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Distinguished member
Oct 17, 2008
Let me try to describe a realistic, but hypothetical situation and get some reaction (sorry, my brain just works this way - too analytical)...

I know docs measure strength on a scale when they do a clinical exam, but it seems impossible for them to really measure strength the way they do until there is profound weakness. Let's invent a scale from 0 to 100.

Patient A is a woman of healthy weight that does not exercise other than normal hard-working daily activities. She might start on the scale at 55.

Patient B is a hard-working construction worker male of healthy weight (sorry - not trying to appear sexist here ladies) lifting with all muscles all the time, and works out 3 days at the gym. He starts out at 90 on the scale.

Suppose they develop weakness in the same place at the same time and it progresses at the same rate. Still with me? :-D So by pulling or pushing on muscles the way they do on an exam, doesn't the guy take longer to get to the point of not resisting the neurologist's exam? Same for a toe or heel walk, rising from a chair, etc. So the guy feels more subjective weakness longer and can't do some of the things he used to be able to do, but the clinical says he's fine.

I just keep thinking dang - I've started at 80 and feel weaker, but have not gotten to a point of them being able to measure (believe me - that can be a good thing I know) but if it is a process that is treatable, they won't hardly even get me past a clinical exam before they dismiss me.

This might be too deep for a Monday, but there you go. Something to ponder and give me your thoughts on.
I have been reading about the different ways that the muscle strength can be measured, and yes, you are right the scale approach based on a purely physical examination can be both subjective (determining where to place someone on the scale) and 'gendered' (although I think that the consideration is probably given to average male or female strength upon first examination).

There are other methods, that involve using various machines that measure muscle strength, but I can not now recall what they are called. They are apparently very rarely used due to being seen as time consuming (I have read somewhere that an examination using technology could take anything up to 3 hours, tackling different muscle groups etc.)
I have thought about what you are describing exactly the same way. Just how bad does it have to get before it is measured by that relatively insensitive exam? I did have my neuro describe my so called weakness as "subtle" 6 months ago...I thought she was just patronizing me. I have gone from where I can no longer lift a bag of soil to my shoulder to where lifting a gallon of milk past waist level is impossible with one hand (hard to drink from the jug that way:grin:) since then...what else is coming? Let's see how I do against the 6 foot four neuro I get this week (ladies I will let you all know....maybe I will swoon...ok I gotta get out more!)

ktmi ... very good insight. As Lydia says, there is also the flip side of this: the doctor's strength. My current PCP is a tiny woman (smaller than me), and when we were doing all the grip and push against resistance tests, I was more or less pushing her around. And she said, "You're so strong!"

Well, I'm not ... So I know her assessment of me must have been way off, and I don't know how she would possibly be able to evaluate a man's strength. I don't mean to be sexist, but I think you're right ... there should be an objective way to measure strength and decline.
I was told by the PT that it has to be at least 60% loss of strength before it can be clinically evaluated by a practitioner. My neurologist also said that a person has to be very weak before it can be assessed. They both have told me that it is the patient that notices the weakness first, and that the input we give them about what we are experiencing is valuable, because they know they can't tell objectively until it is advanced.
oh, and Lydia.... you're making me want to take a trip up to Buffalo for a "second opinion" from your hunky neuro... never can have too many opinions, right? :cool:
Thank you for this thread. This has been a concern/frustration of mine since beginning of this process. My local neuro is a pretty built guy, and so I do feel like he is a reasonable gauge, but it's the point of reference concept. He may conduct a strength test 2 or so months apart, and unless something drastic has changed he's not going to know.

When we moved into our rental 4 and a half years ago, I carried both the washer and dryer up the stairs myself. When my friend moved two weeks ago, I had a hard time helping move appliances. Now if you press down on my arms, you're not going to pick that up. (BethU: I had a similiar experience at the U of U when the specialist let the resident fellow do the strength test. She was a petite gal, and I barely felt any resistance at all.)

It seems like physical and occupational therapists have a much better handle on this. Since they frequently work with resistances and repetitions they can monitor progress over time. Part of me now wishes I'd stayed with my PT to track progression over time (though she was a neck specialist so maybe not...).

Take care,


You beat me to the PT comment :)

Maybe we all need to post pictures of our neuros with their hobbies and birthsigns ;) We could arrange for refferals until the insurance money ran out.

Robert.... hahahah love it! :grin:
Let me know when the bidding starts on Lydia's neuro. I've ALWAYS wanted to visit Buffalo in the winter.
i know the scale of muscle weakness is from 0(paralysis) to 5 (good).
learnt this from my pt,i was at the begining of the year about 2.5 but feel much weaker now.
loss of contraction in my left lower leg noted by a neuro test a few years ago was classed as clinical weakness,i now drag this leg about and the leg/foot is showing signs of atrophy.
you know what is normal strength or weakness in your own body,by this i mean what you should by all accounts be physically able to do as a normal able bodied person.
well, first of all, I'm in on the trip to Buffalo, just let me know when!:grin::grin:

My first neuro, 6/08, let the 2 male interns test my strength first, then he did. They all came to the conclusion that I was a "5". At that time, I had no idea what was going on of course.

Then when I saw my neuro 11/08, he had a female intern, they measured my strength at 5 on the right and 4.5 on the left. I don't know if she would have said 4.5 or not, because I just about pushed her down. Actually I just about pushed my neuro down too! Didn't mean to, but I guess the "oomph" down inside didn't want to consider that I was one bit weaker!

And also now that I think about it, at my clinic visit in 11/08, I had the EMG done, spent a lot of time just talking with the neuro, the ALS association ladies, and the resp therapist, the nurse told me since I really didn't need PT/OT/ST, and it was WAY PAST LUNCH, I could just see them next visit. Mind you, I hadn't eaten either, but on my first visit back in June, the PT didn't measure anything?

I'll make sure I get my money's worth next visit!
ya'll take care,
I went to my neuro today and had this same conversation with my wife when I left. I am young (31) and very athletic. I am starting with a higher baseline that what my neuro is used to seeing. I told my wife today- If I failed the tests he gave me (pushing down on my leg, pulling my wrist) then I would already know myself without a doubt that I have something very very serious and probably would have had a tough time even walking into the office. I know I have weakness, I can feel my leg shake sometimes when I walk down stairs and my arms shake when I lean on something.

CB in Ohio
My arms shake too when I hold does depend on the length of time and the weight of the object. I wasn't sure if I thought it was a big deal or not; not enough to see a doc. I'll mention it tomorrow. Perhaps I HAVE had some weakness all along. Like a tightness in my hands that feel like they don't want to spread open all the way or they could potentially get locked in kind of a contracture. They don't, but they certainly don't feel as flexible as they used to and this has been going on a while. I think I do have weakness of my arms though not in my legs that I notice. Man, my head is a mess. Anxiety keeps climbing.
I have witnessed daily what my Mum has gone through and it does not sound like ALS/MND but there have been some HOT docs along the way....a warped bonus I reckon.:lol:

Good wishes to you all

Kind regards

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