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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31315
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Good afternoon, I am a 32 year old male, sporty (fishing

Customer Question

Good afternoon,

I am a 32 year old male, sporty (fishing and lawn bowls) My dad suffered with motor neuron for 7 years. He was hospitalised in Feb. 2011 with severe lung infection last year. i was called a 4:30am and rushed to the hospital...very traumatic for me - cold sweat and emotional wreck.

He was in hospital for 3 weeks and finally made it home. He passed in his sleep in Dec 2011.

Since that day the strangest things have happened to me. I have always been healthy and sporty with no accidents or major injury. I had a full medical done and all is 100% except my cholesterol of 5.5

Every time my phone rang with his number or the home number i thought it was the same news and i totally freaked out every time...nervous wreck to say the least. Since then i have been getting muscle twitches in my calves and arms, am now on Ciplalex 10mg per day for anxiaty..still twitching - no muscle weakness.

In March one evening i woke up a 2am with the most agonising pain i have ever experienced it passed after 5 minutes, could not lift my arm the next day, went to a physio for 4 weeks no improvement, went to an osteopath twice and made an amazing difference yet never got back to 100% then went to the world angling champs in Italy no problem, got back to catch shark and did a few pushups, shoulder buggered (sore in front, then at the back, then top of the chest - every day a different spot). Had the shoulder scoped no damage and after an examination was diagnosed with thoracic outlet syndrome got a Botox injection in the scalene muscles, 10 days later i could cast for the first time in 3 months (to painful previously). Working on the TOS with the biokinetic guy...burns after exercise.

In July i was sitting in the bus on the way home and had the most painful burning sensation in my calf, lasted 60s until i clicked my hip, sense then pain in the but then below the knee(top of calf) went to every one, manipulations all said pinched nerve / bulging disc... it improved 3 months later (overnight ) after 3 sessions with a new physio, it hurts every time i get up from a seated position. sharp stabbing pain.

I have been anxious about having Motor neuron disease and cant get it out of my head, are any of these related to the disease. If not i can get over it and move on with my life.

Submitted: 4 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 4 years ago.

I am sorry that your question was unanswered for long.

What did your shoulder and knee MRI show?

Dr. Arun
Customer: replied 4 years ago.

Shoulder Mri showed nothing and i have hand no knee MRI,


The calf pain was put down to a bulded disk in the lower back causing siatica

Expert:  Dr. Arun Phophalia replied 4 years ago.

Your symptoms are not suggestive of the motor neuron disease. Your muscle twitches are due to anxiety. Twitching is caused by minor muscle contractions in one particular area, or the persistent and uncontrolled twitching of a muscle group in a distribution of a single nerve fiber or filament. Usually they are benign and resolve on their own, but persistent flutter may need following investigations;


1) electromyography (EMG)

2) nerve conduction velocity (NCV)

3) blood electrolytes like calcium, magnesium, potassium, sodium, etc

4) thyroid and parathyroid function tests

5) blood chemistry and complete metabolic profile


The common causes can be;


1) Idiopathic; no cause is ascertained and majority falls in this group.


2) Increased caffeine intake


3) Increased alcohol intake


4) Medications


5) Deficiency in diet and nutrients / minerals


6) Some neurological diseases; uncommon.


Your shoulder pain and sciatica (and related symptoms; radiculopathy in lower limbs) are truly orthopedic issue in nature and unrelated to the neurological problem. Pinched nerves in the back can be due to;


1) Herniated/degenerated disc in back (as mentioned by you)


2) Lumbar spondylosis; bone spurs in the back vertebrae pressing on the nerves.


Following investigations would be required, if not yet done;


1) X-ray of the lower back

2) MRI of the spine

3) Nerve conduction velocity (NCV) study

4) Electromyography (EMG)


Following comprehensive measures would be helpful, if the symptoms are persisting;


1) Back care in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze. Following more need to be done:


a) Avoid activities which increases the pain.

b) Rest intermittently

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided till pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on floor


2) Anti-inflammatory analgesics like ibuprofen, other analgesics and muscle relaxants


3) Local analgesic gels or sprays / ointment


4) Hot fomentation


5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.


6) Good supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.


7) Lumbosacral corset or support or brace


8) If obese or over weight, reduce weight for long term benefit.


9) Epidural steroid shots


10) Acupuncture


11) Chiropractor manipulation.


You can start the following exercises;


1) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.


2) Curl ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed / couch. Hold for ten seconds, then slowly lower to starting position. As strength builds, aim to complete one sets of ten curls. The exercise should be done twice a day (both the sets).


This is a slide show for the exercises (you can pick up your own set, which suits you);


You can consult following specialists (apart from your GP);


a) Orthopedist

b) MD in Physical medicine and rehabilitation.


Please feel free for your follow up questions.


I would be happy to assist you further, if you need any more information.


Dr. Arun
Dr. Arun Phophalia and 5 other Health Specialists are ready to help you
Customer: replied 4 years ago.

Good morning,


I was recently told the symptoms in my shoulder were as a result of thoracic outlet syndrome. (world class shoulder surgeon)


The lame and burning feeling is persistent. I went in for a botox injection. since then i can go fishing without excruciating pain but my arm still feels like it belongs to someone else.


And suggested exercises?

Expert:  Dr. Arun Phophalia replied 4 years ago.
Hello and welcome, Andrew.

This is an excellent resource for the exercises for thoracic outlet syndrome;

It is privilege assisting you.

Dr. Arun