Muscle atrophy, also commonly referred to as muscle loss or muscle wasting. It  is a condition characterized by a gradual loss of one’s muscle mass in the body. This loss always leads to the infected exhibiting severe weakness due to their poor muscle condition. The appearance also changes as the body shrinks in and they seem to be wasted.

Muscle atrophy causes

There are several causes for muscle atrophy most of which are related to poor lifestyles. However, of its many causes, disuse of muscles is the main cause. By living a lazy lifestyle whereby one does not use their muscles on a regular basis, the muscle mass tends to reduce gradually. As a matter of fact, most of the people suffering from atrophy have been found to live a dormant life. Astronauts are also known to be highly prone to muscle loss due to the lack of gravity in space which means their muscles are more of inactive. Zero gravity means the body does not strain at all hence laxity of the muscles.

The body wasting syndrome, commonly referred to as cachexia, is another popular cause of muscle atrophy. It is quite common among people suffering from conditions such as cancer, AIDS or any other sort of chronic disease. In such cases, the medications given for the diseases tend to weaken the body leading to muscle loss. The condition in itself is another agent of atrophy considering its several negative effects on the patient’s body.

Muscle atrophy can be defined as the deterioration or loss of muscle tissue. It is a common human condition yet little is known about the causes. In order to understand the causes of muscle atrophy, it is important to first understand the physiology of the loss of muscle. Recently researchers  from the University of Iowa determined that a single protein  called GAdd45a is responsible for  about 40% of genetic activity that causes skeletal muscle atrophy by reprogramming genetic content of the muscle cells leading to change in the shape of the nucleus[1].

Muscle Atrophic changes have recently been differentiated into three categories: Muscle wasting, cachexia and sarcopenia. Muscle Wasting is the unintentional weight loss, including fat and fat-free components. Wasting occurs mostly due to inadequacies in ones diet. Cachexia refers to loss of the fat-free mass especially the body cell mass. This occurs with little or no weight loss and is commonly associated with hyper metabolism. Sarcopenia on the other hand refers to loss of muscle mass specifically, and seems to be an intrinsic, age related condition. It may occur due to gradual failure of cells that aid regeneration of muscle fibers [2]

Difference between Neurogenic Muscle atrophy and Disuse Muscle atrophy

Muscle atrophy occurs in two forms; neurogenic atrophy, which is the most severe, is caused by an injury or disease to the nerve that sends impulses to the muscle. Neurogenic atrophy is normally sudden. Another type of atrophy, disuse atrophy is due to lack of physical activity. Inactivity of one’s limbs may eventually result into loss of muscle tone. For instance, extended bed rest due to an illness or a sedentary lifestyle could result in very little use of the muscle. This type of atrophy can is reversible if a patient takes up better exercise and nutrition[3]

Muscle  atrophy can result from these common diseases

[2-4].

  • Muscle atrophy Disease conditions ranging from cancer AIDs congestive heart failure renal failure, severe burns.
  • Inadequate dietary intake or malnutrition which causes progressive weakening resulting in inability to use the muscles.
  • Aging: Elderly people normally lose their ability to maintain muscle function and mass.
  • Injury, such as a broken arm or leg that must be immobilized
  • Dermatomyositis which is a skin condition characterized by inflammation of the skin and muscle.
  • Muscular dystrophy which includes a group of muscle weakening disorders causing progressive loss of muscle and muscle weakness due to deterioration of muscle cells and death of muscle tissue.
  • Arthritis: Rheumatoid arthritis and osteoarthritis are known to cause joint inflammation making mobility difficult. Pain associated with arthritis may cause patients to become sedentary leading to muscle wasting.
  • Multiple sclerosis may also cause disuse atrophy due to weakness of certain limbs and inability to use them.

Causes of neurogenic muscle atrophy include various autoimmune diseases and other disease complications. Nerve function may be interrupted in the brain ,the spinal cord or in peripheral nerves.[3, 4]

  • Autoimmune diseases e.g. Amyotrophic Lateral Sclerosis(ALS) also known as Lou Gehrig’s disease, Guillain -Barre syndrome, are diseases affecting the brain impulses from the muscle.
  • Injuries, particularly neck and spinal cord injuries may cause compression of the nerves supplying certain thus interrupting nerve function. Examples include herniated disc or carpal tunnel syndrome.
  • Diabetic Neuropathy, a common complication of diabetes causes nerve damage due to high blood sugar levels.
  • Alcohol myopathies: Alcohol misuse may cause malfunction of muscle fibres leading to atrophy[5].
  • Multiple sclerosis is a degenerative disease affecting the brain and spinal cord causing weakness in coordination may cause brain and cerebral atrophy due to demyelization and destruction of nerve cells.
  • Stroke: Atrophy may occur in stroke due to a combination of nerve damage, disuse and inflammation of the affected muscle.

Upon diagnosis of the underlying cause of muscle atrophy, initiation of a treatment plan is necessary to reverse the atrophy, as well as reduce th

Neurogenic atrophy

There is also what medical practitioners refer to as neurogenic muscle atrophy. This kind of atrophy is that which is caused by damage to the nervous system. There are several conditions that can lead to this kind of atrophy. Some of the popular ones include the likes of strokes, diabetic neuropathy, Lou Gehrig’s condition and the all too popular osteoarthritis. Muscle atrophy is actually a symptom of these conditions. Since most of the individuals suffering from these conditions cannot work out, the only viable remedy is stimulation of nerves using electrical means. This is done to the affected regions of the body once in a while. Electrical nerve stimulation is also commonly used on people who are stuck in wheel chairs to maintain the muscle tone in good shape.

Max High diagnosed with spinal muscle atrophy

Max High diagnosed with spinal muscle atrophy
Photo by North Charleston

Muscle atrophy prognosis

Though rare, there are cases where atrophy of the muscles comes abruptly without any cause. If this happens, the best thing to do is visit your doctor at the soonest possible. A course of treatment can be established in order to build back your muscles. The bottom line either way is that muscle atrophy is caused by two main factors:

  • An inactive lifestyle
  • Serious body problems

If not dealt at the earliest, muscle atrophy worsens and in very severe cases might even lead to death. It is therefore vital that one seeks medical help urgently for proper treatment. Muscle atrophy tends to render its victims susceptible to other body conditions to the weak state it leaves the body in. Most of the patients end up bedridden. Prevention is always better than cure either way. Maintain a quality lifestyle and avoid such a condition.

Muscle atrophy Treatment – Procedures

 

Muscle atrophy Treatment may vary significantly and is dependent on the type of muscle atrophy one is suffering from

The quality of life of patients with muscle atrophy decreases as they are unable to perform many normal tasks that are mandatory for daily living. Their risks  for accidental injury is even higher when they perform certain tasks[1].

Other factors affecting the choice of treatment may include length of time on has suffered, the presence of other accompanying symptoms. Muscle atrophy may be reversible. Various treatment plans  available [2]are:

  • Physical therapy programs
  • Medication
  • Surgery
  • Electrical Stimulation

Muscle atrophy treatment with Physical therapy

Disuse atrophy is normally corrected with physical exercise programs. Exercise is aimed at strengthening the affected muscles and restoring as much normal function as possible .The key is to use the affected muscles as frequently as possible to avoid wasting.

The physical therapy program employed may depend on the underlying cause of atrophy, extent of atrophy and location of the atrophied muscle. It involves increasing the range of motion for the affected joint and improving the stability of the joint. Routine progressive exercises are done with the assistance of a physical therapist. As the patient improves, more challenging resistive exercises are added.

Aquatic rehabilitation also known as water therapy has also been used to facilitate weight bearing as it decreases the effects of gravity [2, 3] .

Musculoskeletal manipulations are done in case of neurogenic atrophy to reduce nerve compression .This procedure normally done by a chiropractor, involves stretching the spinal column to relieve pressure on compressed nerves.

With proper physical exercise as muscle atrophy treatment, muscle atrophy from disuse may recover within 12 weeks. Severely bed ridden patients may fail to completely reverse the effects of the atrophy.

Muscle atrophy treatment medication

In order to reduce inflammation and compression of affected nerves, doctors may give a course of anti inflammatory medication to patients with neurogenic atrophy particularly for patients with autoimmune disorders. Anabolic steroids are commonly administered to patients for treatment of severe muscle atrophy.

Muscle wasting that occurs due to inadequacies in protein diet or absence of certain muscle building amino acid s may be treated by amino acid therapy. Amino acid therapy may facilitate the regeneration of damaged tissue.

Research is ongoing about use of a class of drugs referred to as Selective Adrenergic Receptor modulators (SARM) to enhance muscle and tissue growth in patients with muscle atrophy [4].
Muscle atrophy treatment – Is Surgery helpful ?
When atrophy occurs as a result of contractures caused by severe burns, surgery is performed to correct the contractures. This may be followed by extensive rehabilitation involving physical therapy. Conditions such as herniated discs also require surgical intervention.

Muscle atrophy treatment – Electrical Stimulation

Electro muscular stimulation (EMS) of low voltage has been used to stimulate denervated muscles where nerve damage is peripheral [5]

Transcutaneous Electrical Nerve Stimulation (TENS) therapy is another non invasive technique used for muscle atrophy treatment for patients who have pain along with the atrophy. It is placed on ones skin over the affected muscle and it elicits a sensory effect of decreased pain or a muscular effect through changes of intensity, frequency and pulse of the current [6].

Treatment options may be limited for incurable and progressive diseases but pain management and mechanical aids to make activities of daily living easier are part of the current advancements in medicine.

Muscle Atrophy Treatment with exercises

For many years exercise therapy has been effectively used as a treatment for patients with muscle atrophy .Recovering muscle after atrophy is possible and requires the guidance of a physical therapist. It is important to consider the underlying reason for the atrophy. There are no standard exercises that have been developed for muscle atrophy treatment and prescribed exercises are normally customized to the patient.

Before starting an exercise regime, it is important to carry out a thorough assessment of the patient’s capabilities, perform certain investigations in order to determine the kind of therapy required. These may include:

  • Measures of motor function
  • Head to toe physical exam
  • Exercise capacity tests which may involve riding a stationary bicycle or walking in the fastest way possible within a specified period of time.

The aim of physical activity in muscle atrophy treatment is both preventive and curative. Disuse atrophy which occurs in persons with sedentary lifestyles may affect those sitting in offices for long periods of time. With this in mind, Many exercises have been developed that can be performed in a sitting position. Systems have been developed such as the use of fitness balls to replace office chairs in the office setting. It is believed that Fitness balls automatically tone the muscles in the back, hips, shoulders and abdomen. A study conducted in 2012 in the USA (2) revealed that office workers who used fitness balls instead of office chairs had improved muscle activity in the leg muscles.

The following are examples of simple exercise to help in preventing muscle for people who have to sit for long hours :

  • Knee extensions that target the thigh muscles and the calf muscles. They involve repeatedly extending legs slowly in a sitting position.
  • Contractions of the quadriceps: This is another exercise targeting the front thigh muscles. This is performed by sitting with legs extended and the knees straightened while heels touching the floor. The quadriceps are then tightened and held for about ten seconds.
  • Shin strengtheners are also performed while sitting. These are done by flexing ones toes while pointed upwards. This movement is repeated about 10 times. Some weight may be placed on top of the feet as it is done.
  • Another exercise, the inner thigh squeeze, which is performed by placing a small ball between one’s knees and pressing them together for a few seconds. Resistance is felt in the inner thighs.

For elderly persons, certain simple exercises such as the ones below are often prescribed:

  • Squeezing of a tennis balls with one’s hand may help to increase and strengthen  grip
  • Use of small dumbbells to perform chest presses
  • Walking: A simple walking program may reverse the effects of atrophy in elderly patients. It is recommended that one takes 30 minutes walk three times a week.
  • Aquatic therapy has been used for a number of years now. The use of water reduces the effects of gravity and makes exercises easier.

Patients with Spinal Muscle atrophy may benefit from assistive devices that may help them perform functional tasks. Exercises that cause excessive fatigue should be avoided, particularly in patients whose respiratory function is compromised. Close monitoring and use of oximetry is necessary.

In order to maximize the effects of exercises  for Muscle atrophy treatment and regain muscle, a multi disciplinary approach is necessary. Nutritional needs of a patient are important and should be met. An increase protein intake aids the rebuilding of muscle.

Acupuncture for muscle atrophy

Muscle atrophy treatment recommended diet

Diet after muscle atrophy should focus primarily on muscle rebuilding and preventing further muscle atrophy. The most popular consensus is –“rebuilding a muscle requires predominantly protein diet”. This statement is partially true and shows only half the nutritional aspect that you need to incorporate in your diet as muscle also require carbohydrates, minerals, vitamins and fat for its survival. So the diet in muscular atrophy should be balanced with increased intake to protein to assist muscle growth.

Your diet must include lean proteins and complex carbohydrates in addition to other vitamins, minerals and fats necessary for muscle build-up. For lean protein Fish is the best source for muscle atrophy treatment as this is lower in saturated fat and has high amount of omega-3-fatty acids, a type of fat that is beneficial to your health. Other sources of Lean protein include Chicken, Turkey, Beef, Eggs, Beans, Peas, Lentils and Low fat dairy products (Saturated fats have been removed from low fat dairy products and they are a good source of Calcium and Vitamin D).

Complex carbohydrates are like necklace of simple sugar molecules; they digest slowly and maintain sugar level stable for longer duration. For complex carbohydrates look forward to including vegetables in your diet. Good source of complex carbohydrate vegetables are Spinach (and other green vegetables), Asparagus, Kale and rough mushrooms. These vegetables are also a good source of other vitamins and minerals and their high fiber content create a sense of fullness of stomach. Other good sources of complex carbs are Whole grains and Fruits. Like vegetables, fruits are also a good source for a variety of minerals and vitamins and variety of fruits consumed is more important than quantity. Whole grain foods include Pasta, Oatmeal and whole grain breads.

Vitamins needed to reverse muscle atrophy primarily include Vitamin E and Vitamin D. Vitamin E has antioxidant property and prevents the muscle against oxidative damage and correcting its deficiency can correct muscle atrophy in certain cases. Good source of Vitamin E for muscle atrophy treatment include Wheat germ oil, Sunflower oil, Safflower oil, Almonds, Spinach and lesser amounts are also found in Mangoes, Papayas and Tomatoes. As for Vitamin D, it plays a significant role in muscle build up and maintaining muscle strength and its supplementation in diet can be very helpful in reversing the effects of muscle atrophy. The best sources of vitamin D are Sunlight, Salmon, Tuna, Milk, Cereal, Pork, Eggs, Mushrooms, Beef liver and Ricotta cheese.

Mineral needed to be supplemented in diet after muscle atrophy predominately should include Selenium and Copper apart from others that are a part of balanced diet for complete growth. Selenium plays role in activating a range of enzymes and maintaining healthy muscles. Good source of Selenium include Nuts (esp. Brazil Nuts), Shellfish, Liver, Sunflower oil, Wheat, Rice, Oat, Lobsters, Crabs and Shrimps.

Chronic failure to include copper in diet can affect the muscular system and its supplementation in diet can help muscle build up after muscular atrophy. Good sources of copper include Liver, Oysters, Sesame seeds, Cocoa powder and chocolates, Sunflower oil, Calamari, lobsters, Sun dried tomatoes and dried herbs.

You may also be interested in reading:

Is it possible to prevent muscle atrophy ?

Understanding protein degradation and muscle atrophy

 

 

REFERENCES

1.            Plus, M., Muscle atrophy. . 2012: National Library of Medicine National Institutes of Health.

2.            Banerjee, A. and D.C. Guttridge, Mechanisms for maintaining muscle. Curr Opin Support Palliat Care, 2012. 6(4): p. 451-6.

3.            Salem, Y. and S.J. Gropack, Aquatic therapy for a child with type III spinal muscular atrophy: a case report. Phys Occup Ther Pediatr, 2010. 30(4): p. 313-24.

4.            Jones, A., et al., Effects of a novel selective androgen receptor modulator on dexamethasone-induced and hypogonadism-induced muscle atrophy. Endocrinology, 2010. 151(8): p. 3706-19.

5.            Vaz, M.A., et al., Neuromuscular electrical stimulation (NMES) reduces structural and functional losses of quadriceps muscle and improves health status in patients with knee osteoarthritis. J Orthop Res, 2013. 31(4): p. 511-6.

6.            Keller, T., et al., New multi-channel transcutaneous electrical stimulation technology for rehabilitation. Conf Proc IEEE Eng Med Biol Soc, 2006. 1: p. 194-7.

7. Yasser Salem (2012). Spinal Muscular Atrophy, Neuromuscular Disorders, Dr. Ashraf Zaher (Ed.), ISBN: 978-953-51-0696-8, InTech, DOI: 10.5772/47952. Available from: http://www.intechopen.com/books/neuromuscular-disorders/spinal-muscular-atrophy

8. Indiana University: Using a Stability Balls as an Office Chair Can Help More Than Just Your Abs

9. Centers for Disease Control and Prevention: Physical Activity – Stage 3