Question:
I am a 53 year old black male experiencing issues with my legs. This started about 5 days ago. My legs feel week in my quadriceps. I went walking on the trails with my wife and felt like a child. My legs have no strength. What next?

Answer:
You need to see a neurologist. I am assuming you’ve been diagnosed with MS.  If this is the case, the onset of weakness in both legs persisting for more than 5 days is probably caused by an MS relapse involving the spinal cord. A neurologist can confirm if this is the cause of your weakness (there are many other possible causes depending on the circumstances) and determine if you would benefit from treatment with high dose corticosteroids to accelerate your recovery. 

If you do not have a known diagnosis of MS, the possible causes of your weakness are too numerous to mention and an evaluation by a neurologist is more urgently required.

Good luck.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego

Here is My Question:
My right leg is weaker than the left, almost like it is dead. I constantly trip because I can't control it, and I also drag my right foot.

Even though I use a frame I find it hard to keep my balance and walk due to the weaker leg. Is there anything I can do to help me with muscle recovery in my right leg?

Answer:
For people with MS who suffer from a weak leg with significant proximal (the muscle that work at the hip joint) and distal (the muscles that work around the ankle joint) weakness, it is extremely important to take a 4 step approach to management that requires the assistance of your MS specialist, a physical therapist with neurological training and an orthotic expert.

1. You must eliminate the foot drop to improve safety, gait mechanics and stresses on other joints, particularly the knee and hip. The traditional way to do this is to obtain an ankle foot orthotic device (AFO).  I prefer the dynamic AFOs with a foot plate that provides a spring action to help with the, “toe off” phase of your gait. A popular model for those with more significant weakness is the Blue Rocker.  As an alternative to an AFO, you may want to investigate a functional electrical stimulation device (FES) that electrically stimulates the weak muscles (called the foot dorsiflexors) to contract at just the right stage of your gait. There are two available models, the Bioness and the WalkAide. Both have their advocates based on various features and means of activation. The last time I looked the Walkaide was considerably cheaper, but both range from $4,000 to $6,000 and there may be difficulty obtaining insurance approval. These devices are well tolerated, work well and do not restrict movement like the AFOs. They also tend to decrease spasticity in the limb and strengthen muscles, both beneficial features.

2. You need to ensure adequate leg lift by your proximal muscles. This is achieved through progressive resistance training (strengthening) and can be enhanced through the use of a Hip Flexor Assist Orthosis (HFAO). The HFAO basically looks like a weight lifters belt with two bungee cords attached that descend down both sides of the leg and end by attaching to your shoe. When you walk the bungee cords are stretched when the leg is extended and assist with hip flexion when you bring the leg forward.  

3. You may also benefit from the addition of Ampyra. This is a Potassium channel blocker approved by the FDA to improve walking speed. It accomplishes this by improving the efficiency of electrical currents in your nervous system and, therefore, may improve the activation of the muscles in your weaker leg.

4. Physical therapy with a therapist trained in neurological disorders is essential to put everything together in a customized fashion to improve your walking safety and efficiency. You may also benefit from a stabilization device such as a cane or walker depending on your degree of postural instability and weakness.

You can also read our symptom pages for strength and balance issues http://www.healthcarejourney.com/balance-and-walking-issues.html

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego

Question:
After a flare-up I had, I've been getting weakness on arms and legs. Will this ever go away?

Answer:
Weakness or any symptoms that emerged with a relapse take time to resolve. Most of the improvement occurs during the first 3 months following a relapse, but further improvement can occur for up to a year. These rehabilitation measures can help you maximize your recovery.

Below are some pages from this website and blogs that discuss weakness in arms and legs and strategies for gaining strength back. Finding a physical therapist who has experience in working with people that have multiple sclerosis is important, and the "PT Blog" listed below can help you find one in your area. 

Revere (Rip) Kinkel MD
Director of the UCSD Multiple Sclerosis Program