13 Most Common Symptoms of ALS

2. Difficulty Walking

You may first notice trouble walking when your steps feel uneven or you start tripping on flat ground. In ALS, the nerve cells that control muscle movement gradually stop working as they should. As these cells weaken, messages from the brain to leg muscles slow down or stop altogether.

This causes muscle weakness, stiffness, and balance problems that make walking more difficult. Simple activities such as climbing stairs or standing up from a chair may start to require more effort. You might drag one foot, swing your leg differently, or feel unsteady even after walks. Some people notice uneven wear on their shoes, which can be an early sign of balance changes.

When ALS affects the muscles that lift the foot, a condition called foot drop can develop. This makes the toes catch on the floor while stepping forward, increasing the risk of stumbling or tripping.

3. Increased Clumsiness

You may start to notice that everyday tasks seem harder to do smoothly. Dropping objects, missing steps, or losing balance while walking can begin to happen more often. This clumsiness usually affects one hand, arm, or leg at first and may gradually involve other areas over time.

These changes occur as motor nerve cells that control muscle movement begin to weaken. When muscles no longer receive clear signals from the brain, coordination and reaction time are affected. Over time, this leads to slower movements, poor balance, and difficulty performing precise actions.

Simple tasks such as buttoning a shirt, writing, or gripping objects may become frustrating. You might notice your grip weakening or your foot dragging slightly when you walk, which can increase tripping or stumbling. These changes often develop gradually, making them easy to overlook in the early stages.

4. Weakness in the Hands and Feet

You may first notice ALS through muscle weakness in the hands or feet. This change can seem minor at first, such as dropping objects more often or having trouble buttoning clothes. These early signs may be easy to overlook but can gradually make daily activities harder.

When ALS affects the hands, gripping items like keys, pens, or utensils may become difficult. Fingers can feel clumsy or stiff, and routine tasks such as tying shoes or writing may take more time and effort. Weakness in the feet often shows up as tripping or difficulty lifting the front part of the foot while walking, a condition known as “foot drop.”

Balance problems may also occur, and movements may feel slower than before. These changes often begin on one side of the body before spreading to both sides. As muscle weakness progresses, the affected muscles may shrink, a process called atrophy, making the arms or legs appear thinner.

5. Poor Posture

Poor posture is a common early sign of ALS. As muscles gradually weaken, it becomes harder for the body to stay upright. You may begin to notice your shoulders slumping, your head dropping forward, or a general leaning posture. These changes often develop slowly and become more noticeable as muscle strength decreases.

Weakness in the neck, back, and core muscles contributes to a stooped or leaning posture. When those muscles cannot properly support body weight, sitting or standing for long periods becomes tiring. Simple tasks, like keeping your head up while talking or watching TV, may start to feel uncomfortable.

Over time, poor posture can lead to pain in the neck, shoulders, or lower back. Uneven muscle strain may cause stiffness or soreness and can affect balance, making walking or standing more difficult. Physical therapy can help you learn safer ways to move and adjust posture as your body changes.

6. Pain

Pain in ALS usually develops as muscle weakness, stiffness, and limited movement increase. When muscles lose strength, other parts of the body must work harder to compensate, which can lead to aches and pressure in areas such as the shoulders, lower back, hips, or neck.

As muscles weaken, they provide less support to the joints, which can result in joint pain. Staying in one position for too long may also become uncomfortable. Simple movements such as turning in bed, sitting up, or shifting position can begin to cause soreness or cramping over time.

Some people experience muscle cramps or tightness that feel sudden or sharp. These sensations can occur in the arms, legs, or abdomen and may come and go. Gentle stretching and regular movement can sometimes help ease this discomfort.

Supportive equipment, such as proper seating, cushions, or braces, can help reduce strain on muscles and joints. These tools improve posture and relieve pressure, which may lessen pain caused by uneven weight distribution or prolonged muscle stress.

7. Tightness

You may notice muscle tightness as one of the early signs of ALS. This tightness often appears in the arms or legs, but it can affect other parts of the body as well. It may make movements feel stiff or less natural than before.

This tightness happens when healthy nerve signals that tell muscles when to contract and relax begin to break down. Without proper signals, muscles may contract too much or at the wrong times, leading to ongoing tension. Over time, muscle tightness can interfere with daily activities. Walking, stretching, or picking up small objects may become harder, and muscles may remain tense even when you try to relax them. Some people describe the sensation as cramps that do not go away, while others compare it to a tight elastic band around the limbs.

8. Fasciculations

Fasciculations are small, involuntary muscle twitches that occur beneath the skin. They appear as brief flickers in the muscle and can be seen in areas such as the arms, legs, tongue, or other parts of the body. These twitches are usually not painful, but they may feel uncomfortable or unusual.

In amyotrophic lateral sclerosis (ALS), fasciculations occur because the motor nerve cells that control muscle movement begin to malfunction. As these cells become damaged and break down, muscles may respond with random twitches. Fasciculations may begin in one area, like a hand or arm, and later spread to other parts of the body.

While occasional muscle twitches can happen in healthy people, fasciculations associated with ALS tend to be more frequent and widespread. They may appear even when muscles are at rest and often occur alongside muscle weakness or muscle shrinking over time.

9. Slurring

Slurring is often one of the first speech changes noticed in ALS. It occurs when the muscles that move the tongue, lips, and jaw begin to weaken. These muscles play a key role in forming clear words and sounds, so even small changes can affect how speech sounds.

In the early stages, you may notice occasional slurring, mild hoarseness, or slight weakness in the tongue. You might need to repeat yourself more often, especially when you are tired or speaking quickly. Everyday conversations are often still manageable at this stage but may require increased effort. With progression to a moderate stage of ALS, speech changes become more pronounced.

Slurring may happen more frequently, spoken words may become shorter, and speaking can take more effort. In advanced stages, speech may become very slow or unclear, making it difficult for others to understand what you are saying.

10. Saliva and Mucus

As ALS progresses, you may notice changes in how your mouth and throat handle saliva and mucus. Weakening of the muscles involved in swallowing can make it harder to clear saliva normally, causing it to build up in the mouth.

When swallowing slows, drooling may occur more often, or saliva may feel thicker or stickier than usual. Some people notice a constant need to clear their throat. As breathing muscles weaken, clearing mucus from the airways can also become more difficult. Coughing may feel less effective, leading to a sensation of chest congestion.

Simple care steps can help manage these changes. Sitting upright after eating or drinking allows saliva to drain more easily, while staying well hydrated can keep mucus from becoming too thick.

11. Crying and Laughter

You may notice sudden changes in emotional expression that feel hard to control. Some people with ALS laugh or cry at times that do not match how they feel inside. This happens because the disease affects areas of the brain that help regulate emotional responses.

You might laugh during a serious moment or cry during a lighthearted conversation. These episodes are usually brief but can feel confusing or embarrassing. They are not a sign of depression or loss of emotional awareness. Instead, they reflect disrupted nerve signals that normally help keep emotional reactions in balance.

This condition, often called pseudobulbar affect, can appear at any stage of ALS and may become more noticeable as muscle weakness or speech difficulties progress. Talking openly with friends or support groups can help others understand that these emotional episodes are part of the condition and not a reflection of your true feelings.

12. Behavioral Changes

ALS impacts more than just muscle movement; it can also cause behavioral changes and affect responses to situations. These changes are often subtle at first and may involve shifts in mood, emotions, or social behavior. Some people may become more impulsive, withdrawn, or less aware of how their actions affect others.

As ALS progresses, changes in attention or judgment may become more noticeable. Tasks that once felt simple, such as planning, organizing, or staying focused, might require extra effort. In some cases, memory or problem-solving skills may be mildly affected, although overall thinking often remains mostly intact.

These changes can vary widely from person to person and may progress slowly over time. Caregivers often notice behavioral or cognitive shifts before the person experiencing them does. A smaller number of people develop changes similar to frontotemporal dementia, which can include unusual social behavior, difficulty with decision-making, or a loss of interest in everyday activities.

13. Risk Factors

ALS can develop for different reasons, and in most cases, the exact cause is unknown. Many people develop the disease without any family history, while others inherit it. When ALS occurs in more than one family member, it is called familial ALS and is linked to genetic changes passed down through generations.

Having a close relative with ALS increases your risk compared to the general population. Researchers have identified several genes associated with the disease, including SOD1. However, inherited forms are uncommon, accounting for only about 5 to 10 percent of all ALS cases.

Environmental and lifestyle factors may also contribute to risk. Some studies suggest possible links to exposure to heavy metals, agricultural chemicals, or solvents, though no single factor has been confirmed. Military service has also been associated with a higher risk, possibly due to physical stress or exposure to certain materials.

Age and gender can influence who develops ALS. Most people are diagnosed between the ages of 55 and 75. Men are slightly more likely than women to develop ALS, although this difference becomes smaller with increasing age.