muscle soreness after activity

I am (impatiently) waiting to see a neurologist at UW Madison in October, hoping to get a diagnosis of some sort (brain MRI showed lesions, but all other tests negative, symptoms since May).  Anyway, my question is about muscle soreness.  One of my main symptoms is left leg weakness.  Most of the time I just know it's there, but not too much of a problem.  But when I try to do more, like take a bike ride with my kids, walk a lot like at a fair, my leg becomes more tired & my muscles get sore.  They don't cramp, but feel like they're on the verge.  Then I do have trouble with normal everyday things like stairs, and being on my feet to do things around the house.  Does anyone else experience this?  I also have other symptoms, pretty much all on the left side, like paresthesias, but this is my main complaint & very frustrating, as I have 2 young boys, I try to be active with biking and playing softball, and my job requires me to be very active as I'm a physical therapist.  

[Quixotic1]

Hi, and welcome again to the MS forum.  I see that you were here briefly in July.  I have experienced exactly what you describe in terms of the weak leg that feels sore, weaker or weird with exercise.  While I can't tell you whether or not you have MS, certainly we can discuss the things that you have brought up in the context of MS.

What I gather from you is that you first began having problems when your left leg became very weak a few months ago.  The worst of the weakness lasted a very short time, but you were left with a lingering and noticeable weakness.  Now you find that the leg muscles are sore and more tired than they should be for the exercise you have done.  Have I got it right?

The other piece of info we have is that you are female, 36, and that you have had some sort of MRI which shows white matter lesions.  You apparently also have migraines and your neurologist seems disposed to write off the lesions as due to the migraine disease.  

Poppycock!!

First, I would like to address the white matter lesions and the migraine disease.  Yes, migraines do, indeed, cause WMD (white matter disease), but no where in my reading are these lesions symptomatic except in the case of frank strokes.  So, your neuro saw that you had symptoms suggestive of white matter disease and went looking for lesions.  When he found such lesions, he wants to dismiss them as the innocuous lesions seen with migraine headaches.  That leaves him without any explanation for your symptoms.  This is silly, but we see it all the time.  Your symptoms are very suggestive of a demyelinating disease and MS is by far the most common.  Those lesions should be viewed with great suspicion as being casusative of your symptoms.  Could some of them be due to migraines?  Of, course.

What is characteristic of your symptoms?  The assymetrical way in which they appeared.  One side which over time grew to include not just the leg, but the arm as well.

If you have read much on this site you will know that the diagnosis of MS must proceed stepwise and is often not an easy task.  When someone presents with symptoms suggestive of demyelination or MS, the neuro must then do a VERY thorough neuro exam.  What did yours show?  Do you have hyperactive tendon reflexes on the left side?  This would be expected, but not demanded by your symptoms.  Do you have demonstrable muscle weakness?  How does it rate over previous strength and over the right side?  Being a PT you have an especially good basis to evaluate this.

After the history and physical the neuro typically does two things.  The first is almost always an MRI of the brain with contrast.  The second is a series of blood tests to rule out the MS mimics.  Okay, the MRI shows lesions and we talked about that above.  I gather the lesions are small and suggest microvascular disease from the migraines.  The problem is that MS lesions truly can be of any size from microscopic to gi-normous.  For the purposes of diagnosis, though, many neuros don't "count" any lesion that is 2mm or less.

But, on to your basic question.  Yes, I have the exact symptoms with exercise that you have.  My first symptom was weakness of the right leg - specifically the hip flexors.  It only showed up with lifting the right knee quite a lot.  But, I also had the rapid fatiguing with exercise.  I didn't have the muscle soreness, but many others here have had this.  About 18 months after the leg weakness began, I had the beginning of right arm weakness - specifically the deltoid.

Why does this happen?  In the context of MS, muscles that have had their motor nerves damaged with demyelination are subject to failure with repetitive use.  There is less "reserve" so to speak within the nerve and it gives up.  The fatigued muscle is likely to cramp or spasm.   As the nerve becomes more damaged you might find, like I did, that stairs that used to be okay are now slower and the toe begins to drag and touch the stair on the way up leaving a mark on the carpet.  Eventually, I couldn't make it all the way to the top and would take the last step or two with the good leg only.

It is summer and if you are riding bikes with your kids in the heat or walking around the fair in the heat, you need to know that demyelinated nerves have slowed conduction when the body temps rises even just a fraction of a degree.  With the myelin insulation damages you can think of the nerve impulse just shorting out and not reaching the muscle with any sort of a good signal.  If you even suspect that MS might be the culprit you must do all that you can to avoid overheating as significant overheating can lead to a bad (or permanent) relapse.  Things that cause overheating include hot showers or baths, exercise, ambient heat.

Here is a quote from one of our Health Pages on Fatigue in MS:

"2) Increased fatigue of exertion. In people with muscle weakness, those muscles will fatigue faster in continued use. Nerves fibers affected by demyelination are susceptible to a) early exhaustion.  This means they become tired with far less use. b) Rate-dependent signal block. This means that the faster you try to move, the more poorly the signal gets to the muscles.  And, c) There can be complete conduction block with increased temperature. As a person exercises or is exposed to higher heat, the demyelinated nerve fiber may completely fail.  All this boils down to decreased stamina that you cannot correct with conditioning exercise.  It also can mean that whatever you are doing, you must do slowly in order to get it done at all.  An attempt to move fast can cause failure of the muscles to even get the signal.  Finally, the act of exercising itself can raise the body's core temperature slightly in all people.  This increase in temperature accentuates the weakness, along with other MS symptoms.  The same occurs no matter why a person gets too hot.  "Too hot" may indicate just a fraction of a degree of increased core temperature."

All in all I am troubled by the severe symptoms that you are having and that your neuro is not inclined to consider that your lesions might be the culprit.  Migraines do not cause symptoms like MS, though they do cause white matter lesions, so it is a bad explanation for your story as I understand it.

If you do have abnormalities on exam like hyperactive tendon reflexes, then it is mandatory that you have a full spine MRI done on the highest MRI strength available.  Hyperreflexia is "by definition" caused by spinal lesions and not brain lesions.

You might read the HP on Spinal Cord Lesions:

http://www.medhelp.org/health_pages/Multiple%20Sclerosis/Spinal-Cord-Lesions/show/764?cid=36

I hope we hear from you about the results of your neuro exam and what is happening with your work up.

Welcome again.  This is a good place to be while the worry and uncertainty take hold of your life.  Whatever turns out, we'll be there for you.

Quix

[HVAC]

My muscles tighten up during any exercise. I have to do a lot of stretching. When I straighten my legs in a stretch you can hear a crunchy sound they are so tight.

Alex

[amos13]

Quix,
Thanks so much for your very informative reply to my posting.  You must have read my earlier posting and you have the details correct.  I started with isolated tingling in my left big toe for about 3 weeks, then had the sudden weakness in the left leg (like it just went floppy) that lasted only about 15 minutes, but have had weakness and decreased sensation in the left leg since.  Gradually I noticed left arm weakness, but not as bad as the leg.  I have been quietly following the multiple sclerosis forum and have gained a lot of valuable information.   On the other hand, learning about everyone's stories about how long things have taken to see doctors, get a diagnosis, etc. is somewhat discouraging.   I have also tried to do a lot of research about the migraines and lesions, and I agree with you that it seems very silly.  When the neuro I saw in July told me she doesn't think it's MS but thinks it's migraines, I asked her if migraines would then cause my symptoms.  She said she couldn't say yes and she couldn't say no.  That answer isn't good enough.  She then referred me to UW Madison.  And who knows if I'll get an answer there???

In addition to the brain MRI which did reveal lesions, I have had a whole spine MRI (negative for lesions or disc pathology), EMG which was negative, blood work to rule out mimics which was all normal.  The neurological exam given by my neuro was normal according to her.  As far as the muscle weakness, in my opinion, she didn't do a very thorough job with the muscle testing.  As I mentioned, I'm a physical therapist, and I evaluate patients' muscle strength every day.  She didn't push hard at all.  A 90 year old sedentary woman could have easily resisted the amount of pressure my neuro gave.  (Can you tell I didn't care for her all too much?)  My PCP is wonderful and ordered the brain MRI right away when I went to him with my symptoms, so I figure I can always go back to him if I need to.

Again, thanks for all the information.  You guys have a great forum here.  It's nice to know I'm not alone, and there are people I don't even know willing to help me out & share their own experiences. I will probably still "quietly" follow it, but post as I get new information or have any additional questions.

Until then!
Amy

[Quixotic1]

I hope you are still quietly reading.  Soon after I wrote my answer to you I overexerted and did suffer some muscle soreness along with increased and persistent weakness.  I had to go up and down the stairs in my home about 5 times one day and help lift some heavy stuff.  The next day - when I was collapsed in my recliner - I noticed a weird soreness in both my right thigh and my left upper arm.  It felt "sick" - not like the sore muscles of overuse I know from my more athletic days before MS.

So, I wanted to add that to your answer.

Quix

[puppythreads]

Dear Amy,

I am late to this post, but really wanted to encourage you to persist until you get answers.  I just moved back home to Maine after working in Madison WI, by the way.  I had been diagnosed 12 years ago with "probable MS."  I went into remission and moved to Madison about 7 years ago to accept the offer I received for a very good job.  Well, about 2-3 years after moving to Madison, the symptoms returned.  The neurologist I saw totally blew off my symptoms and said I did not have MS.  So I limped along until I finally lost my job and my insurance because of the disease "I did not have."  I returned to Maine to live with my folks, just had another brain MRI and have 13 lesions, the largest of which is 7mm.  This is substantially more than I had on my first MRI of 12 years ago.  The neurologist I am seeing in Maine is wonderful.  He pretty much confirmed MS because of my symptoms before he even ordered the MRI---because he really listened to me.  Trust your instincts and the knowledge you have about your own body.  If this Neuro you see in October does not help you and your symptoms persist, find another.  And dont let anyone ever tell you it's just stress.  

Prayers and best wishes to you,

Karen

[ironwoman]

Hi there,

I get the muscles soreness with activity as well.  The more I do, the more sore they get.  And, my weakness is progressive based on how much I use my leg.

I am awaiting dx as well, so we can impatiently wait together.  Good Luck

[sbr497]

I don't know is this is going to help.
I go for jogging everyday morning. I don't have any problems with that.
One of the reason I do that is that without my regular exercises, I feel very dull.
With exercises I come to a point where normal people generally wake up with :-(
But when I do exert myself any other time during the day, I tend to get muscle soreness.
So it looks like MS is more complex to be casted under a simple equation of yes or no.
There are probably more parameters at play then we can probably imagine.

[wadeheather]

I am undx,  but also get muscle soreness as you mentioned. My right leg in particular and my right shoulder/neck/arm. I have a pretty physical job  and walk a lot.  I notice that after my drive home I can barely get out of the car sometimes. Thought maybe I was just getting out of shape, ha! I also have problems with the stairs.  My leg and arm tend to feel heavy more  than cramp or spasm.