MUSCLE & WEAKNESS

In this section, I will talk about muscular problems in MS and how you as an MS sufferer can deal with them. Areas covered in this section will include muscle pain, spasm, cramps, jerkiness, and above all muscle weakness and walking limitations.

Muscle pain, aches, spasm, and jerkiness

These subjects have been discussed in “MANAGEMENT” area under MS section. That was the medical side of it, but here I will mention your side as a patient and how can I help you ease things and make life more comfortable for you.

If you have tried your neurologist in the connection with the above, and have tried some specific medications but with no effect or intolerable side effects, then I would suggest to you the following:

1. Make sure that you don’t suffer from other conditions which might cause such symptoms including: peripheral circulatory insufficiency, electrolyte disturbance, low calcium or vitamin D, low vitamin B12 or folate, anaemia, uncontrolled blood pressure, or sometimes pregnancy. Also, make sure that you don’t suffer from restless leg syndrome.
2. If your legs turn cold frequently, try to keep them warm with woollen socks or blankets before you go to bed.
3. Warm shower and massage before you go to bed might help as well.
4. Drinking a glass of tonic water before you go to be might help. Please make sure that the tonic water you buy contains Quinine.
5. A glass of skimmed milk before you go to bed can be helpful sometimes. Calcium helps in calming you down, helps you to sleep, and may reduce aches and cramps.

Leg weakness

It important for me to say that medications are unlikely to help muscle weakness in MS. Muscle weakness in MS is usually a sign of nerve damage(degeneration), and this tends to happen in progressive MS.

General rule: Muscles are dynamic and they do thrive on using them(exercise). If you don’t use your muscles you will loose them.

The best treatment for muscle weakness is physical activity(physiotherapy) either at your house or with the physiotherapist. Swimming, walking, playing sports, or going to the gym will help improve your muscle power or at least maintain your current power and strength for longer periods of time.

Generally, you can cope easier with two leg weakness, and you do struggle probably more with one leg weakness, or unequal leg weakness in the two legs are involved. That will add balance problem to your weakness including limping, leaning, buckling, leg crossing, and tripping.

Always remember that your worst weakness if proximal(around hips) and far distal(around ankles) with foot drop in particular. That sort of muscle weakness does compromise your walking ability and balance very much and can some time cripple you.

Other important factors to be aware of when we talk about compromising  walking ability such as incoordination with MS cerebellar involvement, and unequal leg lengths. When one leg is taller than the other one, that can affect walking without recognising easily. That can be helped with foot-wear correction by physiotherapist, and can improve walking significantly.

The most disabling weakness in lower limbs which significantly affect walking and balance is what we call “proximal leg weakness”.

Proximal leg weakness affects walking and balance via compensatory mechanisms such as buckling(inability to thrust the body forewords), bending knees, dragging legs when walking, semi-dropped feet, and tripping.

There are many causes of proximal leg weakness including bone thinning such as osteoporosis and osteomalacia. Steroids can cause proximal muscle weakness, as well as some endocrine disorders such as Cushing’s disease. MS usually causes pyramidal total leg weakness, but in some cases can cause proximal leg weakness.

Other disabling leg weakness is caused by foot drop. Foot drop can be one sided or both sides. Either way, the walking is significantly affected through weakness, and the foot drop when the person fails to left the front of his/her feet up and that increases the chances of them hitting the ground and cause tripping then falls.

It is worth mentioning here that MS is not the main cause of foot drop. In fact, foot drop in MS is not that common, and other commoner causes need to be looked at before blaming MS.

What to do to strengthen hip muscles?

1. On standing: Hold into a table, desk, or rails; then move one leg straight fully backwards, then fully forwards and do that 3 times on the first start standing firmly on the opposite leg. Then do the same with the other leg even if that leg is the strong one. Repeat for three times alternating between the two legs, then stop to do similar in the afternoon or evening. Do this everyday for 3-6 months an see how much improvement you get.
2. Lie on your back on a mattress, soft board, or carpet. Move one leg straight up to the most possible and hold it at that position for 30 seconds if you can. Do the same with the other leg, and repeat the same manoeuvre three times on each leg. 
3. Same as in step 2, but try to paddle in the air as if you are paddling on a bike for 3 minutes if you can or aim to that in the next few days. Do that twice per day every day for 306 months and notice the difference in your strength and balance when you walk.

What to do to strengthen ankle muscles?

Foot drop can be the worst disabling defect in the lower limbs, and in this area in particular physical foot support in the form of splints, tubo-grips or shoes adjustments can be very helpful.

A quick note to patients and physiotherapists that foot drop can e real or false foot drop. We need to be very careful ere, as the treatment can be dramatically different.

1. Real foot drop is when the dorsum(upper surface) foot muscles are weak(the dorsi-flexors). There are many causes of that including of course MS. This can be unilateral(commonest), or bilateral. Treatment in this type of foot drop is support…. physical(splints) or electrical in the form of stimulation(FES). Bouncing your feet up frequently can be very helpful to strengthen foot top muscles and reduce foot drop especially if it is partial or very recent, and not through nerve damage(axonal degeneration). Can e helped surgically especially if it is a result of nerve trapping in the lower spine or at the upper part of the leg on the outer side(neck of the fibula) leading to lateral peroneal nerve palsy causing foot drop.
2. False foot drop: when the foot is pulled down by the short or stiff calf muscles. Achilles tendon can be very tight because of shortening due to disuse(lack of stretching). Other causes include fasciitis of the sole of the foot, Achilles tendinitis, and Achilles spur. Positive stretching of the foot up, and attempts to elongate the Achilles tendon might be the best answer to this problem. This will not respond to functional electrical stimulation(FES) !.