I am sharing some insights into ALS that show why the willpower, be brave mantra, you can run and hike mantra is ignorant of the complexities of ALS at the individual level.
"ALS should be considered a syndrome with a broad spectrum rather than a single disease entity because its symptoms and clinical course are very diverse (e.g., UMN vs. LMN predominance, bulbar vs. limb [spinal] predominance, rapid vs. slow progression, and the extent of concomitant cognitive impairment) [5]. ALS was once considered a pure motor disorder with ‘3 Ps’ (progressive, painless, and paralysis); however, a growing body of evidence indicates that ALS is a multisystem disease with early and diverse non-motor symptoms including cognitive and behavioral changes, neuropsychiatric disturbances, sleep disruption, excess secretions, metabolic abnormalities, bowel and bladder dysfunction, changes in bone health, olfactory and somatosensory impairment, and pain [6]. These non-motor symptoms of ALS have attracted research attention over the last decade, with the identification of a repeat expansion of the C9orf72 gene in some patients and many shared pathologies across the spectrum of ALS and frontotemporal dementia in these patients".
Source is
Pain in amyotrophic lateral sclerosis: a narrative review
Soyoung Kwak. J Yeungnam Med Sci. 2022 Jul.
Free PMC article