Motor neuron disease (MND) is a progressive neurodegenerative disorder, manifested by upper and lower motor neuron signs and symptoms. It is characterized by progressive weakness, atrophy, spasticity, dysarthria, dysphagia, and respiratory compromise, ultimately resulting in death. The initial presentation of the disease may be diverse, cramps often being the earliest manifestation of the disease especially in the lower motor neuron component. We present a case of 69 year old female, who presented in the physiotherapy department with complains of low back ache, cramp like pain and weakness in both the legs for the last 6 months. Her neurological examination and investigations confirmed the diagnosis of MND. 

Key Words: Motor neuron disease; Low back ache; Cramps.