A neurologist explains in detail how to tell perceived weakness from ALS weakness.
Is there a way to tell the difference between perceived weakness and weakness from ALS?
“Imagine: You just completed your workout at the gym and you feel that you couldn’t bench press the amount you are accustomed to,” says Anthony P. Geraci, MD, associate professor of neurology at Donald & Barbara Zucker School of Medicine in New York.
“You wonder about it and if you might be weak on that day; maybe you are just tired. This is perceived weakness, a very subjective measure of strength.
“It is very important to understand that the strength of our muscles varies due to a variety of variables on any particular day or time.”
Perceived weakness also often comes in the form of how a muscle group “feels” at rest.
A person may feel that the muscle group is weak and begin fearing ALS.
But the perception of weakness disappears the minute they must pick up heavy boxes from the garage.
The minute they sit before the computer, they start perceiving weakness and fearing ALS.
Why the ALS fear? Because this is the channel that their mind gets tuned into.
“Perceived weakness is NOT true weakness,” says Dr. Geraci. A healthy person may feel a weakness in their leg when sitting before the TV.
The perceived weakness disappears when they find themselves dashing down the street after their dog.
Dr. Geraci explains, “True weakness can only be identified by two means: The first is by identifying the weakness in one limb or part of one limb that leads to functional impairment.
“In other words, a weak hand that drops objects and gives you trouble buttoning your shirt.”
In other words, clinical weakness is exhibited by having trouble doing simple things like blow-drying your hair or hanging up clothes, opening a car door or removing a pot roast from the oven, as opposed to bench pressing 195 pounds this week when last week you pressed 205.
“The second is by having a neurologist objectively determine weakness in a group of muscles,” continues Dr. Geraci.
“Weakness from ALS always is accompanied by atrophy of muscles, and objective findings that only a physician can identify.”
When worried people find this out, they become prone to inspecting the body part in question for signs of atrophy.
They decide on what atrophy must look like, that a “dent” in the calve must absolutely mean muscle atrophy.
This is the mind playing tricks!
We’ve all seen true muscle atrophy; anybody who uses a wheelchair exhibits noticeable atrophy in their legs.
Or, the person with one side of their body mobility-impaired (stroke, cerebral palsy) has very visible muscle atrophy on that side.
But back to perceived weakness…
“In the age of the Internet, it is very easy for people to have a twitch here and there, and a couple of days of bad workouts at the gym followed by an Internet search that spits out ALS as the answer to their symptoms,” says Dr. Geraci.
“My advice is this: First, ALS is very rare, and second, try turning the symptoms around and looking at them as a manifestation of the normal state of affairs in the body you are exercising.”
If you haven’t been exercising, apply this advice to household duties such as carrying the vacuum cleaner up the stairs, carrying children or running down the staircase.
“If you are worried about having ALS, consider the above and ask yourself which group you fit into and I’ll be willing to bet you’ll come to the most likely conclusion: You are just fine.”
Dr. Geraci is also the director of neuromuscular medicine at Northwell Health in New York.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer. \
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