Okay, Chris, I’ll take your questions as: In a person without ALS, can perceived weakness just keep coming down the road until one day it turns into clinical weakness?
(Remember, I’m not a doctor.) I don’t believe that’s the way it works.
Perceived weakness is very normal. We have all had bad days at the gym when we just can’t perform up to par, or when walking the dog we just feel bushed, or when carrying the groceries just seems too much, or when lifting a normal weight our muscle trembles or quivers. You focus on the weakness and it seems to get worse. That is perfectly normal. But after a while, you search the internet, and rush off with fears of ALS. You see a neuro. You tell him about your weakness and his write-up says you have no weakness. He does an EMG and it is clean. He says you're fine. How can that be? Is your neuro an idiot? So you keep watching, measuring, testing, obsessing. And if you don’t have ALS, you just keep waiting, testing, obsessing and the anxiety makes it worse and worse.
But if you do have ALS, what happens? One day you step off the curb and end up on your face because your calf muscles don’t work. Or you trip because you suddenly have foot drop, and you can’t dorsaflex your ankle. Or you go the gym after a vacation of several weeks and find that you can’t do calf raises, at all. Suddenly, unexpectedly, something does not work.
We all feel perceived weakness from time to time, and we perceive it in our major muscles—quads, hamstrings, calves, biceps, triceps, a few others. But while you are counting how many bicep curls you can do with your left arm, you will never get to zero. Not before you trip and fall, or you can’t button your shirt, or stand on your toes—if you have ALS.
So, I believe the process is:
(1) If you have undiagnosed ALS and perceived weakness, there are about 300 skeletal muscles in the body and you will never perceive weakness in the muscle that is going to fail first. When it fails, you will have clinical weakness, have an EMG and get diagnosed. But while focusing on perceived weakness, you will develop massive anxiety, a whole bunch of extraneous symptoms and drive yourself and your neuro team crazy.
(2) If you don’t have ALS, just perceived weakness, you will simply develop massive anxiety, a whole bunch of extraneous symptoms and you will definitely drive yourself and your neuro team crazy. (And maybe a bunch of people on this site.)
Moral of the story—don’t worry about perceived weakness.
I feel weak. This seems harder than normal. So what! That is common to every one of us! And it's not a symptom of ALS.
I can’t do it. Not at all, no matter how hard I try! My muscle just doesn't work. Go see a neuro.
I guess your perceived weakness could be due to a muscle strain, a trigger point or something else. So go ahead and worry about it, but it’s not ALS.