Aching calves and ankle twitching all over calves arms and cheek by jaw. fatigued easy worried/stressed out all the time. bad back pains in middle and lower also get cramps all the time . als?

Many causes of muscle twitching. Most common is a magnesium/calcium deficiency. Start with daily supplementation along with good hydration for a period of no less than one month to see if the symptoms go away. Lowering stress with daily exercise, meditation/prayer, journaling, and talking to a therapist may help. Make sure you get an physical exam to look at back pain/cramps.

At age 38, would be highly skeptical of a diagnosis of ALS. Would instead, focus on the back pain, and search for the pain generator. The twitching could be c/w benign fasciculations, and emotional stress can make this feel worse. Not feasible to point to specific muscle or nerve disorders based on information provided. Perhaps start with physiatrist consultation.