Written by: Vanessa De Aquino, RPN, 3^rd year Nursing BScN student at Trent University  

August: Spinal Muscular Atrophy Awareness Month 

The month of August brings attention to neuromuscular disorders that affect so many people around the world. There is an increased need for research as some of the conditions can be quite devastating to individuals and their families. Patients experience pain, muscle and weight loss, swelling, inflammation, difficulty performing daily tasks and in some severe cases, difficulty breathing, difficulty swallowing, slurred speech, cognitive and behavioural changes, and more. For this reason, let’s learn about the musculoskeletal (MSK) system and how to improve your quality of life when this system is affected whether you have a condition or not. 

Why is MSK so important 

There is a famous saying by Bill Bowerman that says “if you have a body, you are an athlete”. I am sure that the Nike co-founder was not thinking about the functions of the MSK system when he said that, but I am sure he was referring to the body’s resilience and endurance to do incredible things such as running, bending, pushing, pulling, punching, crunching, crawling, flexing and so many more. The bones give the body its shape but also serve as support, movement, and protection for the internal organs. They also produce blood cells and store minerals such as calcium and phosphorus. An adult human has 206 bones and the smaller one is located in the middle ear. The muscles are part of everything one does and, believe it or not, the human body has over 600 of them with the largest one being in the buttocks. Do you know the difference between tendons and ligaments? Tendons attach muscles to bones and ligaments connect bones to bones. Together, all the bones, muscles, tendons, and ligaments work for the body to work in its optimal form. For this reason, the month of August is important to bring awareness about MSK disorders and how some conditions can affect one’s life.  

Did You Know? 

• According to World Health Organization (WHO), approximately 1.71 billion people have a musculoskeletal condition worldwide (1). 
• Musculoskeletal conditions are the leading contributor to disability worldwide, with low back pain being the single leading cause of disability in 160 countries (1). 
• Musculoskeletal conditions significantly limit mobility and dexterity, leading to early retirement from work, lower levels of well-being and reduced ability to participate in society (1). 
• A known fatal neuromuscular disease is ALS (Amyotrophic lateral sclerosis) which got to be known worldwide after the Ice Bucket Challenge.  
• Most neuromuscular disorders are genetic, and a few are autoimmune (2).  

What To Do 

Inclusivity and accessibility are the two keywords. Whether you have a muscular disorder or not, make plans by thinking about activities that are inclusive and accessible. It is very common for other conditions and treatments to take a toll on the body, such as chemotherapy and radiation. They can cause extreme fatigue and going out could be a not-so-enjoyable activity. For this reason, when planning to go out, call ahead to learn about parking, ramps, elevators, bathrooms, wheelchair accessibility and proximity to the bus stop.  

Physical Activities 

When a muscular disease strikes or the MSK system is affected, rehabilitation is key. Speak with your healthcare provider and ask for a rehabilitation referral. See a physiotherapist and consult with an occupational therapist to learn how to adapt to your needs.  

Additionally, if you know an elderly person who needs assistance with physical mobility, the WHO recommends using The Vivifrail program to promote physical exercises for the prevention of frailty and falls, especially in the elderly. The goal of the program is to increase mobility depending on the patient’s locomotor capacity (1). Please assess https://vivifrail.com/resources/. The recommendation is a multimodal exercise program with close supervision that combines exercises and cross-training to emphasize strength in the core muscle groups of the back, thigh, abdomen and lower body.  

Exercise Wheel (by Vivifrail) (3) 

Walk: 

• Begin this exercise only when you have improved your muscle strength. 
• 5-10 seconds x 5 sets. Increase the time until you can walk 1-2 minutes without stopping. 

Rest: 

• Remember to rest between sets.  

Breathe: 

Breathe normally. Do not hold your breath during exercises. 

Diet 

It is well known that protein helps with muscle recovery. Whether you are a carnivore, a vegetarian, a vegan, a pescatarian (someone who does not eat meat but eats fish) or has your own way of selecting your food, Canada’s food guide has great healthy recipes that can guide you to include recipes on your menu according to your liking and taste. Please check it out: https://food-guide.canada.ca/en/ 

Grilled Flank Steak with BBQ vegetables – published in Canada’s Food Guide: (4) 

Recipe developed by Emily Richards, P.H. Ec. for Health Canada and the Heart and Stroke Foundation.

Ingredients: 

• 1 flank steak (about 565 g/1¼ lb) 
• 60 mL (¼ cup) balsamic vinegar 
• 15 mL (1 tbsp) sodium-reduced soy 
• 15 mL (1 tbsp) Worcestershire sauce 
• 2 cloves garlic, grated 
• 10 mL (2 tsp) chopped fresh rosemary 
• 10 mL (2 tsp) extra virgin olive oil 
• 5 mL (1 tsp) Dijon mustard 
• 1 pkg (170 g/6 oz) sliced portabella mushrooms 
• 1 small red onion, cut into wedges 
• 1 zucchini, sliced 
• 1 red pepper, quartered 
• 750 mL (3 cups) baby spinach 

Directions: 

1. Using a fork, pierce flank steak all over and place it in a resealable plastic bag. 
2. In a small bowl, whisk together vinegar, soy sauce, Worcestershire sauce, garlic, rosemary, oil and mustard. Reserve 30 mL (2 tbsp) and pour the remaining mixture into the bag. Refrigerate steak for at least 1 hour or up to 1 day. 
3. In a large bowl, place mushrooms, onion, zucchini and red pepper and spray lightly with cooking spray. Place vegetables on preheated greased grill over medium-high heat for about 10 minutes, turning occasionally until tender-crisp and golden. Return to bowl and drizzle with reserved balsamic mixture and toss to combine. Add spinach to wilt slightly; set aside. 
4. Place steak on the grill, turning occasionally for about 12 minutes or until the desired doneness. Use a digital food thermometer to check that the steak has reached an internal temperature of 74°C (165°F). Remove to a clean cutting board and let stand for 5 minutes before slicing thinly across the grain.  

Bon Appetite! 

Videos 

References  

1. World Health Organization (2022). Musculoskeletal Health. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions 
2. Muscular Dystrophy Canada (n.d.). What are NMDs? https://muscle.ca/discover-md/what-is-muscular-dystrophy/ 
3. Vivifrail (n.d.). Vivifrail Project. https://vivifrail.com/ 
4. Canada’s Food Guide (n.d.). Eat a variety of healthy foods each day. https://food-guide.canada.ca/en/