What Are the Symptoms of ALS?

Medically Reviewed by Arefa Cassoobhoy, MD, MPH on November 20, 2020

ALS can start off with something as simple as a weak feeling in your hands or feet. It’s a disease that attacks the brain cells that control a lot of your muscle movement.

Eventually, ALS (amyotrophic lateral sclerosis or Lou Gehrig’s disease) weakens the diaphragm, a muscle needed for your lungs to work. Trouble breathing is a symptom of advanced ALS.

ALS still has no cure. But if it’s diagnosed early, you may be able to treat some symptoms and keep your muscle control a little longer.

Early Symptoms

Signs of ALS can appear gradually.

You may notice a funny feeling in your hand that makes it harder to grip the steering wheel. Or, you may start to slur your words before any other symptoms show up. Each person with the disease feels different symptoms, especially at first.

Some common early symptoms include:

  • Stumbling
  • A hard time holding items with your hands
  • Slurred speech
  • Swallowing problems
  • Muscle cramps
  • Worsening posture
  • A hard time holding your head up
  • Muscle stiffness

ALS may affect only one hand at first. Or, you may have problems in just one leg, making it hard to walk in a straight line. Over time, it affects almost all of the muscles you control.

ALS doesn’t affect all muscles and organs in the body. The heart and bladder, for instance, usually stay healthy.

Advanced Symptoms

As ALS gets worse, more muscles and activities are affected. Among the more advanced signs of the disease are:

  • Weaker muscles
  • Less muscle mass
  • More serious chewing and swallowing problems
  • Difficulty being understood when speaking
  • Trouble breathing

Ways to Manage Symptoms

During the early stages of the disease, some forms of treatment might help give you a better quality of life. They include:

Physical therapy: It focuses mostly on larger muscles used for standing, walking, balancing, reaching, and so on.

Occupational therapy: It helps with smaller muscle activities, such as buttoning a shirt, using a fork or spoon, or brushing your teeth.

Speech therapy: It can help you speak a little more clearly when you lose control of the muscles of the tongue. Speech therapists can help you manage swallowing problems, too.

In addition to these therapies, certain tools and new technologies can also assist those with ALS. Some of them include:

At more advanced stages, you may need a machine to keep your lungs working. If chewing and swallowing become too hard, even with small bites or a liquid diet, you may need a feeding tube.

When to See a Doctor

A muscle cramp in your leg or a weak feeling in your hand once in a while isn’t usually enough to send you to the doctor. If those feelings last for days or weeks, however, you should make an appointment.

Pay attention to changes in how the muscles in your arms and legs feel. Listen to friends or family if they point out a change in your speech or how you walk.

You can start by seeing your regular doctor. If you think that the weakness or tingling is nerve related, see a neurologist. This is a doctor who specializes in diseases affecting the brain and nervous system.

Some early ALS symptoms are the same as those of other less-serious conditions.

Many of these, such as carpal tunnel syndrome (a problem with the nerves in your wrist), can be treated successfully. To know for sure, don’t hesitate to describe your symptoms to a doctor. The earlier you know what’s causing your symptoms, the sooner you can start to treat them.

Show Sources


National Institute of Neurological Disorders and Stroke: “What is Amyotrophic Lateral Sclerosis?”

ALS Association: “Symptoms and Diagnosis.”

Mayo Clinic: “Amyotrophic Lateral Sclerosis: Symptoms and Causes.”

ALS Association: “Assistive Technology.”

NIH. National Institute of Neurological Disorders and Stroke: “What Is Carpal Tunnel Syndrome?”

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