Could Weakness and Pain in Your Legs Signal ALS Symptoms?

Q: Could Weakness and Pain in Your Legs Signal ALS Symptoms?

Dear Miss Xiao：<br>You mentioned that "when walking, if the feeling underfoot is not right, there will be a sudden pain, and then the legs feel weak and powerless." These are not symptoms of amyotrophic lateral sclerosis (ALS). <br>The ALS you are concerned about primarily refers

Weakness and pain in the legs could be a precursor to amyotrophic lateral sclerosis (ALS)?

In 2021, I was diagnosed with possible sciatica (only through X-rays).
After continuous rehabilitation, I improved for a while, but occasionally my lower back would still feel sore, allowing me to live normally.
Before April 20, my daily life involved mostly sitting in the office, and occasionally doing squats and glute exercises at home.
On April 20, 2023, I woke up in the morning with sudden, excruciating pain in my right leg (including my buttocks).
When I tried to lie on my left side and prop myself up with my hands, the pain in my right buttock was intense, radiating down my entire leg.
I was in so much pain that I couldn't walk or go to the bathroom.
Standing up from a seated position caused extreme pain in my buttocks.
If my right foot touched the floor at an incorrect angle or position, the pain was unbearable, and even when the angle and position were correct, my entire leg felt weak.
At its worst, regardless of whether I was lying down, prone, sitting, or standing, my leg would hurt so much that it would shake.
I could barely sleep; as soon as I lay down, I would be in severe pain the next day when trying to get up.
I visited both rehabilitation and orthopedic specialists, and after taking pain medication, my leg still felt somewhat weak, and I could still feel a bit of pain.
Since the pain was unbearable, I later received a steroid injection in the area above my buttock.
After the injection, I felt much better, but I still experienced a strange sensation in my leg while walking, feeling weak and uncomfortable unless the angle was just right.
Most of the pain was in my buttocks, occasionally shifting to the front of my thigh or the back of my thigh, causing a limp when walking.
If the sensation of my foot hitting the ground felt wrong, I would experience a sharp pain, followed by weakness in my leg.
I subsequently had X-rays and an MRI, and at least three doctors reviewed my MRI, stating that my spine was completely fine and that it did not appear to be a herniated disc.
The doctors advised me to start physical therapy.
On the morning of May 4, I woke up to find that both legs felt somewhat strange, with a sensation of soreness rather than just pain, although my right leg was still more painful.
I have seen at least four doctors, and they all just recommended rehabilitation without conducting more in-depth examinations.
Since I have been resting at home and not working since April 20, yet still experiencing pain up to May 4, I began to wonder if I might have amyotrophic lateral sclerosis (ALS).
If not, which specialist should I consult next? I feel utterly lost and need to return to work soon.
I sincerely ask for some guidance from a doctor; I would be extremely grateful.
Overall pain level on a scale of 10: April 20 (10) -> May 4 (7).
From April 20 to May 4, my leg did not turn black.

Xiao Mou, 20~29 year old female. Ask Date: 2023/05/04

Dr. Jiang Junyi reply Neurology

Dear Miss Xiao:
You mentioned that "when walking, if the feeling underfoot is not right, there will be a sudden pain, and then the legs feel weak and powerless." These are not symptoms of amyotrophic lateral sclerosis (ALS).
The ALS you are concerned about primarily refers to issues with motor neurons, which control muscle movement.
Generally, the motor neurons in the brain are referred to as upper motor neurons, while those in the brainstem and spinal cord are called lower motor neurons.
When motor neurons are affected, our muscles do not receive adequate nutrients and chemicals, which can lead to muscle death.
Your symptoms may suggest considering piriformis syndrome.
The piriformis muscle is located deep in the buttocks and spans between the spine and hip joint.
When the piriformis muscle becomes inflamed and compresses the sciatic nerve, it can cause symptoms of pain and numbness.
This condition is common among office workers who often sit for long periods, tend to cross their legs, do not use appropriate cushions, or keep their phones in their back pockets, leading to prolonged pressure on the piriformis muscle, resulting in localized swelling and tissue inflammation.
Consequently, there may be severe pain in the deep area of the right buttock, which can even affect walking and cause weakness in the legs.
The most common symptoms include a dull ache in the buttocks, a burning sensation in the back of the thigh and foot, reduced range of motion in the hip joint, and increased pain after climbing stairs or prolonged sitting.
For management, you can apply heat to promote local muscle circulation, with a temperature of about 35-40 degrees Celsius for 10-15 minutes, twice a day.
It is advisable to warm up for 10-15 minutes before exercising, such as cycling or running, to avoid muscle tightness, which can easily trigger piriformis syndrome.
For further diagnosis, I recommend consulting a rehabilitation physician for muscle ultrasound or other examinations.
Thank you for your inquiry.
If you have any related questions, feel free to discuss further!
Wishing you good health and happiness,
Dr.
Jiang Junyi
Taoyuan Medical Center

Reply Date: 2023/05/04

More Info

The symptoms you are experiencing, including weakness and pain in your legs, can indeed be concerning and may lead to fears of serious conditions such as Amyotrophic Lateral Sclerosis (ALS). However, it is essential to understand that while ALS is a progressive neurodegenerative disease that affects motor neurons, the symptoms you describe do not necessarily align with the typical presentation of ALS.

ALS primarily manifests through muscle weakness, atrophy, and fasciculations (muscle twitching), which usually progress over time. Patients often experience difficulty with voluntary movements, such as walking, speaking, and swallowing. In contrast, your symptoms seem to be more acute and associated with pain and discomfort rather than the gradual muscle weakness characteristic of ALS.

Your history of sciatica and the sudden onset of severe pain in your right leg, which radiates from your buttocks down to your leg, suggests that your symptoms may be related to a musculoskeletal issue or nerve compression rather than a primary neurodegenerative condition. Sciatica can cause significant pain and weakness due to irritation or compression of the sciatic nerve, often resulting from herniated discs, spinal stenosis, or other spinal issues. The fact that your MRI results showed no significant abnormalities in the spine is reassuring but does not completely rule out other conditions that could be causing your symptoms.

Additionally, the description of your symptoms evolving from severe pain to a more generalized weakness and discomfort raises the possibility of other conditions, such as fibromyalgia, peripheral neuropathy, or even myofascial pain syndrome. These conditions can lead to widespread pain, muscle weakness, and fatigue, often exacerbated by stress or physical activity.

It is also worth considering that your symptoms may be influenced by factors such as electrolyte imbalances, vitamin deficiencies (like Vitamin D), or even medication side effects. Given your history of taking various medications, including statins, it is essential to discuss with your healthcare provider whether any of these could be contributing to your symptoms.

In terms of next steps, it would be prudent to consult with a neurologist who specializes in neuromuscular disorders. They can perform a thorough evaluation, including nerve conduction studies and electromyography (EMG), to assess the function of your nerves and muscles. This can help differentiate between neurological conditions and musculoskeletal issues. Additionally, a referral to a pain management specialist or a physical therapist may be beneficial for addressing your pain and improving your mobility.

In summary, while your symptoms are understandably concerning, they do not strongly indicate ALS. Instead, they may be related to a combination of musculoskeletal issues, nerve compression, or other conditions that warrant further investigation. Seeking a comprehensive evaluation from a specialist will provide clarity and guide you toward appropriate treatment options.

Similar Q&A

Could My Symptoms Indicate ALS or Myasthenia Gravis?

Hello Doctor, I am the person who asked question #114246. I would like to know if these symptoms could possibly be related to conditions like amyotrophic lateral sclerosis (ALS) or myasthenia gravis. I am really scared that I might have such a disease. The more I search online, t...

Dr. Gao Chunde reply Neurology
The weakness in individuals with amyotrophic lateral sclerosis (ALS) does not fluctuate over several days; it progresses gradually step by step. To determine whether the weakness is indeed present, relevant examinations must be conducted, and the decision should be made by the ph...

Understanding Limb Weakness: When to Seek Neurological Care

Last Thursday, after watching a movie about amyotrophic lateral sclerosis (ALS), I gained a preliminary understanding of this disease but also found myself becoming anxious about the possibility of developing it. Coincidentally, since that day, I have been experiencing weakness i...

Dr. Peng Shiwei reply Neurology
Hello, based on your symptoms and age, it is more likely that you are experiencing chronic muscle fatigue. Amyotrophic lateral sclerosis (ALS) typically occurs in middle age and is characterized by noticeable weakness, muscle atrophy, and muscle twitching. Therefore, you may want...

Understanding Early Symptoms of Amyotrophic Lateral Sclerosis (ALS)

Hello, doctor. Recently, I have been experiencing some involuntary muscle twitching in my legs, and I also feel a lack of strength. However, I don't have much trouble when lifting things normally. About two months ago, I visited a neurologist, who asked me to draw circles on...

Dr. Hong Weibin reply Neurology
Hello: Regarding the symptoms of amyotrophic lateral sclerosis (ALS), you can refer to the CommonHealth Knowledge Base at https://kb.commonhealth.com.tw/library/417.html#data-3-collapse. However, if your symptoms are not progressively worsening, you can be reassured that it is us...

Understanding ALS: Symptoms and Concerns About Muscle Weakness

Hello, doctor. Recently, I have been experiencing muscle twitching all over my body, and after some research, I found that it could possibly be amyotrophic lateral sclerosis (ALS). I am becoming increasingly worried and would like to ask you what the feeling of weakness in ALS is...

Dr. Jiang Junyi reply Neurology
Hello Mr. Wei, You mentioned that "the soles of my feet occasionally feel a twitching sensation, and my feet easily become numb." These symptoms are more indicative of peripheral nerve compression, as motor neuron diseases typically do not present with significant sens...