Exercising Weak Limbs

[risnerrose]

Would there be a benefit or a detriment to exercising an arm or leg that is experiencing weakness?  My right arm and leg are showing signs of atrophy, and I wondered if I should do some strengthening exercises.

Sherry  

[supermum_ms]

I've been doing a lot of stretching exercises but i cant do too much or i end up with muscle fatigue, or in other words my legs feel beyond weak and they tremor, sometimes they over fire and i dont want to go back to that again lol. I'm not game to do anything more than stretching and basic basic yoga yet.

I dont know why but my calf muscles are really floppy, i dont know how to explain it properly but to give you an idea if i lift my leg you can see the definition of the muscle, to touch it though gets the jelly effect, all wobbly like its not attatched to the bone, this is abnormal looking and not normal for me. If i stand though i get the estreem opposite affect, they are tight like a drum and by the end of the day my calves are hurting they are so tight.

I did once apon a time tear the muscle off the bone, cant remember which one, the one between your elbow and wrist, and then i could do the same thing, see the muscle hanging low, touch it and it would wobble like jelly. it was beyond painful though so i couldn't use the arm at all for about 16 weeks. My calf muscles look the same as this but only hurt hurt at the end of the day, from use though and not from obvious damage.

I have the issue of finding the balance, i'm sure that without the stretching i would be worse off but my legs are still weaker than i want or need them to be, and yet they are too tight during normal usage. Squatts help to strengthen thigh and calves which is what i need but too much and i end up with these muscles fighting each other like naughty children and i eventually end up walking like a puppet.

Too weird, i just leant over with my hands just above the knees and the muscles around my knees and the lower part of my thigh went into spasms, or over firing for what reason i do not know but nothing really surprises me anymore. Any ideas would be helpful, cause i know i cant be the only one with this happening too.

Cheers.....JJ

[jensequitur]

Unfortunately, yeah.  My right hand is quite weak, and after using it for a while, it just stops working.  I was scrubbing the tub and found I couldn't hold on to the scrubber any more - kept dropping it.  Finally had to switch to a scrub brush with a big handle, as it was easier to hold.  Although not as good at scrubbing out the tub!

I've also been learning how to play the stand-up bass, and after an hour of playing, my fingers get so fatigued that they can't play in time.    

I think I overdid it this weekend - band practice, house cleaning, and now today my hand feels trembly and weak.  It shakes when I hold it out.

I went to the neuro about my smaller-than-usual right leg.  He looked it over, but had no comment.  That leg is weaker than my left, and one of the muscles (the peroneus longus) is definitely atrophied.

[risnerrose]

My right leg (esp. the thigh) is about an inch smaller than the left, and I think it is a loss of mass.  No one seems concerned about it, so I haven't worried with it.

This weekend I became quite frustrated with my arm.  I was attempting to scour the stove burners.  The small circular motions were causing my arm to fatigue and quiver.  It took forever to clean the burners, and I now wonder if I was wrong to push through it.  My arm feels very weak- two days later.  

Are these the things we "just suffer through" as MS patients?  I saw my last month, because my right foot did not respond when it needed to.  His response was . . . "You do understand the course of this disease, don't you?"  I got the impression I needed to "deal with things".  

Just confused,

Sherry

[Quixotic1]

In the post above I made an important distinction between true atrophy and mere loss of mass which occurs very early with disuse.  If your muscles have just loss mass and you can work them - have adequate nerve signal - then you should be able to strengthen them.  If the muscles have areas where the cells has died and that is why they are smaller then, no, they won't exercise back.

Quix

[Quixotic1]

I can't really answer this for sure.  I do know that you start losing muscle mass after only a short time without using them -  as little as three days.  And you can have atrophy just from disuse.

But, exactly what your situation is, I couldn't say.  If you did not lose significant strength I would have to say that you didn't lose significant mass to actual atrophy.  There is a period between losing "mass" in live muscle cells versus losing the cell structure completely as is seen in atrophy.  If the muscle cell is still alive, it can be brought back if the nerve impulse to it is intact.

Quix

[Fluffysmom]

I had significant quad atrophy some months after my last knee surgery, despite physical therapy before and after.

They tried to jump-start my muscles with an electrical nerve stimulator thingy, which wasn't much help, and after a few days became a source of great irritation.  When I returned it in disgust, the electical tingle continued in my leg for several hours after I disconnected the electrodes from my leg.

This was a few months before my neurological symptoms began with tremors in my hands, head and neck; totally unrelated, but now I wonder if any of the atrophy in my quad could be from some of my lesions, or would that need to be spinal lesions?

This was my third surgery on that knee, and I had always rehabbed well previously.

I have continued to due quad sets, with very little change.  

I'd appreciate your opinion on this,

Thanks,

Kathy

[Quixotic1]

And....

If a muscle is atrophied, no amount of exercise is going to restore that part of the muscle that is lost.  You might be able to strengthen what is left, but realize that you may need to do baby exercises.

[Quixotic1]

The bretheren speak the truth.  There is both a need and a danger to exercising weak limbs.

First you want to keep as much strength in weakened muscles as possible.  But, sometimes that is very little strength.  The exercises may seem ridiculously simple and small.  You also want to maintain as much strength as you can in the muscle groups "supporting" the weakened muscles.  It often takes a professional like a PT with neurologic specialty training to do this.

HOWEVER, a weaknened muscle is prone to early fatigue and even to complete nerve block with repetitive use.  What this means is that the muscle which has damaged motor nerves to it may actually fail during excessive exercise.  And excessive may mean as few as a couple uses - depending on the extent of demyelination.

So, the answer is "Yes and No."  When my right leg first became weak, I started out on a progressive walking schedule and pushed it a little too fast.  That combined with some heat one morning led to severe weakness of both legs and my collapse in the street.

When we say a neurologically trained Physical Therapist this does NOT mean a Personal Trainer who would have no idea of the kind of problem we with MS face.  Repeating a muscle contraction (exercise) can only be used to achieve the strength left in the muscle.  Remember, the problem is not a sick muscle, it is the weak signal of the motor nerve going to that muscle.  If the full signal does not reach the muscle it won't contract much or at all.  Repeatedly sending the signal can temporarily wear the nerve out and can end up doing more harm than good.

How do we know what is enough and what is too much?  It is a thin line to balance.  If the muscle starts getting weaker during the exercise, you are definitely overdoing and being counterproductive.  If you become too fatigued during any exercise you are working against yourself.

My benchmark for my weakest muscle (my hip flexors) is climbing the stairs.  As long as I can lift my foot to the stairs, then I climb.  When it stops reaching the top of the next stair, it's time to quit.  Doing this over the last several months, I have returned to being able to take the stairs slowly foot over foot.  All of last year it was one foot only all the way up and all the way down.

I have started an exercise where I lift my foot just 4 inches to a low platform, repetitively.  I am just about ready to start doing it with a small weight on the ankle.

Some days though, my foot won't make it to the top of the first stair at all.  Those are weak days and ones during which I don't push it.

I have been reading warnings for those of us with spasticity.  We must be careful not to inadvertently strength the dominant muscle groups of our spasticity.  For example:  If you have extensor spasticity in your legs (that is, they tend to straighten at the hip and knee and pull the toes down) you do not want to concentrate on exercises that work the extensor muscles, like

rising up on your toes
leg presses
knee extensions
etc.

The stronger these muscles are the more the spasticity will work against your movements and the earlier you will fatigue.  Does this make sense?

Conversely if your spasticity involves the flexor muscles you would want to avoid excessively exercising these.  For example if the spasticity is in the flexor groups of the arm you would need to be careful with things like wrist curls, bicep builders, and shoulder adductions.

See?  This is why most of us need the counsel and care of a PT who understands demyelinated muscles and spasticity.

Of course, the mainstay of exercising with spasticity is long careful and frequent stretching of the muscles that tend to have an abnormal amount of tone.

Help, do we have any PT's here?  

Quix

[HVAC]

A physical therapist is important to determine what you need. I recently I went off on my own and did the wrong thing and ended up with an inflammed shoulder. I am not where you are but I keep exercising my weak side.

Alex

[rendean]

I have atrophy of my shoulder muscles among others. My physical therapist has me doing strengthing exercises with the instruction to stop a set of repetitions of I experiece pain or trembling during the exercise.
I'm not sure about doing it without an exerpienced instructor. Can you get a doc to reccommend PT?

Ren