Muscle Pain and Weakness After Pregnancy: A Neurological Perspective

Q: Muscle Pain and Weakness After Pregnancy: A Neurological Perspective

Hello Miss Hsuan-er： You mentioned that "my whole body feels like it's getting thinner and I don't feel like I have any muscle left; is it all atrophying?" Muscle atrophy may first require consideration of insufficient protein intake. <br>Your concerns might also need to address

Muscle fasciculations, soreness, weakness..?

Hello, Doctor.
I apologize for bothering you, but I would like to ask a question.
I gave birth around mid-May this year.
Due to a short cervical length, I had to undergo bed rest for about three months.
After giving birth, I experienced some muscle loss, but my strength seemed to be relatively normal.
However, one day I suddenly woke up with severe pain in my calves and a feeling of weakness while walking, although I did not fall.
Additionally, I experienced muscle fasciculations at rest and a sensation of crawling throughout my body.
When walking, I felt a sense of impending collapse with each step.
My palms also felt stiff, and my fine motor skills were not as agile; after a little activity, my hands would feel sore, and there was tenderness in the thenar muscle below my thumb.

I subsequently visited a neurologist.
Given my history of bed rest, I was uncertain whether my muscles had atrophied, as my calves had already become thinner.
However, I felt extremely fatigued, and my weight had suddenly dropped significantly.
Just walking a little or moving would cause considerable pain, making me want to sit down.
When I rested, I would still feel muscle twitching, and I was very worried about amyotrophic lateral sclerosis (ALS).
However, the doctor said my symptoms did not resemble ALS and that ALS typically does not present with pain.
He ordered nerve conduction studies, which included motor nerve conduction tests for the upper and lower limbs, F waves, H reflexes, sensory nerve conduction velocity measurements, and X-rays of the cervical and lumbar spine.
After reviewing the results, he confidently stated that everything was normal and that it was definitely not ALS.
He suggested an electromyography (EMG) test, but the doctor said it was unnecessary and assured me it was not ALS, then sent me home.

However, my symptoms have not improved at all.
Although I can perform movements now, I feel that the sensory symptoms are becoming more severe.
My shoulders ache when I lift my arms, my fingers are stiff and somewhat painful when bent, and the sensation of muscle twitching is still quite pronounced.
Recently, I have also noticed something strange with my swallowing; it feels like I can't swallow properly when eating.
Additionally, I feel that all my muscles are becoming thinner, and it seems like I have lost muscle mass.
Have they all atrophied? I would like to ask if the tests mentioned above can truly rule out ALS.
Should I consult another doctor for an EMG? I have been very troubled for over two months and am extremely anxious.
Thank you very much.
🙏

Xuan Er, 20~29 year old female. Ask Date: 2023/11/28

Dr. Jiang Junyi reply Neurology

Hello Miss Hsuan-er: You mentioned that "my whole body feels like it's getting thinner and I don't feel like I have any muscle left; is it all atrophying?" Muscle atrophy may first require consideration of insufficient protein intake.
Your concerns might also need to address autoimmune issues and thyroid problems.
I recommend ruling out these two areas of related diseases first.
Thank you for your question, and feel free to discuss any related issues further! Wishing you good health and peace.
Dr.
Chiang Jun-yi, Tao Medical Center, cares about you.

Reply Date: 2023/11/28

More Info

It sounds like you are experiencing a complex array of symptoms following your recent pregnancy, which can understandably be quite distressing. Muscle pain, weakness, and sensations like twitching or crawling can be alarming, especially when they persist over time. Let's break down your concerns from a neurological perspective and consider the potential causes and next steps.

Firstly, it’s important to acknowledge that pregnancy and the postpartum period can lead to significant physiological changes in a woman's body. Hormonal fluctuations, changes in physical activity levels, and the stress of childbirth can all contribute to muscle weakness and discomfort. Additionally, if you were on bed rest during your pregnancy due to a short cervix, this could have led to some deconditioning of your muscles, particularly in your lower limbs.

The symptoms you describe, such as muscle soreness, weakness, and the sensation of twitching or crawling under the skin, can be attributed to several factors. One possibility is that you may be experiencing a form of neuropathy or nerve irritation, which can occur due to changes in posture, weight distribution, or even vitamin deficiencies that can arise postpartum. For instance, deficiencies in vitamin B12 or magnesium can lead to muscle cramps and weakness.

Regarding your concern about amyotrophic lateral sclerosis (ALS), it’s reassuring that your neurologist has assessed your symptoms and conducted a thorough examination, including nerve conduction studies. These tests are designed to evaluate the function of your nerves and muscles. In ALS, one would typically see specific patterns of nerve damage and muscle atrophy, which your doctor has indicated are not present in your case. While it’s understandable to worry about such serious conditions, the absence of significant findings in your tests is a positive sign.

However, your ongoing symptoms warrant further investigation. If you feel that your concerns have not been fully addressed, it may be beneficial to seek a second opinion or to request a referral to a specialist in neuromuscular disorders. An electromyography (EMG) test could provide additional insights into your muscle function and help rule out other conditions that might not have been considered yet.

In the meantime, consider some supportive measures to help manage your symptoms. Gentle physical therapy could be beneficial in rebuilding strength and improving mobility. A physical therapist can tailor a program to your specific needs, focusing on gradual strengthening and flexibility exercises. Additionally, mindfulness practices or relaxation techniques may help alleviate some of the anxiety associated with your symptoms.

Lastly, it’s crucial to maintain open communication with your healthcare providers. If you feel that your symptoms are worsening or if new symptoms arise, don’t hesitate to reach out for further evaluation. Your health and well-being are paramount, and it’s essential to advocate for yourself during this process.

In summary, while your symptoms are concerning, the tests you've undergone have not indicated a serious neurological condition like ALS. However, continued monitoring and possibly further testing may be necessary to fully understand and address your symptoms. Engaging in physical therapy and maintaining a dialogue with your healthcare team can help you navigate this challenging period.

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