If twitching muscles are terrifying you about ALS, here’s all the reassurance you need from someone “eight years out” from benign fasciculations.

“Muscle twitching, also called fasciculations, are small, local, involuntary muscle contractions which may be visible under the skin,” says Morton Tavel, MD, Clinical Professor Emeritus of Medicine, Indiana University School of Medicine, and author of “Health Tips, Myths and Tricks: A Physician’s Advice.” Dr. Tavel adds, “Deeper areas can be felt but are not visible.”

Rules for Twitching Muscle Reassurance

Muscle Twitching Is Common

Dr. Tavel explains, “They are encountered by virtually all healthy people, though for most, they are quite infrequent. In some cases, the presence of fasciculations can be annoying but, if a neurological examination is normal, they are best disregarded.

“Fasciculations have a variety of causes, the majority of which are benign, especially when the eyelids are affected.”

Search Result Deception

If ALS sites appear at the top of the first page of search results for “Why do my muscles twitch?” this in NO way correlates to the odds that your twitching muscles are being caused by ALS.

Just because sites that mention ALS are in the top half of the first page of results, doesn’t mean this is what you should fixate on. However, people tend to fixate on the first five results of a search.

What puts something on the first page of Google is the way the article is written plus other factors that Google’s web crawlers detect.

If it’s cleverly written, especially on an SEO-optimized site, it will be in the top three—and often in the No. 1 spot.

If I wrote an SEO-optimized article claiming that most muscle twitching is caused by drinking orange milkshakes, it just might end up on the first page of search results.

Avoid ALS Sites

These will only get you more worked up, more panicky. Many posters in ALS forums don’t even have ALS.

I also wonder how many thread responses you must read before you come upon one that was posted by an actual neurologist.

Be leery of forums. These are people just as panicky as you. However, every so often, a thread is started by someone who got a very bad diagnosis—not necessarily ALS; could be MS or some other neurological malady.

Just stay off the ALS sites. These will only fuel your panic.

Avoid Yahoo! Answers

I swear, some of the answers are really nutty. The fact that the avatars are cartoon faces all in the same pose doesn’t help with the credibility of the people “answering” the questions. Just skip it.

Give Yourself Strength Tests

As a former personal trainer, group fitness instructor and always longtime fitness and strength enthusiast, I fully endorse strength tests for reassurance.

But you must do these within reason. Come on, if you’re not into lifting weights , don’t expect to effortlessly hoist a 30 pound box of books onto a high shelf without difficulty (especially if you’re a woman who’s never weight trained).

Don’t try strength tests you’ve never done, either. For instance, if you’ve never before balanced for one minute on one leg while holding a bowling ball…don’t do this as a strength or coordination test.

Instead, keep tabs on tests of strength that your body is already used to, such as trotting up a flight of stairs, carrying out heavy garbage, and of course…gym workouts.

If your best bench press is five pounds less than it was last week, don’t panic.

If you normally bench 185 but next week can’t even do a single pushup, then yes, something is going on—but still, don’t jump to conclusions; it could be an injured rotator cuff.

Being able to lift more weights than previously, of course, is major reassurance. For reassurance, keep tabs on your gym progress.

Avoid Mirrors Other than for Normal Use

  • Stop checking your tongue!
  • Stop checking the symmetry of your legs!
  • Stop analyzing your dents!

Love Your Dents!

Did you know that people trying to lose weight just LOVE to see dents? So do people training for a physique or bodybuilding competition.

Dents almost always mean three things going on: 1) Low body fat in that area; new ALS awareness draws your attention to it, 2) Recent fat loss which increases “definition,” and 3) The body’s natural asymmetry if the dent is visible or more prominent on one side.

When I was a personal trainer, my clients loved showing me their newly discovered dents. Except they didn’t call them dents. They called them “definition.”

Dents in extreme form are called “cuts” by physique and bodybuilding athletes. A person with the so-called buff body has tons of dents, and if you look closely enough, they are NOT symmetrical.

For example, the “dent” (technically known as “separation”) in the quadriceps muscle group is often a bit more pronounced in one leg than the other.

Time Passage

Though anyone who’s frightened by twitching muscles doesn’t have the patience to wait things out, it’s so very true that time passage without progression of symptoms is a powerful reassurance tool.

Mark a red “X” on a hardcopy calendar to indicate each day that there’s no progression, such as true muscle weakness (e.g., you can’t hold up your hairbrush, can’t blow dry your hair, can’t hang up clothes, can’t lift up the cat, can’t carry groceries, etc.)

Not being able to carry a 30 pound box of books up from the basement without fatigue doesn’t count—unless you’re a bodybuilder—and even then, bodybuilders aren’t immune to fatigue.

Sliver Thin Odds of ALS

You’re more likely to get killed in a car accident than develop ALS. Do you not realize how rare ALS actually is?

Sure, it gets a lot of publicity, especially with the ice bucket challenges, but this is a very rare disease. Yet how many people have you personally known who died from cancer?

Get an EMG

If push comes to shove with your anxiety, get it over with: an EMG. Normal results go a long way in reassuring you.

morton tavel, MD

Dr. Tavel’s medical research includes over 125 publications, editorials and book reviews in peer-reviewed national medical journals. He was formerly director of the cardiac rehabilitation program at St. Vincent Hospital in Indiana.