by Nicole Cutler, L.Ac.

In general, those who choose massage therapy as a profession share a genuine desire to help people. Wanting to help others is the cornerstone of compassion, defined by freedictionary.com as “deep awareness of the suffering of another coupled with the wish to relieve it.” When it comes to relieving the suffering caused by muscular dystrophy, massage therapists have the opportunity of a lifetime.

Describing over 30 genetic diseases characterized by progressive weakness and skeletal muscle degeneration, muscular dystrophy (MD) can occur in infancy, childhood or adulthood. The disorders differ in terms of the distribution and extent of muscle weakness, age of onset, rate of progression and pattern of inheritance.

The primary types of MD include:

· Duchenne – This is the most common form of MD and primarily affects boys. It is caused by the absence of dystrophin, a protein involved in maintaining the integrity of muscle. Onset is between 3 and 5 years and the disorder progresses rapidly. Most boys are unable to walk by age 12, and later need a respirator to breathe.

· Becker – Becker MD is very similar to, but less severe than Duchenne MD. Those afflicted with Becker MD have faulty or not enough dystrophin. This form generally affects older boys and young men, and progresses more slowly, usually over several decades.

· Facioscapulohumeral – Also known as Landouzy-Dejerine disease, this form of MD usually begins in the teenage years. It causes progressive weakness in muscles of the face, arms, legs, shoulders and chest. It progresses slowly and can vary in symptoms from mild to disabling.

· Myotonic – Also known as Steinert’s disease, this MD is the most common adult form and is typified by prolonged muscle spasms, cataracts, cardiac abnormalities and endocrine disturbances. Individuals with myotonic MD typically exhibit long, thin faces, drooping eyelids and a swan-like neck.

Physiology
Both the Duchenne and Becker forms of MD revolve around a problem with, or the absence of, the protein dystrophin. Dystrophin is necessary for normal muscle tissue function. Here is a quick refresher to help place dystrophin’s role in muscle physiology. Myosin, the muscle’s thick filament, pulls on actin, the thin filament, by swiveling its head. This causes the actin to slide towards the M line, (the center of the muscle’s sarcomere), shortening the muscle. Dystrophin has many spider-like links to actin, attaching actin to the endomysium (part of the muscle’s tendon). Therefore, when actin slides towards the M line, the dystrophin pulls on the bone-surrounding endomysium, which ultimately creates movement. Therefore, a deficiency or lack of dystrophin has devastating effects on muscle movement, control and health.

Signs and Symptoms
Signs and symptoms vary according to the type of muscular dystrophy. Typical symptoms include:

· Muscle weakness
· Lack of coordination
· Progressive crippling
· Involuntary muscle contractions
· Loss of mobility

Many specific signs and symptoms vary from among the different forms of MD. Each type is different in the age of onset, what parts of the body the symptoms primarily affect and how rapidly the disease progresses. For example, signs and symptoms unique to Duchenne MD may include:

· Frequent falls
· Large calf muscles
· Difficulty getting up from a lying or sitting position
· Weakness in lower leg muscles, resulting in difficulty with running and jumping
· Waddling gait
· Mild mental retardation (in some cases)

Treatment
There is no specific treatment to stop or reverse any form of MD. Treatment plans are designed to help prevent or reduce deformities in the joints and spine and to allow people with MD to remain mobile as long as possible. While not curative, typical treatment approaches utilize medications, physical therapy, respiratory therapy, speech therapy, orthopedic appliances used for support, and corrective orthopedic surgery. Drug therapy includes corticosteroids to slow muscle degeneration, anticonvulsants to control seizures and muscle activity, immunosuppressants to delay damage to dying muscle cells and antibiotics to fight respiratory infections.

A host of alternative treatments are often turned to for periodic, symptomatic relief for muscular dystrophy. In particular, massage therapy has been reported to ease a wide range of MD’s symptoms including:

· Relieving muscle pain
· Relaxing tight or contracted muscles
· Increasing circulation in a deprived area
· Restoring some range of motion

Since the goal of all bodywork is analogous to its application for muscular dystrophy, it almost appears massage is designed specifically for MD’s symptoms. While never intended to replace or supersede a physician’s advice, adding regular massage therapy sessions to a MD management plan can help reduce spasms, ease chronically tightened muscles, and improve the person’s quality of life. By seeking to help those with muscular dystrophy, a practitioner’s compassion can go a long, long way.

Recommended Study:
Anatomy and Pathology
Anatomy and Physiology
Pharmacology for Massage

References:

Osborn, Karrie, Sea of Calm, Massage and Bodywork, February/March 2003.

www.thefreedictionary.com, Compassion – definition, Farlex, Inc., 2007.

www.massagetherapy101.com, Deep Muscle Therapy, massagetherapy101.com, 2007.

www.mayoclinic.com, Muscular Dystrophy, Mayo Foundation for Medical Education and Research, 2007.

www.muscular-dystrophy.org, Alternative Therapies, Muscular Dystrophy Campaign, 2007.

www.ninds.nih.gov, Muscular Dystrophy Information Page, National Institute of Neurological Disorders and Stroke, 2007.

www.wellingtoncollege.com, Dystrophin – The Connective Tissue Link, Wellington College, May 2006.