Which item is NOT a MSK or neuromuscular change related to existing muscle imbalances?

• A. Change in bowel and bladder
• B. Loss of sensation
• C. Loss of strength
• D. Pain at the site of the sac repair

Answer: (A)

Muscle imbalances in conditions like spina bifida come from motor and sensory nerve involvement that leads to weakness, altered sensation, contractures, and gait/posture changes. Change in bowel and bladder functions are governed by autonomic and spinal cord control of visceral organs, not by the musculoskeletal or neuromuscular changes that create imbalances in the limbs. In other words, bowel and bladder changes reflect neural/visceral dysfunction rather than a direct musculoskeletal imbalance. The other options—loss of sensation and loss of strength—are direct results of neural and muscular impairment contributing to imbalance, and pain at the sac repair site can relate to tissue/soft tissue stress or post-surgical healing within the musculoskeletal/neuromuscular domain. So the item that is not a MSK or neuromuscular change related to existing muscle imbalances is the change in bowel and bladder.