Muscle Ratcheting and Tremor - Specific Information

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Muscle Ratcheting and Tremor - Specific Information

Postby yaumno on November 10th, 2013, 1:38 am

Here is what I have learned about the "muscle ratcheting" condition that is experienced by many of the members of this forum. This information also pertains to fine tremors in the extremities and a general shakiness experienced upon exhertion.

For those readers that may not know what the "muscle ratcheting" condition means - I can explain it thusly: My muscles jitter/jump/shake when I perform certain voluntary movements at certain speeds. This occurs in all of my muscles and never changes. It is most obvious when lowering a limb from a bent position, when descending down stairs, or when bending over. I can feel my muscles shaking as it happens, and other people can see and feel the shaking if they watch my body as I perform such motions. It occurs most obviously at medium speeds and is almost unnoticable at very rapid or very slow speeds of movement.

These symptoms, especially the muscle ratcheting, are not part of the commonly used symptom nomenclature in neurology clinics.
When I first started looking into this I came across piles of information about all of the standard neurology clinic symptoms including: clonus, myoclonus, dystonia, hypertonia, rigitidy, spacticity, myokymia. Yet none of these even slightly resembled the condition I was trying to describe. If you are experiencing "muscle ratcheting" and your doctor has diagnosed you with one of these symptoms then I suggest that you seek a second opinion.

The "muscle ratcheting" only occurs during eccentric muscular contractions.
I visited a physical therapist and she noted something specific about the muscle shaking - it was only occurring during eccentric contractions (controlled muscle lengthening, i.e. extending an arm or leg). In this state, two muscle groups compete simultaneously with varying amounts of tension to produce fluid movements.
The other two types of contractions are isometric (muscle tension without lengthening or shortening, e.g. pushing against an immovable object or holding a pose), and isometric (active muscle shortening, i.e. a bicep curl).
This is important because it means that specific neuromuscular features are involved in this phenomenon and that it is not a generalized symptom of all muscle activity such as "rigidity" or "spasticity."

The "muscle ratcheting" is a normal part of movement in healthy individuals.
I had my roommate perform the same movements in which I noticed the muscle shaking in myself and he also had the shaking! However, his was much less noticeable and occurred during less of the range of motion. This was important because it let me know that this was a normal phenomenon that had somehow become abnormally intense.

"Muscle ratcheting," and fine tremors in the fingers and extremities, are actually "Enhanced Physiological Tremor"
I also started researching tremor. I knew that the fine tremors in my fingers had become very noticeable after the electric shock that started my BFS, but this was a minor concern compared to the other symptoms. However, upon reading some very thorough medical textbooks about tremor, I came across the term "physiological tremor."
As you may be unaware, this is the term given to the normal shakiness that everyone experiences during certain tasks. Everyone's fingertips quiver if the fingers are extended fully and held against gravity, and everyone is familiar with chattering teeth due to extreme fear or nervousness. The textbooks I read also explained that the physiological tremor is responsible for basically all non-pathological muscle shakiness, and this is the reason that our muscles quiver a little bit when used in a certain way (i.e. what I noticed in my roommate's 'normal' body).
Once I found this term I started using new search terms such as, "enhanced physiological tremor," and, "exaggerated physiological tremor." The search results, even in medical research databases, yielded a paucity of sources. However, I did come across some amazing information.

"Enhanced Physiological Tremor" has many causes, one of which is related to emotions and anxiety.
Here is a pertinent quote from "Marsden's Book of Movement Disorders," :
"There are many causes of exaggerated physiological tremor...The commonest is emotional overactivity. Stress, anxiety, fear, and anger all enhance physiological tremor, probably due to enhanced sympathomimetic activity stimulating peripheral beta-adrenoreceptors. In those with chronic emotional problems, such as anxiety states, exaggerated physiological tremor may be a presenting complaint."
When I read this for the first time I had a 'Eureka!" moment. A few of the neurologists I had visited thought that I was anxious, and even wrote "unidentified anxiety state" on my record. Furthermore, anxiety has been considered as one of the main culprits for the syndrome by many of the members on the BFS forum. I even came across a list of symptoms on an anxiety support site that had this as one of the possible symptoms of anxiety, it said:
"Your muscles vibrate, jitter, tremor, or shake when they are used or moved. For example, you experience shaking, tremor, vibrating, or jitteriness when raising and/or lowering an arm or leg."
Considering this information, I'm now pretty certain that the muscle ratcheting condition that we are experiencing is simply an enhanced physiological tremor due to anxiety. This also probably explains many of the accounts of "shaky hands" or "jittering/trembling" that I have read on the experiences forum. However there are some puzzling pieces that still remain.

Et cetera
Firstly, I don't experience many of the normal symptoms of anxiety such as increased heart rate, sweating, or paleness. I would have thought that in order to have a really rare symptom of anxiety, like the muscle shaking, that I must also have the most common symptoms. I have spoken to some psychologists and psychiatrists about this and they are getting back to me soon.
Secondly, the texts that I read recommended beta-blocker therapy with Propranolol to reduce the tremors. My neurologists recommended this months ago and I took 60 mg of Propranolol daily for about 6 weeks with no change in the muscle shaking. However, upon reviewing the sources that I read, most of them recommended a daily dose of 120 mg or more to reduce the tremors so I am considering restarting beta-blocker therapy with a much higher dose to see if there is any effect. I have also considered that, instead of epinephrine/nor-epinephrine, perhaps another anxiety related hormone such as Cortisol may be to blame.
I am working on controlling my anxiety and hopefully this will eventually end my symptoms.


My main reason for this post is that all of the threads I found about this condition were rife with flippant or imprecise explanations for it. I think the above information might be a solid first step in truly understanding this specific symptom and perhaps later we could learn how to resolve it in those individuals in which it does not spontaneously remit.
Last edited by yaumno on November 10th, 2013, 11:32 am, edited 1 time in total.
Tempus edax rerum: "Time devours all things" - Ovid from "Metamorphoses"
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Re: Muscle Ratcheting and Tremor - Specific Information

Postby Yuliasir on November 10th, 2013, 3:00 am

Hi, thanks for excellent post, I hope it owuld helpful for many fellows here who experience ratcheting and confuse it with clonus ot Parkinson-related 'cogwheel' movements.

as for anxiety, you do not need to be pale, sweating or have constant heart palpitations. Those are symptomes related to acute adrenaline shot and subsequent autonomous system reaction (in sudden fear or in panick attack). As a person with chronic anxiety, I can tell you that much important is having constant sometimes elevated level of adrenaline to develop all those issues. Yes, if we are suddenly frightened, then ratcheting, extended tremors, cricopharingeal spasms (up to loss of ability to speak loudly) are pronounced even in generally healthy people.
But if your body is under prolonged action of adrenaline or other stress hormones, like in chronic anxiety, most probably you would experience just constant central brain excitation, and your autonomous system would be used to it, so no sweating, heartbeats or pale face - but still enhanced tremors, probbaly due to that part of muscle activity which is centrally mediated ;)
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Re: Muscle Ratcheting and Tremor - Specific Information

Postby emmie.s on November 10th, 2013, 1:37 pm

Really detailed, useful information. Thanks for sharing your research and knowledge with us! :)
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Re: Muscle Ratcheting and Tremor - Specific Information

Postby TyWebb on November 13th, 2013, 8:18 pm

That ought to be added to neurology textbooks!
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Re: Muscle Ratcheting and Tremor - Specific Information

Postby shell67 on November 14th, 2013, 12:44 pm

Interesting you should say this...because I just spoke to my neurologist about the muscle shakiness I was experiencing in my left arm, and he recommended the beta blocker for me. I'll let you know if I find relief. Thanks -- now I know what to call this weird sensation!
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Re: Muscle Ratcheting and Tremor - Specific Information

Postby yaumno on November 15th, 2013, 10:51 am

shell67 wrote:Interesting you should say this...because I just spoke to my neurologist about the muscle shakiness I was experiencing in my left arm, and he recommended the beta blocker for me. I'll let you know if I find relief. Thanks -- now I know what to call this weird sensation!


Thanks, definitely let us know how it turns out. Could you perhaps describe the shakiness that you experience in your left arm? (When it happens, how it feels, what does it look like externally)

You say that it is occurring in your left arm, so presumably not in the right? It's definitely important to know if it's unilateral.
Tempus edax rerum: "Time devours all things" - Ovid from "Metamorphoses"
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Re: Muscle Ratcheting and Tremor - Specific Information

Postby Watereddown on January 8th, 2014, 2:58 pm

I too started noticing my arm shake, It kind of feels like it begins in my shoulder. Like if i were to hold a pushup position in the up form, my right arm would be shaking but not the left. It doesn't happen all the time, but when it does, it definitely throws me into a spell of panic lol
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Re: Muscle Ratcheting and Tremor - Specific Information

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