Could this be early on set of ALS? Back Pain /Abdominal Tightness

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Lbrooks51115

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Good Evening. I am a 53 year old man and I will be the first to admit I have an unhealthy habit of surfing the internet for symptoms when I have symptoms that I have not experienced before. I apologize for the length in advance but would really appreciate your feedback.

Three weeks ago while at work I noticed some very very odd "vibrations" coming from pocket like my cell phone was in there, but there was no cell phone. Very strange..The PCP theorized that was coming from a nerve in my back but I will say it took place a few days before the back went out. It happened very sporadically for 3-4 days and than my lower back goes out. But this was different. I have had spasmodic back issue in the past and it comes and goes in a few days-usually spasms. This was different.It was extreme painful back stiffness that would get much worse if I had been sitting down for a while and than stood up. In the past when I had spasms it hurt if I turned over in bed but this was very different and would bother me after sitting and trying to stand.

In addition to the lower back going out, my lower abdomen muscles at the same time became extremely tight-like really tight. This was not anything I had ever experienced. Of course once I started googling it was off to the races. I had those fasciculations before my back went out, found some articles on how lower back pain in some instances has been a precursor to ALS, and you combine it with the lower chest tightness (Spasticity?) and of course I am wreck.

I went to my PCP and they prescribed some predisone for the back and took an xRAY. Nothing spectacular other than I have an alignment issue with my spine from years of bad posture and desk work. When I raised the issue of ALS they said doubtful but I made an appointment with the neurologist. He told me there is no way you have ALS after doing literally a 5 minute exam but you may have a pinched nerve but he said if you would like a nerve conduction and an EMG I would be happy to do that and it could clear you of ALS and tell us if you have a pinched nerve. I did the the nerve study and EMG on the right and left legs and it was not 100% clean. They did find abnormalities in the nerves/muscles that are connected to the L5 Nerve Lumbar spine. Both the Doctor who administered the EMG and my neurologist stated that this is likely nothing to worry about because the abnormalities are confined to a pattern that points to the Lumbar Spine and a pinched nerve which is what triggered the whole episode. The muscles and nerves not attached to the L5 were normal (but they only tested those two areas) My neurologist was even more confident saying I should feel good about the result. "I came with questions and he has given me answers"

Over the last 2 weeks my back is still stiff but has improved compared to where it was and the tightness in my lower abdomen is still there but not nearly as strong. The fasciculations disappeared as soon as I started taking the steroids (I get the occasional one on the calf which is normal for me). I have noticed my legs have felt weak the last couple of days which has concerned me but as the moderators have said, that's a felling not a clinical presentation (and who knows what I have been reading gets into my mind). I am going to have an MRI to validate the pinched nerve and than do some PT but I guess I am wondering if I should be satisfied with the explanation on the abnormal EMG. Even the DR who administered the EMG said while high probability is its related to the back its not impossible that it is early ALS onset-not likely. I am sad because I was hoping I would get a definitive answer. I am literally at mean age of ALS diagnosis. Any help or guidance would be greatly appreciated.
 
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Please read this if you have not already done so:

Pain points away from ALS. I don’t know where you read that lower back pain is a precursor to ALS, as this is not the case.

The hallmark of ALS is clinical weakness (as detected by a physician) leading to muscle function failure. Examples of failure would include inability to rise up on your toes or heels, inability to fasten a button or open a ziplock bag, slurred speech that others notice. Also the back improvements are a good sign.

Twitching is common, nonspecific, and meaningless in the absence of muscle function failure which you have not described.

Most likely the back pain and tightness are mechanical. Depending on the MRI results, you might see an orthopedist, neurosurgeon, or physical therapist.

EMGs can show abnormalities for many reasons, not just ALS. It sounds like you’re clear of ALS. Congratulations.
 
Karen thanks for the response and suggestion on the MRI- I really do appreciate it and now I just need to stop with my hypochondriac tendencies. Apologies about my one long single paragraph and thanks for editing! The back pain and the precursor to ALS was an article written by an Italian or French researcher trying to see if there were any early symptoms that you could see to predict ALS (Google Back Pain ALS early symptoms). I think I grabbed on to it because of my phobia and because of how different symptoms that I was experiencing from past back issues and I panicked. They should probably find anther symptom since 50% of people have back issues once they hit 40!
 
Back pain and twitchiness? Sounds like my typical day/ week. Best of life and health to you. A good sauna or whirlpool can help both issues, if you enjoy them 🙂
 
Thanks Lenore much appreciated and best of life and health to you as well!
 
I am sorry Dr. Karen for bothering you but I have one other question and that's abdominal tightness. It's extreme tightness that hits my lower abdomen when I stand up and of course when I search Dr. Google the only thing I can find is Spasticity which in ALS impacts the Abdomen. Groups of muscles that tighten up. I have had this since the back went out. 3 weeks ago. The orthopedic back doctor and Neurologist had no explanation. I have never had something like this before and while it is less severe than 3 weeks ago it is still there. Are there any simple medical explanation for this? Obviously I will consult again with my neurologist but I think it was this specific symptom that was really had me stumped and nervous. Thanks again.
 
You’re not describing spasticity. See a physical therapist.
 
Thanks Dr. Karen, I see the PT on Wednesday. One last question. I finally was able to get my EMG results and was hoping you could take a quick look. The fact that there is no spontaneous is a good thing but don't understand how concerned I should be about the MUAP abnormality on 4 muscles.

Thanks Again.
 

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Please re-post the summary and conclusions (the text got cut off). It doesn’t look at all like the sort of pattern we see with ALS. Know that EMGs can be abnormal for many other reasons besides ALS, and all those other reasons would be more common.
 
I could see the conclusions. As it notes your emg is consistent with a spinal issue. It is not worrisome at all for ALS. We often see people in this section with similar findings that are related to a back issue.
you are good to go.
 
Ok thanks Nikki and Dr. Karen. I assume the MUAP is the number that matters because that identifies any muscle weakness and therefore an abnormal MUAP is something that you would see early in the manifestation of the disease? It scares me that there is some identified weakness albeit mild but I trust the doctor and you guys and not Dr. Google. Thank you
 
Congrats on the no ALS and clear EMG. Now that all your questions have been answered, and you do not have this awful disease, you are now free to go on your way.

Best of luck to you and take good care.
 
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