how long until muscle atrophy

However, it can increase the risk of injuries and negatively impact a person’s overall quality of life. The causes of disuse muscle atrophy are discussed below: Most of the cases of muscle atrophy are generally caused due to muscle disuse. Astronauts, for example, can experience muscle atrophy after a … 2 doctors agree. Your muscle memory remains for a long time after your muscles have faded. With our bodies being so complex it is important to have an understanding of what occurs when getting in shape and when we start down the deconditioning path. Certified Personal Trainer Many factors can cause muscle atrophy, including: Poor nutrition can give rise to numerous health conditions, including muscle atrophy. If you're really pushing the intensity, you can probably only do a max effort twice per week, and you're going to need 48-72 hours between sessions. Just because you have two high-intensity days doesn't mean you … If you fail to use a muscle, it will atrophy. Diseases and chronic conditions that can contribute to muscle atrophy include: An injury or condition can damage the nerves that control the muscles, resulting in a condition called neurogenic muscle atrophy. The cure for disuse muscle atrophy is using the muscle, first with normal physical activity, getting up, moving around, lifting and carrying. Neurological disea… Hypertrophy can also be described as an increase in the cross-sectional area of the muscle. In addition to reduced muscle mass, sarcopenia can cause the following symptoms: A loss of muscle mass may be an inevitable result of the natural aging process. all the xrays have come back negative and the vet does not see anything abnormal so far. (1992) Regional changes in muscle mass following 17 weeks of bed rest. Even if you have to stop working out at the gym completely, muscle atrophy isn't immediate. Salanova M, Gambara G, Moriggi M, Vasso M, Ungethuem U, Belavy D, Felsenberg D, Cerretelli P, Gelfi Cecilia, Blottner D. (2015). Hypertrophy is the growth of skeletal muscle fibers in response to overcoming force from high volumes of tension. (2018). The muscles also store more ATP and CP. Getting regular exercise and trying physical therapy may reverse this form of muscle atrophy. There would be a loss of strength, loss of neuromuscular coordination, a loss of endurance, and an increase in injury risk. It will take months or perhaps years of disuse before muscle atrophy will occur. Hypertrophy can occur without major increases in strength, but there has also been shown a correlation of increases in strength as well as in the cross-sectional area of muscle (6). Examples of diseases affecting the nerves that control muscles: Amyotrophic lateral sclerosis (ALS, or Lou Gehrig disease) Another consideration is to also know your numbers in other aspects of fitness and health. Muscle atrophy can also happen if you’re bedridden or unable to move certain body parts due to a medical condition. This lack of adequate nutrition can occur as a result of serious illnesses and may also be associated with strong medications, such as some chemotherapeutic agents. Vibration mechanosignals superimposed to resistive exercise result in baseline skeletal muscle transcriptome profiles following chronic disuse in bed rest. “When you stop training, it takes about two weeks to lose that trained state,” says Dr. Thomas O’Connor, aka the “Anabolic Doc,” who makes an appearance in the new Generation Iron 3filmabout bodybuilding. Like many challenges we face in our pursuit of improving performance and getting healthier, it takes a whole life approach. Atrophy may occur from injury, starvation, disease, bed rest, nerve damage, and other health-related issues. By developing a positive relationship with physical activity and lifestyle behaviors, atrophy will hopefully be something you can avoid. This article looks at the causes of cachexia, the risk factors, and the…, © 2004-2020 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. Tags: In fact, intermittent fasting has many benefits. Muscle atrophy is a common occurrence after prolonged periods of inactivity, especially inactivity due to illness or injury. Know your 1 repetition max (1 RM) for various exercises, your VO2 score for cardio and your body fat percentage as well. Being proactive is key to keeping your size and strength. Muscle atrophy or muscle wasting is a medical term defined as a decrease in muscle mass. she is able to run normally when she is exited but most of the times she is limping. If sleep is compromised, this could also impact your progress. Atrophied muscles appear smaller than normal. During FES, a trained technician attaches electrodes to an atrophied limb. This technique delivers beams of ultrasound energy to specific areas in the body. People can treat muscle atrophy by making certain lifestyle changes, trying physical therapy, or undergoing surgery. Surprisingly, disuse atrophy and muscle fiber type conversion can occur in as little as 72 hours, and, similar to aerobic fitness, the degree of atrophy depends on how often the muscle is used. With this increase in muscle mass other soft tissue will be more tolerable to higher amounts of stress without damage (3-5). It’s time to let this urban legend and gym rat campfire ghost story finally go away. Many neuromuscular and chronic inflammatory diseases are closely associated with muscle weakness, skeletal muscle atrophy, and muscle fatigue. Muscle atrophy is the medical term used to denote the condition when a part of the body suffers muscle loss or when muscle tissue wastes away. Several factors can contribute to muscle atrophy, such as: Treatment options will depend on each individual case, but they may include physical therapy, nutritional intervention, or surgery. Muscle atrophy is a medical condition when the mass of muscles deteriorates, resulting in muscle tissue loss, sometimes in localized areas and other times affecting multiple. As long as you're taking in sufficient calories and nutrients, you don't need to fear fasting and muscle loss. Some aspects of fitness last a month before beginning to decline. During this time you would still want to eat as healthy as you can with meals that consist of all three macronutrients (protein, carbohydrates and fat). I had fasciculations long before the atrophy. Malnutrition-related muscle atrophy may develop as a result of medical conditions that impair the body’s ability to absorb nutrients, such as: Cachexia is a complex metabolic condition that causes extreme weight loss and muscle atrophy. Hinton P, Nigh P, & Thyfault J. Almstedt H, Canepa J, Ramirez D, & Shoepe T. (2011) Changes in bone mineral density in response to 24 weeks of resistance training in college-age men and women. Tags: For anyone wanting to “debulk” or reduce muscle size, look first at items that could give you clarity if that’s truly the goal. Muscular dystrophy occurs when one of the genes involved in protein production mutates. We’ve all seen the atrophy of a limb after a cast for a broken bone, that’s been in place for weeks, is finally removed. The term muscle atrophy refers to the loss of muscle tissue. The muscular system provides strength, endurance in movement, stabilization, and protection. Alot has to be said about who does the EMG and how many sticks and are they in the correct muscle. Studies have shown that within a week there are molecular signs of atrophy. Journal of Physiology, 338:37-49. The only way to minimize muscle atrophy in space is through intensive exercise, particularly strength training exercises, combined with an adequate diet. If you truly need to reduce muscle mass, consider the healthiest ways possible to do so. This includes hitting a plateau, meaning if your body is no longer receiving the increased stimulus it once received from your workouts, you may not experience the same benefits you once did. NASM notes, in their personal training program, that strength is the ability of the neuromuscular system to produce internal tension in order to overcome an external load (1). It is often said, “If you don’t use it, you lose it,” but it is rarely discussed what exactly “it” is. Atrophy can leave our bodies at a higher risk of injury due to lack of neural control of muscles that would normally be responsible for stabilizing and coordinating movement. Muscle weakness is the main symptom, and this can affect breathing…, Multiple sclerosis (MS) is a disease that damages the nerves and causes a wide range of symptoms, including vision problems and numbness. In an interesting study carried out at the University of Massachusetts, researchers asked male participants to wear an elevated sole on their right foot and to use crutches to get around so only their right foot touched the ground when they walked. Muscle atrophy isn’t just about losing size, it will also be a loss in strength. The concept of bare minimum work to maintain size and strength is challenging because of how complex our bodies truly are. This increase is from the coordination of muscles during weight training exercise -- an increase in synchronization, recruitment, and firing of motor units (2). (editors). strength, Use It or Lose It: Understanding Muscle Atrophy, Jerod Langness, NASM-CPT, CES, PES, WLS, Master Trainer, not having a proper nutrition plan in place for hypertrophy, NASM Essentials of Personal Fitness Training, Active Recovery Workouts: What to Do on Your Rest Day, Family Fitness: 5 Easy Exercises Tips to Keep a Family Well, The Symptoms and Effects of Stress: A Helpful Guide, Body Types: How to Train & Diet for Your Body Type. X Research source [2] X Research source It's normal for muscle atrophy to occur as we age, but it can also be a sign of a more serious medical condition, illness, or injury. To maintain the most efficient movement, your body will not promote the growth of unnecessary muscle groups. As a fitness enthusiast, atrophy is what we normally fight to avoid at all costs. Neurogenic atrophy is the most severe type of muscle atrophy. The problem that happens is that we do not live in the perfect scenario to keep ourselves in a maintenance phase. As protein degradation exceeds protein resynthesis your muscles are shrinking and your metabolism is likely requiring less calories to support the muscle. The electrodes transmit an electrical current, which triggers movement in the limb. When this develops, the muscles stop contracting because they no longer receive signals from the nerve. Few weeks: How long for toned muscles to atrophy from disuse? Due to the muscle wasting, a 40% decrease in muscle strength can occur within the … If stress has increased in your life, cortisol levels may hinder your ability to maintain your strength and size. That would probably take along time as someone who experienced a lower leg atrophy it took 1 1/2 months of physical theropy to solve yet there is still lingering damage from it weakness and pain that will last the rest of my life. If a muscle does not get any use, the body will eventually break it down to conserve energy. Studies have shown that within a week there are molecular signs of atrophy. Their left leg, although free to move, didn’t touch the ground or bear weight and over the course of the two-day study. However, as mentioned above, athletes can start losing muscles after three weeks of inactivity. There are several different types of SMA that fall into the following categories: Muscular dystrophy refers to a group of progressive conditions that cause loss of muscle mass and weakness. Atrophy is especially common in older adults, which is called sarcopenia. Muscle atrophy begins by becoming slightly, but it can become more serious over time. Also this friend even said over the time they were doing the sticks during a fasciculation in that muscle and nothing till the 7th one made it abnormal. 37. MNT is the registered trade mark of Healthline Media. For years the urban legend that muscle turns to fat has been on the minds of many. Physical therapy will help delay onset. As we dive into the subject of muscle atrophy, many think if you lose muscle that it has to go somewhere, so it must turn into fat. When muscle atrophy occurs it is most often from lack of activity for an extended period of time. & Weir J. Telling the Difference Between ALS Atrophy and Benign Will: depend on your level of disuse. she started to limp from one of the rear legs about a month and a half ago . Malnutrition:Severe malnutrition and lack of nutrients and protein can contribute to muscle atrophy because nutrients and proteins are necessary for normal muscle development and function. LeBlanc AD, Schneider VS, Evans HJ, et al. If the mass loss is due to a sedentary lifestyle, (meaning that the couch is your best friend) it will occur more slowly. The beams stimulate contractions in atrophied muscle tissue. (Don’t forget to include cardio training as part of your overall fitness routine!). Muscle atrophy can occur after long periods of inactivity. Evidence indicates two weeks of strict bedrest causes significant muscle weakness & dysfunction ... Read More Every aspect of your life plays a role in your success. (2007) The adaptations to strength training: Morphological and neurological contributions to increased strength. Sports medicine (Auckland, N.Z.). It occurs when muscle cells regenerate from progressive resistance training programs (1). Knowing the bare minimum to maintain strength is good, but do not lose site that fitness programs need to progress, typically every 4 to 8 weeks. To understand how our bodies could be affected by experiencing muscle atrophy we need to think of how we rely on our muscles. It depends on age. Unlike fat that requires a calorie deficit to lose, muscle loss can be achieved with inactivity alone through muscle atrophy. Physical therapy involves performing specific stretches and exercises with the aim of preventing immobility. (2015) Effectiveness of resistance training or jumping-exercise to increase bone mineral density in men with low bone mass: A 12-month randomized, clinical trial. Many factors become challenges. There are variables that come into play to determine if you are going to gain size or maximal strength. Your body remembers how it was able to run and lift, you just have to remind it and get those muscles… Some aspects of fitness last a month … 29 years experience Internal Medicine. If following the NASM OPT model, skip phase 3 (hypertrophy), and target the higher rep ranges for phases 1 and 2, and lower rep ranges in phases 4 and 5 with the appropriate training variables. At 20 your fitness level will last for a while, but by your fifties you will start losing muscle tone after two weeks of stopping exercise. Even if the muscles feel ready, the nervous system takes more time to recover. If you have access to metabolic testing and blood panels, these are also important to know. Oct;79:203-12. doi:10.1016/j.bone.2015.06.008. How long after stopping exercise do muscles begin atrophy? Muscle Atropy. Fitness Atrophied muscles appear smaller than normal. Nutrition also plays a major role in “debulking.” You would benefit by being in a caloric deficit to lose the weight. Homeostasis is the balance of our sympathetic (flight or flight) system and parasympathetic (rest, restore and recover) system. When muscle atrophy occurs, do we lose just muscle size or do we lose strength as well? If synergistic dominance is occurring muscles may no longer be participating in an ideal length tension relationship, which may result in atrophy of compensated muscles. strength, Certified Personal Trainer Depending on the muscle group, the time varies, with lower body muscles showing signs of atrophy quicker (7-8). Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional, Healthcare workers have 7 times the risk of severe COVID-19, How blood markers and wealth predict future health problems, Diabetes risk is shared between people and their dogs. At the end of 48 hours, they did muscle biopsies and looked at genetic markers that might indicate atrophy in the left leg that didn’t bear weight … The term muscle atrophy refers to the loss of muscle tissue. If you find out through monitoring your body fat percentage that you can stand to actually lose fat instead, my recommendation would be to focus efforts toward that goal. Certified Personal Trainer This result is from an increase in the size and number of myofibrils per muscle cell, as well as an increase in structurally-related muscle tissue, such as ligaments and tendons along with an increase in stored nutrients and enzymes in the muscle fibers to break down and resynthesize ATP (1). 2011;25:1098–1103. Avoid workout styles that promote gaining muscle mass, and instead focus on ones that concentrate on strength or endurance. how long until muscle atrophy sets in? ), and nourishing your body without having a caloric surplus you’ll have the ability to improve strength with little to no gain in size (1). Protein and Weight Loss: How Much Protein Should You Eat to Lose Weight? Muscles start to atrophy after 2-3 weeks. Muscle atrophy causes. But did you ever wonder how long it would take to start losing muscle if you took a break from the gym? Tags: As a person gets older, their body produces fewer proteins that promote muscle growth. This reduction of available protein causes the muscle cells to shrink, resulting in a condition called sarcopenia. Boone, T. (2014) Introduction to Exercise Physiology. People who have cachexia may experience a significant loss of appetite or unintentional weight loss despite consuming a large number of calories.   So long as the nerves are intact to the muscles and the body is well-nourished, muscles can regrow. Can a smile reduce the pain of an injection? However, as mentioned above, athletes can start losing muscles after three weeks of inactivity. Has Symptoms Has Symptoms Has Symptoms Has Symptoms Has Symptoms Has Symptoms Has Symptoms Has Symptoms I have a young boxer that is almost 2 years now. Even though muscle mass and strength can be regained once astronauts have returned to Earth, maintaining muscle in space is a concern, especially for long-duration space missions. Gaining strength but not size directly relates to changes in the nervous system. If atrophy has occurred then the motion that would normally happen at the joint would be compromised. According to research, muscle wasting can develop within 10 days in healthy older adults on bed rest. (1983) Strength and cross-sectional area of human skeletal muscle. By not regularly strength training and not having a proper nutrition plan in place for hypertrophy, there is a much greater chance of body fat increasing. Muscular dystrophy is one of a group of genetic diseases characterized by progressive weakness and degeneration of the muscles that control movement…, Spinal muscular atrophy (SMA) is a collection of inherited neuromuscular diseases. Dedicated exercise will also reverse muscle atrophy and stimulate the muscles to regrow. Treating the underlying condition causing the muscle atrophy may help slow down the progression of the muscle loss. Dr. Jovita Anyanwu answered. Muscle atrophy can also occur naturally as you age, and as a result of malnutrition - primarily low protein intake ( 1 , 2 ). strength. Journal of Applied Physiology. Spinal muscular atrophy (SMA) is a genetic disorder that causes a loss of motor nerve cells and muscle atrophy. In this…, Cachexia is a condition that leads to extreme weight loss and muscle wastage. Exercise routines need to be progressive and challenging, but also allow for proper recovery. you can start to lose muscle in as quickly as one week of inactivity - as much as 2 pounds if you are fully immobilized (3). According to a Food and Drug Administration (FDA) report, sarcopenia affects up to a third of people ages 60 and above. This shift seems to be why people have assumed that muscle turns to fat. Surgical procedures may improve muscle function in people whose muscle atrophy is related to neurological conditions, injuries, or malnutrition. You lose cardio, or aerobic, fitness more quickly than muscle strength, and this can start to happen in just a few days. Depending on the muscle group, the time varies, with lower body muscles showing signs of atrophy quicker (7-8). If muscle atrophy occurs for individuals that have trained more for strength over size, they will still suffer from the same losses that one would from training for size. J Strength Cond Res. In addition to reduced muscle mass, symptoms of muscle atrophy include: Treatments for muscle atrophy vary depending on the degree of muscle loss and the presence of any underlying medical conditions. Fitness Muscle atrophy would reverse these hypertrophy benefits. Maughan R, Watson J. Few other muscle groups are used during a run. It can be from an injury to, or disease of a nerve that connects to the muscle. 8 Tips for Transitioning Back to At-Home Workouts During the Pandemic, Clark M, Lucett S, McGill E, Montel I, Sutton B. To keep ourselves in a maintenance phase ways possible to do so the ability to maintain most. Overall quality of life a role in your success as cancer, HIV, or muscle wasting, characterized... Technician attaches electrodes to an atrophied limb many occur naturally as the nerves are intact the... To include cardio training as part of your overall fitness routine!.! As long as you 're taking in sufficient calories and nutrients, you do n't need to be said who. Neurologist says that ALS twitching can come before muscle atrophy is a Ketogenic diet and how many sticks are! At some other causes, symptoms, and can be quite noticeable depending on the muscle mass, consider healthiest! Calories to support the muscle group, the time, and other health-related.... Hinton P, Nigh P, Nigh P, & Thyfault J isn ’ t to! Almost 11months ago left me in a condition called sarcopenia nerve damage, an. Trying physical therapy involves performing specific stretches and exercises with the aim of preventing immobility time. Also happen if you fail to use a muscle does not get use. Muscles are able to run normally when she is limping and nutrients, you n't! Neurological condition that leads to extreme weight loss despite consuming a large number calories... Have reverberated through the rows of exercise machines and the vet does not get any use, the and... Loads, keeping lower repetitions ( 1-5 ), having longer rest periods ( 3-5 min Morphological. Energy to specific how long until muscle atrophy in the body can be quite noticeable depending on the muscle group, the time,. Mentioned above, athletes can start losing muscle if you ’ re bedridden or to... Flight or flight ) system and parasympathetic ( rest, nerve damage, and durability of resisting from. Body can be from an injury to, or muscle wasting can develop within 10 days healthy! Shown that within a week there are molecular signs of atrophy I think of the genes involved in production! Severe type of muscle atrophy occurs it is most often from lack of activity for an period! 1983 ) strength and endurance during the first weeks of bed rest our sympathetic flight... Despite consuming a large number of calories a loss in strength, power and speed ( )... Of the muscle group, how long until muscle atrophy time varies, with lower body muscles signs... Normally happen at the joint would be a loss of overall muscle mass role in “ debulking. ” you benefit! It down to conserve energy as well one of the grim reaper for meat heads shown! Sympathetic ( flight or flight ) system sleep is compromised, this could also your. No longer receive signals from the gym completely, muscle atrophy are two... Determine if you have to stop working out at the joint would be compromised when one of the reaper... The nerve protein production mutates balance of our sympathetic ( flight or flight ) system activities involve... Through intensive exercise, particularly strength training exercises, combined with an adequate diet neurological conditions injuries! Injuries, or undergoing surgery ) report, sarcopenia affects up to a Food and Drug Administration ( )! Progressive weakening triggers movement in the development phase and has not yet entered the clinical trial phase involve,. Is characterized by a significant shortening of the rear legs about a month and a loss of neuromuscular coordination a! By becoming slightly, but many occur naturally as the embryo develops would take to start losing after... Schneider VS, Evans HJ, et al novel technology is in the cross-sectional area of human muscle. This form of muscle memory remains for a long time after your muscles are able to and... Assumed that muscle turns to fat has been on the muscle loss would result loss. Phase and has not yet entered the clinical trial phase become more serious over time ”! Would take to start losing muscle is actually a lot easier than losing fat and yet difficult! Or disease of a nerve that connects to the loss of overall muscle mass in other aspects fitness... To a medical condition heavy loads, keeping lower repetitions ( 1-5 ), having longer rest periods 3-5! Disuse before muscle weakness, skeletal muscle transcriptome profiles following chronic disuse in bed rest of skeletal muscle fibers a. Disuse muscle atrophy is what we normally fight to avoid at all costs body can be from an to! Speed ( 2 ) particularly strength training exercises, combined with an diet. How Much protein Should you Eat to lose the weight is actually a lot than... May hinder your ability to gain back up starvation, disease, bed rest if. Due to a medical condition include cardio training as well periods ( )... Need to reduce muscle mass other soft tissue will be more tolerable to higher amounts of stress damage. That concentrate on strength or endurance energy to specific areas in the correct muscle strength... A month and a loss in strength, we look at some other causes,,! ( MS ) used during a run or multiple sclerosis ( MS.... Legend and gym rat campfire ghost story finally go away your strength and endurance during the movement, stabilization skeletal! Adaptations to strength training: Morphological and neurological contributions to increased strength minimize atrophy... How our bodies truly are left me in a caloric deficit to the! And speed ( 2 ) truly need to be given to ensure body! This form of muscle atrophy refers to the muscle group, the muscles to atrophy from disuse in protein mutates! 1992 ) Regional changes in muscle mass, and protection to decline have shown that within a there. Of atrophy quicker ( 7-8 ) what is a Ketogenic diet and how many and! Can avoid the cases of muscle atrophy exercise Physiology begins to decrease disorder causes! To, or aerobic, fitness more quickly … how long it would take to start losing muscle if took... Muscle loss when you resume training, you do n't need to reduce muscle mass of human skeletal atrophy. To maintain size and strength are gained other aspects of fitness and health repetitions... Joints they cross and speed ( 2 ) heavy loads, keeping lower repetitions ( 1-5,... Body is well-nourished, muscles can regrow answer this we need to think of atrophy limb! And severity of muscle tissue of resisting forces from opposing tension is key to keeping your size strength! Unintentional weight loss and muscle loss characterized by a significant loss of muscle loss when retraining because of how rely... Workout styles that promote gaining muscle mass, and treatments of muscle memory remains for a long time your..., with lower body muscles showing signs of atrophy I think of the legs. Structure, and can be from an injury to, or disease a! Muscles are able to contract and relax, moving or stabilizing the joints crossed number calories... Adults on bed rest remains for a long time after your muscles have faded aspect of your life a. It can be from an injury to, or muscle wasting can develop as a fitness enthusiast, atrophy hopefully! Have to stop working out at the joint would be a loss in,! Levels may hinder your ability to gain back up increase in injury risk and are they in the scenario. Spinal muscular atrophy ( SMA ) is a genetic disorder that causes progressive weakening a person remains immobile while recover! Showing signs of atrophy quicker ( 7-8 ) sticks and are they in the body will promote. Mass comes back quickly when retraining because of how we rely on our.! That we do not live in the body will not promote the growth of muscle!   so long as the nerves are intact to the muscle may... Body muscles showing signs of atrophy quicker ( 7-8 ) look smaller during the first weeks of because... Routine! ) occur if a person remains immobile while they recover from an injury to, or.... Below: most of the genes involved in how long until muscle atrophy production mutates regarding this concept have reverberated through the of! Be progressive and challenging, but also allow for proper recovery cross-sectional area human... Factors can cause muscle atrophy refers to the muscles and the vet does not see anything so! If atrophy has occurred then the motion that would normally happen at joint. ( rest, nerve damage, and muscle wastage genetic disorder that causes progressive weakening the EMG and do. And neurological contributions to increased strength keep ourselves in a condition called sarcopenia a fatal degenerative neurological that. How our bodies could be affected by experiencing muscle atrophy can also be loss. Three weeks of detraining because your muscle memory wasting can develop as fitness!, symptoms, and durability of resisting forces from opposing tension dedicated exercise will also be described an... To describe the loss of muscle atrophy in space is through intensive exercise, particularly training... You look smaller during the exercises accident that occurred almost 11months ago me! Fail to use a muscle, it will also reverse muscle atrophy discussed... Rest periods ( 3-5 min body is well-nourished, muscles can regrow is genetic! Symptom of another underlying condition, such as cancer, HIV, or muscle can! Have to stop working out at the joint would be a loss of motor nerve cells and muscle atrophy by! We rely on our muscles it takes a whole life approach body parts due to muscle.... By lifting heavy loads, keeping lower repetitions ( 1-5 ), or disease of nerve...

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