Muscle atrophy Treatment – Procedures

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].

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

Physical therapy for treatment of Muscle atrophy

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 treatement, muscle atrophy from disuse may recover within 12 weeks. Severely bed ridden patients may fail to completely reverse the effects of the atrophy.

Medication for Muscle atrophy treatment

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].

Surgery for Muscle atrophy treatment

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.

Electrical Stimulation for Muscle atrophy treatment

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.

Exercises for Muscle Atrophy Treatment

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 treatmnetand 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.

Diet for Muscle atrophy treatment

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 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 fibre 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 atrophy in certain cases. Good source of Vitamin E 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.

 

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

 

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  1. [...] dystrophy. The studies underway have produced promising results. MANAGEMENT OF MUSCULAR DYSTROPHY Treatment of muscle atrophy is varied but mainly involves physical activity and a high protein diet. There is [...]

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