A human disease modifier gene is a gene that regulates another gene's function or effects. The presence of a modifier gene is not sufficient to cause a disease. Nonetheless, the presence of a modifier gene alters the disease's onset and severity. A genetic modifier can interact in several ways with another gene product. Changes in penetration and expressiveness, direct interaction with the target gene product, mechanistic contribution to the same biological process and/or functional compensation through other routes might all have effects. Despite long hypothesized genetic modifiers, their influence is yet unclear. Improved computational tools, international consortia with larger patient cohorts, improved laboratory precision procedures, and high-throughput technology have all helped find and verify genetic modifiers in recent years. As new possible genetic modifiers are found, common pathways can be established linking some modifying genes or neuromuscular diseases. The most promising metabolic pathways include the TGF-1 signaling system, inflammation, endoplasmic reticulum metabolism, axon formation, regeneration, extracellular matrix, RNA metabolism and protein transport. Perhaps in the future, we will conceive of neuromuscular diseases in terms of impaired molecular processes and the amount involving multiple metabolic pathways, rather than main genetic variations or medical nomenclature. Another fascinating feature of genetic modifiers in neuromuscular diseases is the involvement of genetic moderators in oligogenic inheritance. Preliminary research on animal models and people indicates that more rare, non-synonymous mutations in NMD-related genes might worsen muscle damage and lead to a more severe phenotype. Besides oligogenic inheritance, the "diagnostic gap"—individuals who remain unresolved after exome or genome sequencing—can be explained by the action of genetic modifiers. In the coming years, genetic modification research is expected to advance from diagnostic to therapeutic levels, and it would be extremely tempting from a therapeutic point of view to identify "protective" modifiers and comparable metabolic pathways for NMDs.