occurs with an increased input activity of the Amygdala, anterior cingulate gyrus, primary sensory cortex and Thalamic circuits. This is accompanied by, but also is inductive of, increased peripheral responsiveness of nociceptors, resulting in a reduced pain threshold, allodynia and hyperalgesia.

Both of the above mentioned processes, create a sustained status of contracture, that might as well compress neighboring structures and might partially explain Myofascial pains, Fibromyalgia, and neuropathic pains.

Treatment Mechanics

Precise placement of Electrically stimulated Dry needles, using Ultra sound guidance, affect central sensitization, by altering nociceptive segmental output:

- Mechanically disrupting contracture knots, reducing overlap of Actin and Myosin filaments, also causing axonal denervation, with changes at endplate Choline Estrase and Acetyl Choline receptors (similar to a normal muscle regeneration process)

- Inducing LTR: + Local Twitch Responses, are involuntary spinal reflexes, that eliminate typical end plate noise and associated spikes with Trigger points. + They also induce a reduction of certain chemicals as, Bradykinin, Substance P, Leukotrienes, Cytokines and gene related peptides, therefore reducing pain. + They also cause local stimulation of mechanoreceptors coupled with slow C fibers, thus reducing pain relay to the Insular region and the Anterior cingulate gyrus.

- Pain is not a measure of tissue damage, but an indicator of the Brain’s conviction about the need to protect certain tissues.