Muscle Weakness: Neurological Insights on Involuntary Control

Muscles do not exert force voluntarily?

Hello Doctor: Here are my symptoms: my muscles throughout my body are very soft, to the point that it affects my daily life.
My muscles do not exert force automatically; I need to consciously control them.
Normally, people exert some force during activities, such as in physical education classes where I notice my classmates' muscles are firm.
They are not necessarily muscular; they are simply exerting force, which makes them feel stiff.
I have observed this for a long time, regardless of whether someone is overweight or underweight.
I usually exercise, so when I exert myself, my muscle definition is quite noticeable.
However, if I do not consciously control my muscles, they do not exert any force at all.
1.
When I lift objects, my hands tremble and feel sore, but when I put them down, they feel normal and much more comfortable.
After holding something for a while, my hands start trembling and feeling sore again.
2.
When standing or sitting, if someone accidentally kicks my foot, it moves, but my classmates remain stable and do not get displaced.
3.
While riding a bike, when I focus on oncoming traffic or traffic lights, only a few of my muscles exert force, and some may even stop working, making it difficult to maintain balance, which can lead to falling.
If I exert my muscles to ride, I feel stable, but it distracts me, which is dangerous, and I cannot maintain that effort for long.
4.
My thigh and glute muscles also struggle to exert force.
When standing on a bus, I sway significantly, even elderly people can stand more steadily than I can.
5.
When sitting on a hard chair at school, I hear a cracking sound from my muscles and bones pressing against the wooden chair, which is very uncomfortable, painful, and numb (my glute muscles do not exert force automatically).
Even at home, I have to use my back to sit properly because it feels more comfortable with less nerve pressure.
6.
When wearing jeans, I notice my buttocks sagging significantly in the mirror.
7.
When I stand, my calves are hard, but most of my thighs and glutes are soft—not soft from lack of exercise, but soft from not exerting force.
The softness is such that I can feel my bones when pressing down, and the same goes for running.
8.
When walking, my leg muscles visibly sway.
9.
My muscles are very soft; when I lie down, I notice that my feet open outward beyond the normal range, almost touching the edge of the bed at 180 degrees.
When sleeping on my stomach, I feel my glutes are somewhat open, and the same goes for side sleeping.
However, when I touch my father's glutes, even while sleeping, he exerts force and keeps them tightly together, with his feet opening within 80 degrees while lying down, which is normal for him at 58 years old.
My soft muscles and difficulty exerting force have been present since I can remember; it is congenital.
This is not a matter of insufficient training; generally, people do not need to train to walk or do anything else, and their muscles function normally.
Moreover, I exercise regularly and still experience this difficulty in exerting force.
The above conditions improve with conscious control, but not for long.
Existing conditions: flat feet and knee valgus.
What could this be? Thank you for taking the time to respond!

Xiansheng, 10~19 year old female. Ask Date: 2006/06/08

Dr. Huang Yingzhe reply Neurology

Dear Director Huang Ying-Che of the Neurology Department at Tainan Hospital, Ministry of Health and Welfare:
Upon initial consideration, I would suspect a possible muscular disorder.
Please visit a medical center's neurology department for further evaluation.
Tainan Hospital is concerned about your health.

Reply Date: 2006/06/08

More Info

Your symptoms present a complex picture that may involve several neurological and muscular factors. The key issues you describe—muscle weakness, difficulty in involuntary muscle control, and the need for conscious effort to engage your muscles—are concerning and warrant a thorough evaluation by a healthcare professional, particularly a neurologist or a specialist in neuromuscular disorders.

Understanding Muscle Weakness and Control
Muscle weakness can manifest in various ways, including the inability to exert force without conscious effort, as you described. This can be due to several underlying conditions, including but not limited to:
1. Neuromuscular Disorders: Conditions such as myasthenia gravis or muscular dystrophies can lead to muscle weakness and fatigue. In myasthenia gravis, for instance, the communication between nerves and muscles is impaired, leading to weakness that worsens with activity and improves with rest.

2. Peripheral Neuropathy: Damage to the peripheral nerves can result in weakness, numbness, and difficulty in controlling muscle movements. This can be caused by diabetes, vitamin deficiencies, or autoimmune diseases.

3. Central Nervous System Disorders: Conditions affecting the brain or spinal cord, such as multiple sclerosis, can lead to muscle weakness and coordination issues.
4. Muscle Disorders: Primary muscle diseases, such as myopathies, can also cause weakness and difficulty in muscle control.

Your Specific Symptoms
1. Involuntary Muscle Control: The fact that your muscles do not engage without conscious effort suggests a possible neuromuscular transmission issue. This could be related to the way your nervous system communicates with your muscles.

2. Tremors and Fatigue: The tremors you experience when lifting objects and the subsequent fatigue could indicate that your muscles are not receiving adequate signals from your nervous system, leading to overexertion when you do attempt to use them.

3. Balance and Stability Issues: Your difficulty in maintaining balance while standing or riding a bike suggests that your proprioceptive feedback (the body's ability to sense its position in space) may be impaired. This could be due to weak stabilizing muscles or issues with the nervous system's ability to process balance information.

4. Physical Appearance and Posture: The observations regarding your muscle tone and posture, such as the noticeable softness of your muscles and the way your body responds to pressure, may indicate a lack of muscle engagement or strength.

Recommendations for Evaluation
Given the complexity of your symptoms, a comprehensive evaluation is essential. Here are some steps you might consider:
1. Neurological Examination: A thorough neurological exam can help assess your muscle strength, reflexes, and coordination. This will provide insight into whether the issue is primarily muscular, neurological, or a combination of both.

2. Electromyography (EMG) and Nerve Conduction Studies: These tests can help determine if there is a problem with the electrical activity of your muscles or the nerves that control them. They can identify conditions like neuropathy or myopathy.

3. MRI or CT Scans: Imaging studies may be necessary to rule out structural issues in the brain or spinal cord that could be affecting your muscle control.

4. Blood Tests: Checking for vitamin deficiencies, thyroid function, and autoimmune markers can help identify underlying metabolic or systemic issues.

5. Physical Therapy: Engaging in a tailored physical therapy program can help improve muscle strength, coordination, and overall function. A physical therapist can work with you to develop exercises that enhance your muscle engagement and stability.

Conclusion
Your symptoms are concerning and suggest a potential underlying neuromuscular condition that requires further investigation. It is crucial to consult with a healthcare professional who can provide a detailed assessment and appropriate diagnostic tests. Early diagnosis and intervention can significantly improve outcomes and help you manage your symptoms effectively. Please prioritize seeking medical advice to address these issues comprehensively.

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