Onset of MS after sports injury?

[rlestra5]

Hi all,

I'm new here - I play competitive volleyball and I started feeling some minor shin pain about 2 years after playing indoors. A few weeks later I played again and I landed on the court with screaming leg pain (both legs). I'm not sure why this happened. I then rested, and saw numerous orthopedists, foot doctors, neurologists, and had so many MRIs and other tests done I can't even remember them all. I am currently dealing with chronic burning pain in both lower legs. For one reason or another, this pain has not gone away since I initially injured myself almost 2 years ago. I have rested for months at a time. The most common things the docs have mentioned are tarsal tunnel syndrome, compartment syndrome, and posterior tibial tendon dysfunction. I am not sure any of these diagnoses are correct. The MRIs I've had also have mentioned things like "tenosynivitis" and "stress reaction", but none have really been conclusive.

I did have bloodwork done twice from my general physician and things looked fine. I had my back looked at and it was fine. I am 34 years old. I was also tested for Lyme's through the bloodwork done with my GP, and it came back negative. I know this is a longshot, but I am just wondering if the fairly constant burning legs could be a sign of MS. I am not feeling pain in other areas of my body really, just both lower legs. To be more specific, sometimes it feels as though something is almost "attacking" my legs. The calf area & insides of the lower legs from below the knee down toward the ankle. I periodically get tingling in the bottom of my feet/down near the heel/etc as well. Sometimes I will feel the burning pain actually pulsate in a specific area for a very short period, then subside. Outsides of the lower legs feel fine. It is all 95% inside. I am also getting itching. It could be anywhere - on my back, thigh, arm, etc. I don't remember having this type of itching before, although I'm not sure it was never present prior to the injury. Sometimes the calves actually feel crampy and tight for no reason, or even sore/tender upon touch. Anyway, it is hard for me to fathom how the symptoms have not subsided with all the rest and conservative measures I have taken (foam rolling, electric stim, heat, physical therapy on different occasions) The problem does feel orthopedic or neurologic in nature, but I am not getting any clear signs from the docs as to what it could be.

Any thoughts on this? Is this something that sounds like an MS?

Thank you,
Ryan

[jimmylegs]

hey ryan, welcome
can you be more specific about the nature of your burning pain? skin, muscle, bone, all of the above, constant, varies with movement, etc?

the first thing i looked for was just burning pain athletes. got this, basically says what you'd expect, repetitive type of injury and so on. http://journals.sagepub.com/doi/abs/10. ... 8111426115

because nutrition is more my thing than the diagnostic side, and burning neuropathy can be the result of several deficiencies, i went looking at impacts of competitive volleyball on athletes' nutritional status. i'm not finding a lot of scientific effort has been put into your cohort per se (if only you were a teenage female volleyball athlete!), but here are some tidbits

Nutritional and anthropometric profile of adolescent volleyball athletes
http://www.scielo.br/scielo.php?pid=S15 ... ci_arttext
"Diets consisted of high energy and protein intake, and low carbohydrate intake. The consumption of calcium, folate and vitamin E was below the recommendations."

that would make me go looking for interactions between carbs, calcium, folate, and vit E, in relation to neuropathy and/or tendon health (bc of the mention of tenosynovitis)

not much, but maybe a starting point ooh actually vit E is looking pretty good in an anti-inflammatory sense at least.

Vitamin E and immunity after the Kona triathlon world championship
http://sncshop.com.br/wp-content/upload ... amin_e.pdf

do you know which foods in your daily routine are contributing to your daily vit E requirement? i would just comment on that one, that if you decided to try vit E as a supplement, don't bother with alpha tocopherol as used in that study, go with a proper natural ratio E8 complex. i must say, when i first went down with this whole thing, it was a protocol which involved TONS of vitamin E that really made a huge difference. it had other things in the mix too so i'll never know if it was one ingredient i really needed, or if it was the combo that was important. end of the day, don't care - whatever it was, it worked

the only chronic pain i've ever had as a direct result of athletic activity was patellofemoral syndrome. if i was dealing with it now, beyond just resting it i guess i would try things for strengthening bone. in hindsight i was definitely magnesium deficient back then, it might have helped with a bunch of things if i had known.

[rlestra5]

Hi jimmylegs,

Thanks for your response. The burning feels muscular/possibly tendon related. I mostly feel it in the calves and inside of the lower legs. But the pain sometimes appears in different areas. Could be around the ankle, or minor tingling in the bottom of the feet. I actually find that it sometimes hurts LESS when I am walking or moving on it (although I sometimes feel cramping or aching afterward). Sitting motionless at rest or driving seems to aggravate it more actually. I have been upping my Vitamin D intake, but that doesn't really seem to be helping. Like I said, at times it just almost feels like something is "attacking" the legs for no good reason. That is one reason I speculated MS. The pain has been tolerable, but nagging. Not sure why this has persisted for 2 years. The last orthopedist I saw speculated achilles tendonitis, but I have been told that tendonitis appears in MRI imaging - well, I had two MRIs of the lower legs and neither one mentioned tendonitis. All the other bloodwork I had done did not show a deficiency in magnesium, potassium, etc I don't believe. But overall, the pain does feel pretty constant. I am not getting bad flare-ups like I once did soon after the injury occurred, but I can still feel something is not right. I really have no pain anywhere else body-wise. Does this help paint a better picture of my symptoms?

Thanks,
Ryan

[jimmylegs]

hi no problem yes this provides enough additional detail to flag some ideas for follow-up.
if muscular, i would take a very close look at magnesium.
upping vit d3 without mineral cofactors could make a pre-existing mag problem worse.
do note the emphasis on vit E in the above; it's good stuff
do you have your lab results on file? if so, a look at the serum mag level could be telling.
docs aren't in on the details of interpreting serum mag results quite yet.
i LOVE this, for some reason only just found it yesterday:

Magnesium in Prevention and Therapy
http://www.mdpi.com/2072-6643/7/9/5388/htm
Dietary surveys of people in Europe and in the United States still reveal that intakes of magnesium are lower than the recommended amounts [20,21,22]. Epidemiological studies in Europe and North America have shown that people consuming Western-type diets are low in magnesium content, i.e. <30%–50% of the RDA for magnesium. It is suggested that the dietary intakes of magnesium in the United States have been declining over the last 100 years from about 500 mg/day to 175–225 mg/day. This is likely a result of the increasing use of fertilizers and processed foods [5,9,22,23,24].

In healthy individuals, magnesium serum concentration is closely maintained within the physiological range. The normal reference range for the magnesium in blood serum is 0.76–1.15 mmol/L [7,16,17,18,19]. (JL: that varies, this range is on the high side which is better. i've seen 0.65-1.05 as a normal range on lab work, which is lame)
According to many magnesium researchers, the appropriate lower reference limit of the serum magnesium concentration should be 0.85 mmol/L, especially for patients with diabetes [17,18,52,53]. For example, in the NHANES I study the reference interval for serum magnesium was determined in 15,820 individuals between the ages of 18 and 74 years. The results of this study identified the reference interval as 0.75 mmol/L to 0.955 mmol/L (JL: ugh more laaammme, represents a whole society with crap mag status) with a mean concentration of 0.85 mmol/L[54]. In a European study, magnesium deficiency was determined clinically and compared with the serum magnesium concentration. It was found that in individuals with serum magnesium level of 0.70 mmol/L, 90% of the individuals had clinical magnesium deficiency and at a cut off magnesium level of 0.75 mmol/L, 50% of individuals had clinical magnesium deficiency. At a cut off level of 0.80 mmol/L, 10% of individuals had clinical magnesium deficiency and at a cut off of 0.90 mmol/L, only 1% of the individuals had clinical magnesium deficiency [55].

translation: stay well out of the lower half of that normal range for serum mag. BRING IT, EUROPE!!! WTG!!!

[rlestra5]

Thanks jimmylegs. I will keep magnesium in mind. But how would you actually know if you had MS? From the people in this forum who definitively DO have it, what are their tell-tale signs? Is it possible to have it with mostly just the burning type sensations and aching in the legs, or would problems have to be present elsewhere as well?

[Snoopy]

Thanks jimmylegs. I will keep magnesium in mind. But how would you actually know if you had MS? From the people in this forum who definitively DO have it, what are their tell-tale signs?

MS has a diagnostic Criteria --- The Revised McDonald Criteria.

Each of us with MS present differently. There really is no tell-tale signs simply because there is no symptom that is exclusive to MS, many other things cause similar symptoms as those seen in MS. A diagnosis of MS cannot be based upon symptoms alone. The diagnostic criteria for MS relies heavily on MRI evidence and from what you have posted your MRIs do not show any evidence of MS. It would probably be a good idea to investigate and discuss with your Drs. the possibilities of what was found on MRI has the cause for your symptoms. Having blood work done to evaluate vitamin/mineral levels might be a good idea.

[jimmylegs]

yep you don't just 'know' with ms. the docs rubber stamp you after there are enough check boxes ticked off.
for me, day to day 'ms' is large fibre peripheral neuropathy, meaning impaired vibration and texture sense in hands and feet, like an actual stocking and glove feeling. proprioception is a bit wonky. i work on it by doing weird things like carrying a cup of tea down the stairs in the dark. no spills and no using the rail or wall for balance is a win. means i am not too dependent on eyesight for positioning. and if my temperature gets too high or too low, there can be some loss of nerve conductivity. and that is about it off the top of my head

[rlestra5]

ok thank you both, I did have blood tests done (twice actually) and nothing came back strange - except slightly low vit d levels one year. so strange that i've been told neurologically i'm fine when the pain i get is "burning" in nature. i find that hard to believe. i also thought i might have just had tight calves and that this is an orthopedic issue but i have been rolling them out just about daily and I already have pretty supportive sneakers as well as custom orthotics. why hasn't physical therapy helped? i'm really not sure. the mri's i've had have only been of the legs though - do you think it's worth it to have brain mri'ed just in case? i had thought about having surgery at one point, but surgery WHAT FOR? i've had no clear diagnosis which means surgery would be 'experimental' and i am not okay with that at all. i also did get tested for chronic exertional compartment syndrome, and it did test positive on one leg believe it not, but not in the area where i have been experiencing pain, so the doctor ruled that out (plus, i really have not been exertional). i love to play volleyball so i really don't want to give it up but i hate the discomfort and pain during/after play, as i experienced last summer. ugh.

[Scott1]

Hi,
It doesn't sound like MS to me. More likely Periformis syndrome which involves the sciatic nerve or a variation on Posterior Femoral Cutaneous Nerve entrapment which also involves the Glute Med and the Periformis.

For Periformis Syndrome they should inject cortisone into the membrane over the muscle. That's a guided injection so they don't hit the sciatic.

For PFCN entrapment they usually do a nerve block but freeing up the periformis might help. The shin pain is triggered by the knee capsule being pulled up by the muscles above it. A big fall on your backside can cause either.
Watch abduction (moving your leg laterally away from your body) for a while. A pilates instructor with a dance background would be all over this.
You could try some dry needling from someone like an osteopath into the TFL (tensor fasciae latae )muscle as well.
Whatever muscle it is it, the injury to one side will mean the opposite side works twice as hard. You end up with the pelvis out of alignment and that causes pain in the back.
Rest is the normal prescription but isn't always the right one.
Compartment syndrome would likely involve a tight psoas. I don't think you would be playing competitive volleyball with that.

You will have a devil of a job getting these things looked at.

Regards,

[jimmylegs]

heya some important tests can be passed over when standard panels are done (for example did they test your vitamin E status? noticed that was low in one of the athlete studies posted above), and some tests can come back 'normal' but still be a problem.
do you have your results from past tests on file by chance? low vit d3 could signal other things going on, which could tie in with the tight muscles.
honestly i don't think brain mri would tell you much about what you're feeling in your legs. i don't think they've been able to establish a tight relationship between brain mri and edss BUT it has been a long time since i looked at the research along those lines. personally the only thing i have ever 'felt' going on in my brain was either mood related, or cognitive/spatial. my sensory issues are all spine stuff. overall i couldn't really say if a brain mri would be worth it for burning calf muscles. i get that it's frustrating though.
are you on any supplements for athletes, have you had a referral to or have access to a dietitian or sports nutritionist at all, has anyone gone over your diet in terms of making sure you're getting all required essentials at a level that exceeds joe average recommendations and would meet your increased requirements? i ask this because the system around bloodwork atm makes it not the best at picking up fine grained nutritional issues - so far. but a sports dietitian would probably spot issues more readily. curious: do you know how many mgs per kg body weight of elemental magnesium you're getting daily from food, fluids and any supplements?

related:
Minerals, trace elements and related biological variables in athletes and during physical activity
http://www.sciencedirect.com/science/ar ... 8101005988
"Magnesium may be lost in sweat [27]. Lukaski [4] found that Mg movement from plasma into erythrocytes was greater as exercise became more anaerobic, and that the amount of Mg lost in urine was related to the degree of exercise-induced anaerobiosis as indexed by post-exercise oxygen uptake and plasma lactate concentration. König et al. [14] reported that a morning Pl–Mg concentration <0.75 mmol/l is indicative of a Mg deficit. Marathon runners show significant decreases of serum (Ser)–Mg and urine–Mg [18], whereas Shephard and Shek [22] found that Pl–Mg increases and that ultrafiltrable Mg decreases after maximum exercise. Nuviala et al. [23] observed that serum (Ser)–Mg levels for women involved in different sports were significantly higher in 23 runners than 65 control women, and that urinary excretion of Mg was significantly greater in 19 basketball players. Conversely, hypokinesia (HK) may induce mineral changes in bone, cells of many tissues, serum, urine and feces. In fact, the use of Mg supplements was not effective in preventing negative Mg balance in athletes during a prolonged 364-day period of HK [31]."

actually <. 95 mmol/l can be indicative of a Mg deficit.. the point being, athletic mag loss is something to consider and i wonder what dose and form of magnesium they were using in that trial of supplements for mg balance above..

[Snoopy]

You had MRIs of the legs but has any of your Drs. done MRIs of the spine (cervical, Thoracic, Lumbar)? Problems with your legs only makes me wonder if you have injured your spine (herniated/bulging discs), specifically the lumbar area. Lumbar problems can cause problems with legs and might account for the burning.

MS is a disease of the Central Nervous System(CNS) which includes the brain, spinal cord, and optic nerves. Lesions can show up anywhere within the CNS. Problems with the legs, in MS, would indicate spinal cord involvement more so than brain. A spine MRI would be able to detect MS as well as a spine problem.

MS has, for the most part, mainly effected my spinal cord (Thoracic, Cervical). Mobility is my main struggle and has been for all of my 32 years of diagnosis. I am still walking

[jimmylegs]

oh yeah and in the past waaay back i did have lhermitte's which is a sign of an active lesion in the c spine. i was b12 deficient back then however, and my old spinal lesions do match a b12 deficiency (thoracic & cervical) pattern. the brain lesions not so much.

[Snoopy]

Lhermitte's sign, in MS, is related to cervical spinal cord lesions. For some this symptom will go away when inflammation resolves. For others, like me, Lhermitte's sign remains as a permanent symptom regardless of inflammation. At one point my MRI showed numerous c-spine lesions and currently I have 4.

[jimmylegs]

you have four active lesions?? can i inquire as to your b12 status?

[Snoopy]

None of my lesions are active. I have had some permanent MS symptoms from the very beginning, Lhermitte's being one of them.
My B-12 has always ranged from 800-1100.