Introduction
Atrophy and dystrophy are both terms related to the functioning of muscles. They may seem similar, but they are not the same. Muscular atrophy is the wasting of muscles with loss of tissue while muscular dystrophy is a group of muscle diseases with weakness in the muscles resulting in reduced mobility.
Muscular dystrophy can produce debility and the person becomes progressively disabled as they lose the power of movement. It is a group of diseases that produce progressive weakness and loss of muscle mass. In muscular dystrophy, the problem is at the genomic level, where abnormal genes (mutations) interfere with the production of proteins needed to form healthy muscle tissue.
Signs & symptoms
- Balance problems, difficulty walking, and falls.
- Difficulty rising from a lying or sitting position.
- Trouble running and jumping.
- Waddling gait.
- Walking on the toes.
- Large calf muscles.
- Muscle pain and stiffness.
- Learning disabilities.
- Difficulty with swallowing.
- Facial weakness.
- Gradual difficulty walking and speaking,
- Memory loss,
- Tingling or weakness of extremities.
- Impaired balance and coordination.
Causes
Genetic mutations or abnormal genes
Pathophysiology
Multiple proteins are involved in the complex interactions for the proper functioning of the muscles. For the stability of sarcolemma, dystrophin and dystrophin-associated glycoproteins (DAGs) are very important.
The dystrophin gene is located on the short arm of chromosome X near the p21 locus and codes for the large protein Dp427. Dystrophin accounts for only a small amount of the proteins in striated muscle, but it has a vital role in the maintenance of the muscle’s membrane integrity.
Dystrophin functions as a homotetramer at the costomeres in skeletal muscles, and it gets associated with actin at its N-terminus and the DAG complex at the C-terminus, forming a stable complex that interacts with laminin in the extracellular matrix. Lack of dystrophin leads to cellular instability at these points. It can cause progressive leakage of intracellular components. This results in the high levels of creatine phosphokinase (CPK) present in patients with Duchenne MD.
Less-active forms of dystrophin may still function as a sarcolemmal anchor, but they are not effective as they allow some leakage of intracellular substances. This is the classic Becker dystrophy. In both Duchenne and Becker MD, the muscle cell unit gradually dies, and macrophages invade. Although the damage in MD is not reported to be immunologically mediated, class I human leukocyte antigens (HLAs) are found on the membrane of dystrophic muscles. This makes these muscles more susceptible to T-cell mediated attacks.
Physical examination including muscle bulk, tone and strength.
Medical history
MRI
Blood tests to identify mutations in some of the genes that cause types of muscular dystrophy.
Muscle biopsy.
Treatments
At present, there is no permanent cure for muscular dystrophy. Medications and therapies help to slow the progression and keep the patient moving for a longer time.
Medications like corticosteroids and cardiac medications like beta-blockers and angiotensin-converting enzyme inhibitors are also tried in the treatment of MD. Other treatments include:
Physical therapy
General exercises:
Breathing assistance:
Mobility aids like canes, wheelchairs, and walkers
Braces
ultrasound therapy
Treatments for muscle atrophy depend on the degree of muscle loss and the underlying medical conditions if any.
Treating the underlying condition causing the muscle atrophy is found the most effective way.
Treatments for muscle atrophy include:
Physical therapy
Physical therapy may help improve mobility in people with muscle atrophy.
Functional electrical stimulation (FES)
Focused ultrasound therapy
Surgery
Prognosis
Progressive muscular atrophy has a relatively poor prognosis. But the prognosis for muscular atrophy is good as the person is otherwise normal and only one group of muscles is affected. The prognosis is bad in almost all cases of muscular dystrophy due to the progressive and steady deterioration. Yet some cases may be mild and progress very slowly.
Complications
Trouble walking, most are confined to a wheelchair.
Trouble using arms and fingers for activities.
Shortening of muscles or tendons around joints
Breathing problems
Curved spine
Heart problems
Swallowing problems
Disease & Ayurveda
Peseedourballyam/Peseekshayam
Nidana
Causative factors for the vitiation of Vaata and Kapha
Kshata-injury
Purvaaroopa
Not mentioned
Samprapti
Due to various reasons, the vitiated Kaphadosha gets lodged in raktadhatu, mamsaddhatu and medodhatu which are very closely related and the circulation of Vaatadosha and body fluids are affected. Due to defective circulation and nervous supply, vitiated Kapha and Vaata doshas when getting lodged in muscles, develop weakness, heaviness & pain of the muscles and restricts the body movements and locomotor functions.
Lakshana
Weakness of muscles
Heaviness of muscles
Pain & tenderness in the affected area
Inability to move and limited locomotor functions
Divisions
Not mentioned
Prognosis
Yaapyam/asaadhyam
Chikithsa
Samana
Lepanam with Rookshana dravyas
Swedanam
Mardanam (in completely vaatika)
Udwartanam
After the blockage of channels is removed by Rookshana&langhana, the application of oils and nourishing therapies should be done.
Sodhana
Abhyangam
Swedanam
Virechanam
Asthapanavasti
Anuvasanavasti
Commonly used medicines
Maharasnadi kashayam
Rasnasunthyadi kashayam
Yogarajaguggulu
Shaddharanam choornam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Measures that may provide relief from muscle problems include:
- Regular stretching exercises
- Traction and pulling
- Sona bath, steam bath etc.
- avoiding weight lifting sessions until the problem is resolved
- Stress-relief activities and exercises such as yoga and meditation to relieve tension
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, obstruct channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil, Ragi, Flax seeds
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from extreme climate changes.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid a sedentary lifestyle.
Yoga
Regular stretching and mild cardio exercises are advised according to the strength of the patient. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve the bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625012/
https://pubmed.ncbi.nlm.nih.gov/8004806/
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
Dr. Nair is a regular speaker at Ayurveda-related conferences and has visited Germany to propagate Ayurveda. You can write directly to him-
rajesh@ayurvedaforall.com
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