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    In ALS, the muscle shrinks, also after prolonged disuse. Since the motor nerve in the brain is destroyed, the nerve doesn’t order the muscle to contract. So the patient sits in a chair, is lifted by caregivers to the toilet, and then is lifted to bed. The muscle never gets the signal to contract, so there is no attempted movement. The muscle itself is NOT failing, so it is not pushing against anything, so it doesn’t feel pain. So the answer to your question, in the case of atrophy due to ALS, the patient feels just fine—no pain, no nothing. He looks at his muscle and thinks, “I feel normal, but I can’t walk!”
    2/3
    In most cases of (non-ALS) atrophy, the muscle shrinks because of prolonged disuse. A career in an office job, perhaps. In these cases, when the patient attempts to use the muscle, perhaps an old man jumping for a rebound, the patient would feel weakness as the muscle is ordered to contract, but it doesn’t have the strength to do so. The muscle pulls against its attachment points on the bones, and it can’t do the job. The old man feels his leg is weak.
    1/3
    In some cases (not ALS), the muscle shrinks because there was an insult to either the nerve that feeds the muscle, the muscle itself, or another insult that causes the muscle itself to lose protein. For instance, when the muscle has not yet recovered from a big intramuscular bruise, the patient would feel pain when he tries to use that muscle, and this pain would signal the brain to stop activating that atrophied muscle. The patient definitely feels pain and complains of weakness.
    3 of 3
    As to your calf, the twitch and atrophy business might mean something, or not. It might mean you need to get more sleep. But you don’t have any reason to think about ALS, anyway.
    2 of 3
    My wife’s first symptom was she fell down. Boom. A muscle on her foot was no longer holding her up. Being a scientific-thinking person, she knew that you don’t just fall over for no reason, so she went directly to a neurologist and got diagnosed with ALS.

    Over time, we saw some twitching on some of the muscles. It happened this way: She would see the twitch on a muscle, and a week later that muscle became paralyzed.

    But most of her paralysis did NOT have any twitching involved. Also, most of her twitching was not associated with any paralysis. Twitching is just too random to be an indicator of anything.

    Healthy people twitch. It’s usually caused by stress (makes my belly twitch), or by lack of electrolytes (when my arms or legs twitch, I drink a Gatorade), or the muscle/nerve is temporarily damaged (like from bumping into the corner of a doorway, but not even noticing it.)
    If a large piece of muscle has atrophied, there could be several reasons. ALS isn’t one of them. Show it to your family doctor and let her start an investigation.

    I use the generic word “Twitches” because there are differences in different kinds of muscle movements that some people call fasciculations. It takes a real doctor to diagnose a muscle movement disorder, so I’m certainly not going to try over the internet.

    But I know ALS fairly well, and I can say a few things about that.

    Lots of people twitch, and it has nothing to do with ALS. If a person—a person who has ALS--says that their first symptom was twitching, I only infer that they had twitching (like many people do) and they got ALS. Maybe it’s legit. Maybe it’s coincident.

    1 of 2
    Sorry, Aswertido. If it's got anything to do with health or ALS stuff, I always insist that it go in the public forum "Do I Have ALS" so everybody can benefit from the answer.

    If you're still shy to share, you can put it in a Visitor Message, just like you did, and I'll erase it after reading.
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