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Multiple Sclerosis Hugs <|> The Basics

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    Multiple Sclerosis Hugs <|> The Basics

    MS Hug: The Basics
    • MS hugs are localized pain caused by muscle spasms between your ribs.
    • Symptoms: MS hugs can be frightening, painful experiences that feel like a snake has you in it’s coils and is suffocating you. They are called hugs because it feels like someone is hugging too tight.
    • Causes: There are a number of triggers, including heat, stress, movement and injury that can set off a hug.
    • Treatment: Any treatment to relax and repair the muscles.
    • Prevention: Strengthening the rib muscles can often reduce or eliminate many hugs.

    MS Hug Basics: Background
    The chest has 12 rib bones on each side of the body and between each rib are intercostal muscles. The 11 groups of intercostal muscles have both blood vessels and nerves; and are found in the intercostal space between each rib. Intercostal muscles are considered skeletal muscles because they directly attach to and help control a bone (your ribs). During breathing, these muscles tighten and loosen to expand and deflate the chest. These muscles also help keep your ribs in place and form the chest wall

    Intercostal pain is known as parietal pain when limited to only the chest wall. In the MS community, parietal pain is often called a “MS Hug.” MS Hug pain may be related to muscles, nerves or ribs. The muscle spasms might be detected by clinical examination, X rays or even via a MRI scan. Severe MS Hugs attacks are often mistaken for a heart attack and end up with the patient, especially first-timers, in the ER.

    The pain is often alarming and may mimic heart attack pain. Chest pain should always be taken seriously. If you believe you are having a heart attack, please call 911 for emergency assistance. Symptoms that may suggest a life-threatening emergency include, but are not limited to:
    • Passing out, sudden confusion, dizziness, or change alertness.
    • Chest or rib pain, especially what spreads down the left arm, jaw, shoulder, or back.
    • Severe chest pain when breathing or coughing that prevents you from natural breathing, or where you are coughing up mucus (yellow-greenish in color).
    • Fluttering chest feeling or heart palpitations. Any pressure in the chest or any chest sensation for cramping, tightness or tearing.
    • Severe abdominal pain.

    Never take a chance with severe chest pain.If you believe the situation is urgent than treat it as such.
    It’s far better to be in the ER with a MS Hug than having a heart attack that goes untreated.

    Spasms normally occur when the muscle is fatigued, stressed, inadequately dehydrated or nourished, or otherwise in distress. For example, you don’t get ‘tennis elbow’ without some type of repetitive motion. For non-emergent pain, please consult your doctor, or neurologist, for pain in the chest region to rule out any problems that require medical attention. Chest movement can increase the pain of the MS Hug, especially quick or big movements like coughing or sneezing.

    Some people are more susceptible to MS hugs and include people:
    • that are elderly, due to the development of arthritis and other compounding health problems
    • that do not properly warm up or that overdo their exercises.
    • that frequently wear binding clothing.
    • that participate in sports or athletics. These people have a higher risk of muscle injury, especially those that routinely stress their intercostal muscles and do not get adequate rest and recovery periods.
    • that smoke.
    • with muscle weakness or poor muscle tone, flexibility, or posture.
    • with poor core strength or who are sedentary individuals
    • with the varicella zoster virus that causes chickenpox or shingles

    People with chronic MS Hugs are more susceptible to having low oxygen levels, pneumonia, respiratory issues and chronic chest pain.

    MS Hug pain is normally described as tearing, sharp, severe, stabbing pains that came on suddenly. These pains may occur with every breath or with movement and are often debilitating. The ribs are often described as sore achy and increases when deep breathing, bending or twisting the upper body. Swelling and tenderness of the ribs may or may not be seen. MS Hugs normally go away after a few seconds, but can last minutes or even longer. In addition to pain, patients may complain of shallow breathing and shortness of breath. A MS Hug may also be accompanied by paresthesia (e.g. pins and needles, numbness, burning hot or cold sensation, etc).

    Shallow breathing can be the result of painful breathing. This can lead to abnormal, and unhealthy, low-levels of oxygen in your body. Since normal breathing hurts, your body naturally begins to protect itself, with more shallow breathing to avoid the pain. Your may notice that other activities are also being avoided to prevent an increase in pain.

    Be mindful of activities that can stretch or pull your intercostal muscles, especially without properly warming up. This can take the form of forcefully swinging your arms or exaggerated twisting of your upper chest. Direct intercostal injuries can occur from falls or other physical trauma. For MS patients, excessive stress, heat or fatigue, are all conditions that increase the likelihood of experiencing a MS Hug.

    Not all chest pain is MS Hug pain. Respiratory and cardiac possibilities have already been addressed, but dehydration, weak muscles, muscle injury, shingles, infection, neuropathy, neuritis, tears, twisting and stretching exercises, sports, arthritis, and many other ailments can result in similar pain to MS Hugs. Tracking your symptoms can play a major role in helping physicians correctly diagnose and treat your specific ailment.

    Treating MS Hugs
    Treating a MS Hug is fairly similar to treating fractured ribs.
    • Resting and avoiding any activities that cause the pain to increase.
    • You can ice or a cold compress to the inflamed area for 20 minutes, 3-4 times per day. Wrap any ice bag in a towel so you do not have direct ice to body contact that could result in skin damage.
    • Drink water and ensure proper nutrition. Muscles need water and proper nutrition to function normally.
    • Try changing physical positions (sitting upright, standing, laying down) to see if any position is more comfortable.
    • Try wearing compression clothing may reduce the pain sensation. I often wear gloves on my hands to reduce the tingling, pins & needles sensations. The same can be done around your chest to reduce the sensation of pain.
    • If the hug lasts for some duration, taking NSAIDs may reduce inflammation and provide some level of pain relief. If additional relief is necessary, your doctor may prescribe a medication to reduce spasticity, nerve pain or a relaxant for the muscles.
    • Your doctor can prescribe therapy to help with reducing MS Hugs. Most therapists, whether occupation, physical or speech, can provide a customized MS-hug treatment and prevention plan for you. The goal would be to increase the health of your intercostal muscles and improve your breathing. Never continue any exercises or stretch that causes you pain. Some of the relaxation or light exercises therapists may suggest are:
    • To gently lift your hands above your head (the surrender position during a bank robbery) and take a deep, gentile breath, inflating your lungs as much as possible. Do not go past the point of pain. Repeat this 5 times every 30 minutes. Any other activities that will help you relax are encouraged, provided they do not increase your pain (i.e. watching a comedy might be fun, but when you start to laugh too hard you might increase your pain.
    • To sit or stand with your neck and back straight. Deeply inhale, without causing additional pain and then slowly exhale. Keep your shoulders flat and concentrate on inflating your lungs. Do this 8-10 times/every hour. Alternatively, you can take a deep breath, hold it for 3-5 seconds and then fully exhale. This exercise may be easiest laying on your back, with knees bent and a pillow inserted to help support your head and/or knees.
    • To lie on your back with knees bent. Slowly rotate your knees side to side as far as you can, without causing pain. Repeat this 10 times. Alternatively, you can lay on your affected side and take deep breaths.
    • Place a foam roller under your upper back (to expand your chest), then relax and try to breathe normally. Attempt this for up to 90 seconds, provided no pain is experienced. For even a greater stretch you can lift your arms over your head.

    Please consult with your doctor or therapist before starting an exercise program or attempting any exercise you are unfamiliar with.

    • Other MS Hug treatments may include: heat/cold treatment, using anti-inflammatory medications, elimination of any activities (besides breathing) that increases your pain, hydration, relaxation, hydration, rib taping, etc. For specific instances treatment may involve antidepressants, antihistamines, antiviral medications, topic analgesics, even corticosteroids for more severe cases.

    Complimentary treatments for MS Hugs may include yoga, acupuncture, massage and RICE (Rest, Ice, Compression and Elevation. The elevating part may be difficult.

    Preventing MS Hugs
    Preventing MS Hugs is much like the treatment, but far more important. You can reduce your chance of getting a MS Hug, by properly maintaining healthy intercostal muscles. Staying hydrated, managing your stress level, and combing gentle stretching with deep breathing activities can help strengthen the muscles and reduce the opportunity for MS Hugs to recur.

    I hope some of the mystery has been removed from the “MS Hug.” MS Hugs can be frightful and painful experiences, but maintaining healthy intercostal muscles can greatly reduce the intensity and frequency of the dreaded MS Hug.