Weak? Feel weak? What is the difference?
Twopack, Mary brings up a discussion topic that many of us can relate to -
weakness vs. feeling weak
I hope you enjoy reading this summary of our collective experiences and explanations.
Are you actually weak or just have the feeling of being weak? Many of us are interested in what could cause the “sensation” of weakness. Many of us feel weak (especially in the legs) and feel like we are fighting to maintain balance but oftentimes when doctors test for strength, they seem satisfied with the exam. We often feel maybe there is something we can do to just get stronger!
For example, some try building their endurance and strength through walking pets, or using light weights. But, over several months, experience no increase in stamina or strength. Why?
When brushing your teeth, do you support your elbow with your other hand? Do you feel like someone has strapped sand bags to your legs while you climb steps? Or, do you prop your elbow up on the sill of the window to blow-dry your hair? And, who the heck put buckles to our knees? We don’t need no stinking buckles!
So why do our limbs give up so quickly? Because we very much wish they would just submit and do what we want them to do without restraint! What do we have to do, and more importantly, what do we need to know about this problem? Some explanation is in order.
Some get a “jello-like feeling” in a muscle, but the muscle still does pretty much everything they want it to do. This feeling “can” be separate from true weakness. Early fatigability says that the nerves to the affected muscles are being damaged by the MS. The site of damage is not the muscles themselves. The muscles are fine - in the beginning. It’s the myelinated motor nerves that have been attacked somewhere in the central nervous system causing issue.
A nerve with damaged myelin can’t conduct the nerve signal as efficiently as a healthy nerve. If most of the signal is arriving, but it is delayed, the muscle may feel normal initially. But with repeated firing, the nerve signal gets weaker and weaker, and the muscle then doesn’t get the full signal to contract and subsequently can do it’s full share of work. We perceive this as weakness even though the problem is in the signal “to” the muscle and not “in” the muscle itself.
Upon exam doctors check for “good” strength just at one point in time (i.e., every 6 months). Some recent studies have been admonishing the doctors to listen better to our complaints of getting worse. Because we typically know what we can do, and what we can’t. We can't depend on this spot check for strength. At times, we know what happens better than they can test for.
Case and Points provided by Doc Quix:
So, if it feels like our legs are weaker - let's check it out. For me, it is next to impossible to lift my right knee as I walk. Initially, I couldn't lift it up to my waist like I could the other leg. But, I could climb stairs - without much problem. However, over several months I noticed first that my right toes started to drag on the stairs and make a mark in the nap of the carpet as I went up. Finally, after a few years, I could lift my foot to the next stair only by a process of turning my knee inward and swinging it over to kind of throw my foot up onto the step. Then, I move it in place with my hand. Now I can manage this weird way of getting the foot up in the morning, but by mid-afternoon I cannot get the foot up onto the step at all.
If our arm feels weak to lift it up, then we can report that we can't hold it over our head. Or saying we can begin to brush or blow-dry our hair, but can't sustain the position. That is the case with my right deltoid. It fatigues very quickly, and I do most work with my left now.
So now that we know the difference, what do we do about it?
Important mentions and guidance from our members!
Ë We need to report what we have lost or what we now cannot do to our neuro. If they test us and tell us we are normal, we MUST protest and tell them that we might be good for one or two uses but the muscle begins to fail as we do more.
Ë If we go to the gym we can actually see a decrease in the strength - and measure it. This might be expressed in a decreasing distance that we walk, or a ever-slowing pace. We can time how long our usual walks last now and before.
Ë We can separate strength from endurance. The many cause of fatigue fight us in all of our muscles, while we may have true weakness in this and that muscle.
Ë No matter how strong we were - even if we were extraordinarily strong, if the signal can't reach the muscle in full power then the muscle CAN NOT contract. Think about the person that is an athlete that has a spine injury. The muscles are just a fit as they always were, but if the signal can't reach them (because of the spine injury) those muscles just sit there all floppy and useless. In MS, the problem is the poor nerve signal, not a disease in the muscles. This often increasing weakness is part of the disease we live with. Exercise is only as good as the signal is that tells the muscle to contract.
Ë Your doc should be intensely interested not only in what you tell him, but in examining you for signs of problems or deterioration. My neuro (Doc Quix) did a full neuro exam on me EVERY visit. He examined 18 pairs of muscle groups at each visit and compared them to his prior notes. So when my right hip flexors and right deltoid weakened over time he could see it. Sometimes he would say that the exam was stable, but he would note that I said it was fatiguing earlier.
Ë MS is notorious for systemic fatigue. The sense of feeling like you just ran a marathon - as if, but still, it can be overwhelming. That fatigue is a different kind on top of any localized weakness.
Ë If our doctors say that "all is normal" we can and should all ask for a Physical Therapy evaluation and treatment if appropriate. The PTs will quickly see the problems and can report back to the neurologist. Then it is on paper and part of our record.
Ë PT is HARD and I (Dh) am in pain a lot even after just a minimal amount of stretching and exercise but I know it is good to keep the strength I can keep.
Ë Press forward despite whatever MS is trying to steal away!
~ Members of Medhelp’s Multiple Sclerosis forum