Overview:
The “MS Hug” or “girdling” as it is often referred to is a feeling of tightness occurring in a person’s chest, waist and/or torso regions among people afflicted with multiple sclerosis (MS). It has been described by people similar to having a tight rubber band or strap squeezing the region where the sensation is occurring of a girdle like sensation. The feeling can be barely noticeable to extremely painful and debilitating and is normally felt anywhere from waist level all the way up to a person’s jaw.
Some describe the “MS Hug” as a feeling of significant pressure within the torso regions to a feeling of burning or tingling. Some people also get feelings of aching, stabbing, crawling or pins and needles. This is a kind of dysaesthesia (meaning “not normal sensation”) and is classed, medically, as a kind of pain.
The “MS Hug” varies from person to person in severity and is not a symptom that is specific to multiple sclerosis as it does occur within people who endure spinal cord problems such as injury or transverse myelitis which is disease resulting in inflammation in the spinal cord.
Heat, stress, and fatigue are common triggers for MS symptoms, including MS hug. An increase in symptoms does not necessarily mean your disease has progressed however it is important that people who endure MS do not overtax themselves resulting in symptoms appearing such as the MS Hug.
A “MS Hug” may last for only a few seconds to mere minutes, hours or longer.
What Causes MS Hugs?
The “MS Hug” is the result of small muscles called intercostal muscles going into a spasm condition. The intercostal muscles help to keep a person’s ribs in place and still give flexibility for movements. The feeling that results from these spasms can be specific to just one region, several regions or the entire area.
The spasms occur due to signals from the central nervous system resulting in the involuntary contraction of the intercostal muscles.
The intercostal muscles fill up the spaces between the adjacent ribs. They are arranged in three sets, external, internal and innermost internal, eleven pairs of each.
There are three principal layers:
External intercostal muscles, which aid in quiet and forced inhalation. They originate on ribs 1-11 and have their insertion on ribs 2-12. The external intercostals are responsible for the elevation of the ribs, and expanding the transverse dimensions of the thoracic cavity.
Internal intercostal muscles, which aid in forced expiration (quiet expiration is a passive process). They originate on ribs 2-12 and have their insertions on ribs 1-11. The internal intercostals are responsible for the depression of the ribs decreasing the transverse dimensions of the thoracic cavity.
Innermost intercostal muscle, the deep layers of the internal intercostal muscles which are separated from them by the neurovascular bundle.
If you experience the “MS Hug” as a new symptom and are on a disease modifying treatment already it is important to contact your neurologist and inform him or her of the incident and follow their instruction.
If the feelings persist an MRI is often ordered to make certain that the problem is not the result of other problems such as cardiology issues, lung disease, gastrointestinal dysfunction or disease, inflammation of cartilage tissue in the rib cage or even gallbladder problems.
Occasionally though rare the “MS Hug” can be extremely debilitating where it can interfere with the ability to breath resulting in feelings similar to extreme anxiety or a heart attack. If pain is also associated a trip to the hospital may be in order to rule out a person having a heart condition occurring.
Fatigue, stress and increases in bodily temperature appear to be some of the triggers of this multiple sclerosis symptom.
Lifestyle Adjustments:
As with many symptoms in multiple sclerosis lifestyle adjustments can help reduce this symptom. Avoiding triggers such as heat, stress and anxiety. Not pushing yourself past the limits you are aware of with your MS. Avoid quick torso movements if possible as some people report sudden torso twists or movements have resulted in intercostal muscle contractions.
Practice deep breathing techniques, yoga, meditation or massage therapies as people have stated these help in both coping with this symptom as well as staving off its severity when it occurs.
Treatments & Management:
There are a variety of drugs that can treat the symptoms of the MS Hug as shown below:
Baclofen (lioresal)
Valium (diazepam)
Lorazepam
Zanaflex
Lyrica (pregabalin)
Neurontin (gabapentin)
In cases where the symptom is associated with a new exacerbation (MS Attack) medications such as these below may be prescribed:
Solumedrol
IVIG
Novantrone
Over The Counter Medications:
Some people state that at the onset of and MS Hug that ibuprofen or acetaminophen seem to lessen the impact of the intercostal contractions.
Ibuprofen examples as Advil and Motrin are available as over the counter medications. Acetaminophen such as Tylenol are also available over the counter. Be sure and speak to your healthcare provider before taking these medications to make sure they are in fact safe towards your usage for this purposing.
Devices:
Some people report that TENS units (Transcutaneous Electrical Nerve Stimulation) help to reduce or eliminate MS Hugs.
If considering using a TENS unit make sure you are aware of how, where and what strengths to use the unit at. TENS units sent electrical shock impulses out and are commonly used for pain management, sports injuries and more. They can be dangerous to use as well. Since they send out electrical impulses they should never be used around the heart or significant arteries. For MS Hugs they may provide relief or make the condition worse. If attempting to use a TENS unit on intercostal contractions start with the lowest setting and make sure to not use it anywhere in relation to the heart. Cardiac patients or patients with pacemakers or similar devices should NOT USE A TENS UNIT AT ALL.
Infrared and/or sonic based massage units. Physical therapists in addition to TENS units for muscle pain and spasms often turn to infrared and/or
sonic based electrical devices to help reduce pain or spasms. Many of these devices or combinations of the two up to and including ones with laser therapy are available to purchase. These can also be highly effective in pain reduction and getting the intercostal muscles to contract.
With any of the electrical therapy based technologies it is important to speak with your healthcare provider prior to purchasing any of these devices and to make sure that they are properly used as they can also be dangerous when used improperly.
Natural Treatment Options:
There are numerous mechanisms people use to attempt to cope with intercostal contractions which include:
Deep Breathing – Breathing in and out methodically, several variations exist
Breathing in deep through the nose and out through the mouth.
Timing one’s breaths which also takes attention off the feeling of the hug
Holding one’s breath shortly.
Breathing deeper in successive breaths.
Combinations of the above.
Stomach Breathing – Instead of using your chest to breath in and out shift towards more of using your tummy trying avoid your rib cage expanding and contracting as much.
Heating Pad(s) – Without turning up a heating pad too high use the heating pad on the region feeling affected. Many heating pads have an inner liner that also alows them to delivery moist heat which is preferable. Heat can help blood flow and assist muscles in relaxing.
Warm Baths – In similar respect to heating pads warm (not hot) baths can also assist in release of muscle contractions.
Acupuncture – Some patients express that acupuncture helps relieve the symptom and is usually well tolerated.
Massage Therapy – Gently massage the areas where the Hug appears to be coming from or have another person do so.
Meditation & Tai Chi – These types of therapies towards MS Hugs work to relax the parasympathetic nervous system. The sympathetic nervous system in short explanation is part of the autonomic nervous system responsible for “on” conditions such as “Beat Heart or contract muscle”. The parasympathetic nervous system also part of the autonomic nervous system is responsible for the “off” condition, aka: relax muscle.
Myofascial release is a type of physical therapy often used to treat myofascial pain syndrome. Myofascial pain syndrome is a chronic pain disorder caused by sensitivity and tightness in your myofascial tissues. These tissues surround and support the muscles throughout your body. The pain usually originates from specific points within your myofascial tissues called “trigger points.” Myofascial release focuses on reducing pain by easing the tension and tightness in the trigger points. It’s not always easy to understand what trigger point is responsible for the pain. Localizing pain to a specific trigger point is very difficult. For that reason, myofascial release is often used over a broad area of muscle and tissue rather than at single points.
What To Do At The Onset Of An MS Hug?
Finding which mechanisms work best for you can be trial and error.
We have heard from many people who experience intercostal muscle contractions and derived a protocol from them that appears to work with many people though some have had no positive effect at all.
Draw a warm bath and immerse your torso in the warm water. Close your eyes and focus on the darkness. Breathe in normally and exhale through your mouth several times. Now breathe in a bit deeper and exhale again through your mouth 4 to 5 times with a slight delay between breaths.
Breath in a bit deeper and hold your breath counting slowly, about one second between counts to 3… “1 and 2 and 3” and again exhale through your mouth. Continue this process. Do this 5-10 times.
Breath in yet deeper again and hold… “1 and 2 and 3” seconds and again exhale through your mouth.
For many people they begin to feel the Hug subside using this protocol. Essentially as the Hug begins to feel relief breath a bit deeper. Consider it as your breathing / holding helping to release the contraction.
Why does this seem to work? In speaking with some care professionals they stated that as musculature is contracted blood flow may be restricted. The warmth and assist of deep breathing helps both relax the muscles and help blood flow.
Your results may vary and as with all things its always wise to speak with your care provider when trying to mitigate any symptoms of MS.
Always Consult Your Care Team With MS Hugs FIRST:
With this particular symptom if it is new symptom not experienced before by the patient they should contact their healthcare provider before attempting ANY therapies. This is QUITE IMPORTANT and here is why. Simply stated since the MS Hug often is associated with a tightening in the chest, chest pain and various buzzing or tingling sensations it may well NOT be MS at all but instead another condition which may require immediate attention such as heart attack, coronary arterial blockage, gastrointestinal distress or other conditions.
Thus engaging in breathing therapies, meditations, Tai Chi, taking a medication or tepid bath may well result in a much much larger issue coming to bare rapidly.
For new MS patients or MS Patients where this symptom appears to be new WE CANNOT STRESS ENOUGH how important it is to consult your healthcare team and if they are unavailable a trip to the emergency room may well be in order. You do not want ignore the prospect that you may be having a cardiology based incident.
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