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What Is Causing My Leg Issues Weakness vs Spasticity
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What Is Causing My Leg Issues Weakness vs Spasticity

It's funny how you come accustomed to mobility issues. I'm not sure how long I've had these issues or when they occurred but I started to notice how different my left side was compared to my right when I started PT. I guess it's not everyday that you go around the house doing leg lifts, stretches, etc..

I hope I can explain this correctly because I would like to know the reason behind it all. That's just the way my brain works..I want to know why.

Of course, I have the foot drop. This is one issue on the left side. I can't raise my toes or my ankle above a flat footed position or a negative position (I think that's what my PT called it). I noticed on the same left side that I can't pivot my leg. I can pivot it out, opening my legs up, but if I try to pivot it to show the left side of my left leg, it won't budge. This has cause me a great deal of difficulty in shaving my legs, so now I buy a depilatory cream to make my life easier.

Another issue I have is lifting the leg. If I'm in a sitting position, I can lift the right leg all the way up. The left leg will not lift all the way and will not raise straight. My foot will pivot on it's side and my knee will raise the leg but it will raise the leg like I'm opening my legs....not straight. I can force the leg to go up straight, but I can not raise it by my own will.

When I'm doing my leg lifts..the right side is good, the left side however is really bad. It will only go so far and that's it. If I want to raise it further I find myself using my abdominal muscles to raise the leg further, which still isn't as far as the right.

With all these issues there is no pain involved..just tightness, heaviness. The leg just stops like it has reached it's full range. Other people or myself can pull the leg into it's full range using my arms but I can't do it on my own or by my own will. I also noticed the more it is put in a normal full range position, the more it protest by shaking and jerking out...going back into it's own normal position, which is not normal range.

Is this from spasticity? Weakness? Both? Something else?
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Avatar_m_tn
Greetings,

I had exact same issue with respect to my left leg, but I don't shave my legs so haven't noticed that problem. Besides my shower is too small, I'd have to use the large one which my wife has taken over.

Ampyra has helped a lot of MS'ers move better, I strongly suggest you ask your neuro about an Rx, then hope you're one of the 50 to 60% that responds. My wife and friends all see me walking better - not great, but better.

A PT suggested that when I use my exercycle I spend about 1 minute in 5 pedaling backward - with Ampyra it helps even though there is minimal resistance. Last week or thereabouts for the first time in ages I was able to lift my left leg a bit while seated.

A very bright PA suggested I take Tizanidine 4 mg, it helps with the low level spasticity she noticed some years back - my neuro didn't - he touches me as little as possible, she saw it. It reduces the low level pain I have in my thighs and notice most as the day gets older. If when you stand you feel tightness in your thighs you might have spasticity.  I am very aware that although my left thigh is thinner than my right, both are muscular - no flab.

I hope this helps.

Mark



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279234_tn?1363108849
Thanks Mark for the suggestions.

I'm already on Baclofen for the spasticity..but I'm not sure if it's just loosing it's punch or if my spasticity is getting worse. My docs said I could increase the dosage because I'm such a conservative dose, but I haven't yet. I wasn't sure if my insurance would give a problem if I ran out early if I did increase it too.

I have both weakness and spasticity..Did you get both when you had this issue?

How does Ampyra work? Does it take away the spasticity?

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Avatar_m_tn
Baclofen and Tizanidine have different mechanisms, according to Wikipedia and since it is the time of day when Ambien hits I suggest you take a look.

I can say that my left leg is noticeably weaker than my right, that bones and fingers don't have the same range of motion they used to.

My unofficial analysis is that some nerves that go to my left leg lack myelin, so not enough muscle cells get the signal, the result is some muscles spasm, some just hang around, not enough do enough to enable easy walking.

Ampyra works by lessening the resistance and therefore the drop in voltage between two neurons. this causes stronger signals getting to the nerves and they are making more muscles move. Side effects are minor.

It also works on my brain, I'm remembering lines of poetry and lines of songs from th 60s, a big surprise both combing and going.
I've said in many spots that my spirits are good, put that may be due to positive cash flow in my first full year of retirement and plans for how I want to live my remaining minutes, days and years.

I just fell asleep, and will give you my best wishes, please contact me back channel if you have any questions.
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279234_tn?1363108849
Does anyone know what kind of spasticity is this considered...flexor? extensor? a little of both?

I have noticed that when I wake up in the mornings, I sleep with my legs bent, and I do have a hard time (painful at times) straightening my legs. Now I have seen Quix's explanation of how and what extensor spasticity is and I think I grasp that concept. Unlike Quix, I can somewhat look at my heal, even though it's a little stiff to do so.

My issue is..it all depends on my leg positioning on what it wants to do. The above description (that I noticed since PT)..it does this constantly. If I'm up on my legs for a long period of time, shortly in to it, my lower back will become spastic all the way down the leg. I will have an issue with sitting and bending. There is also times if my legs are in a bent position I will have issues with straightening. I noticed that when my feet hang over a couch or I'm lying in a recliner, the right leg is following the form of the recliner and the left side is stiff and not following the form but sticking out straight.

My PT noticed something about my foot drop that I never knew. I always thought that my foot drop was caused by weakness but I may have been wrong. While I was lying down, she would take my ankle and flex it toward me and ask me to hold it. I actually could. Now the ankle felt like I had 100lbs. attached to it and it took all my concentration but I could do it. She did have to stay away from my toes..my foot began to jerk around like crazy (she said that was interesting) and I did feel my leg protesting to this action the more it was done..but I have to take what I can get.

Any Insight would be appreciated
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147426_tn?1317269232
Hi, SB, you are describing a bunch of things, mostly weakness, but clearly some of the muscle groups have overlying spasticity.  Remember that spasticity almost almost occurs in the setting of weakness, but it is not a requirement.  You "can" have spasticity without weakness.

Clearly in those situations where the passive (not involving you using your muscles) movement of some of the joints leads to jerking as spasming you are dealing with an element of spasticity.

It becomes hard to tease out exactly how much weakness is due to spasticity and how much is due to weakness.  I'm sure an experienced PT can do it or a Rehab Specialist or Physical Medicine Doc can, but it would be hard for us.  Pure weakness feels a lot like a muscle being pulled in the opposite direction by spasticity.

THE HIPS

There are groups of muscles beyond the usual "extensor" and "flexor".  Clearly you have some flexor weakness of the hips.  When you are sitting and try to lift your leg straight up you are further flexing the hip.  They are already flexed as you sit.  The hips are in neutral position when you are standing or lying flat.  

When you are talking about pivoting your leg, you are describing what is called "rotation at the hip".  Your description of pivoting out is "External Rotation of the Hip" into the "frogleg" position.  Sounds like this is okay for you.  However, you appear to have weaknes in "Internal Rotation" which is making the position of Knock-Knees.

In describing these things, when possible it is always with reference to the midline of the body.  So , if your knee is being taken "away from the midline" it is external rotation.  If the knee is being brought inward (toward the midline) it is internal rotation.

THE ANKLES

It does sound like you have an element of weakness and an element of spasticity to your foot drop.  Whereas you "can" bring up the toes a bit or hold them in "dorsiflexion."  Clearly they are too weak to do this while you walk, likely from some mild extensor spasticity pulling the toe-part of the foot into "plantar flexion".

With regard to the ankle the movement is described with respect to the sole of the foot, which is the "plantar" surface of the foot.  Think "planting" the foot down on the ground or "plantar warts".  In ballet they point their toes - this is plantar flexion of the ankle.

Ankle reflexes are often called the Plantar Reflexes, because the reaction they look for when they tap the Achilles tendon is a quick motion of the foot into Plantar Flexion.  The motion is up and down so the "midline" of the body is irrelevant.

The top of the foot is the dorsum of the foot.  Dorsal is the "top".   Think of a shark's menacing "dorsal fin" zigzagging through the water.

ASSESSING SPASTICITY

The hallmark of spasticity is that it is "Rate Dependent".  This is something your PT could probably assess.  With you lying passively and not using any muscular effort, the examiner moves the limb at the joint.  As they move the limb they assess the muscle tone and the amount of resistance to movement.  In a normal person they will be able to move the joint through the full range of motion.  If the limb is spastic it may feel stiffer (ie. more resistance) or it may feel normal when the limb is moved slowly.  However, if there is spasticity the examiner will feel progressively more resistance the faster the joint is flexed and extended.  This is spasticity.  The faster that the stretch receptors are triggered the more the muscle group will contract against the stretching.

That is why I can stand and look back over my shoulder at my heel when I bring it slowly back - by bending my knee - but if I try to "kick up my heels" they stay glued to the ground, by the extensor spasticity in my quads.

Quix
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