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Girdling, also known as the MS hug, is a collection of symptoms caused by spasms in the muscles around the ribs. It is a common symptom of multiple sclerosis and can cause tightness around the chest, ranging from an annoying tickle to a vise-like grip that makes it difficult to breathe. The pain can last from a few seconds to several hours or even days. While there is no medication to completely avoid girdling, people can avoid triggers such as heat, stress, and fatigue.
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Multiple sclerosis (MS)
The MS hug is a collection of symptoms, which can include pain or pressure alongside other sensations. The pain can be persistent and uncomfortable, limiting mobility and independence. It can last from a few seconds to several hours, and in rarer cases, several days. Heat, stress, and fatigue are common triggers for the MS hug, and it can be more or less frequent and severe depending on the person.
The MS hug is not a life-threatening symptom, and it often doesn't require treatment. However, if it becomes long-lasting or extremely painful, medications that manage nerve pain and/or muscle spasms may be used. These can include drugs that fight nerve pain, such as amitriptyline, duloxetine, gabapentin, and pregabalin. Muscle relaxers like baclofen may also be prescribed. Relaxation techniques, rest, and complementary approaches such as warm compresses or baths may also help manage symptoms.
It is important to note that girdling pain is not unique to MS and can also be caused by other inflammatory conditions, such as transverse myelitis, an inflammation of the spinal cord.
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Transverse myelitis
TM is a heterogeneous condition with several identified causes. In 60% of patients, the cause is idiopathic, meaning the underlying cause is unknown. However, TM is often caused by other conditions, such as immune system disorders, infections, or damage to nerve fibres. Infections associated with TM include bacterial infections like Lyme disease and Campylobacter jejuni, and viral infections like HIV, herpes simplex, and Zika virus. TM can also be caused by spinal cord injuries, vascular disorders, and paraneoplastic syndrome.
TM symptoms usually develop over a few hours to several days or weeks and vary depending on the affected level of the spinal cord. Common symptoms include weakness and numbness in the limbs, deficits in sensation and motor skills, abnormal sensations like burning or tingling, and bladder and bowel dysfunction. In severe cases, TM can lead to partial or complete paralysis.
Most people with TM recover at least partially, with most recovery taking place within the first three months. However, some individuals may experience permanent effects or recurrence, especially if an underlying illness caused the inflammation. Treatment for TM includes medications and rehabilitative therapy.
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Nerve damage
The MS hug is caused by damage to the myelin sheath, the protective coating that insulates nerve fibres. This damage results in neuropathic pain, also known as dysesthesia, which refers to abnormal sensations. In the case of the MS hug, it is the intercostal muscles between the ribs that spasm, creating a sensation like being squeezed or hugged too tightly. This can range from mild discomfort to severe pain and can last from a few seconds to several days.
Heat, stress, fatigue, and exertion are common triggers for the MS hug. While there is no medication to completely prevent these episodes, certain drugs can help manage nerve pain and muscle spasms, such as anticonvulsants, antidepressants, and muscle relaxants. It is important for individuals experiencing girdling pain to work with their doctors to identify triggers and develop strategies for management and prevention.
In addition to MS, nerve damage can also cause muscle girdling in the case of limb-girdle muscular dystrophy (LGMD). LGMD is a group of disorders characterised by weakness and atrophy of the limb-girdle muscles, particularly in the hips and shoulders. This is due to genetic mutations that affect protein production, leading to impaired muscle function. LGMD can cause difficulty with movements such as walking, rising from a seated position, or reaching overhead.
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Muscle spasms
Muscle girdling is a symptom of multiple sclerosis (MS) known as the "MS hug" or "girdle-band sensation". This is caused by spasms in the intercostal muscles, which are located between the ribs and help with movement and flexibility. The pain of an MS hug is neuropathic and caused by nerve damage, but it is the muscle spasms that create the pressure, tightness, and aching.
The MS hug causes a sensation of tightness and squeezing around the chest, rib cage, or torso, which can be painful and make it difficult to breathe. This can come and go over several weeks and may last from a few seconds to hours, and in rarer cases, several days. The pain can be triggered by heat, stress, fatigue, and exertion, and may be worse with temperature changes.
Although there is no medication to avoid an MS hug, there are ways to manage the pain. Over-the-counter painkillers are unlikely to bring relief, but medications that manage nerve pain and/or muscle spasms may be used, such as muscle relaxants, antispastic drugs, antiseizure medications, and anticonvulsants. Relaxation techniques, rest, and other complementary approaches may also help.
It is important to note that girdling pain around the torso can also be caused by costochondritis, which is the inflammation of cartilage between the ribs. This usually has no clear cause but may result from injury, physical strain, or illness.
Another cause of muscle girdling is limb-girdle muscular dystrophy (LGMD), a group of disorders with many subtypes categorized by disease gene and inheritance. LGMD causes weakness and atrophy of the limb-girdle muscles, usually manifesting in the proximal muscles around the hips and shoulders. It is caused by a mutation in one of the genes, which results in a flaw that prevents cells from producing the proteins needed for healthy muscles.
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Genetic causes
While my search did not return any information on "muscle girdling", I found results for "limb-girdle muscular dystrophy", a group of disorders that cause weakness and wasting of the muscles in the arms and legs. Limb-girdle muscular dystrophy (LGMD) is the fourth most common genetic cause of muscle weakness, with a worldwide prevalence of 0.8 to 6.9 per 100,000 individuals. Approximately 5,000 people are living with LGMD in the United States alone.
LGMD is caused by mutations in various genes, which provide instructions for making proteins essential for muscle maintenance and repair. These mutations result in nonfunctional or deficient proteins, leading to abnormal muscle function. The two major groups of LGMDs, classified by inheritance patterns, are:
- LGMD1: This group has an autosomal dominant inheritance pattern, meaning that a single copy of the abnormal gene is sufficient to cause the disease.
- LGMD2: This group exhibits an autosomal recessive inheritance pattern, requiring two copies of the abnormal gene for the disease to manifest.
The severity, age of onset, and specific features of LGMD can vary significantly, even within the same family. Some individuals may experience muscle wasting, changes in posture, and difficulty running or walking, while others may develop joint stiffness or overgrowth of the calf muscles. In some cases, LGMD can lead to weakening of the heart muscle.
Dozens of different genes have been identified that, when mutated, cause specific subtypes of LGMD. These subtypes are generally classified by letters and numbers that indicate the suspected gene involvement and the inheritance pattern. For example, alpha-sarcoglycan deficiency and beta-sarcoglycan deficiency are two potential subtypes of LGMD.
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Frequently asked questions
The MS hug, also known as girdling or banding, is a collection of symptoms caused by spasms in the muscles around the ribs. It causes tightness around the chest and is a common sensation for people with MS.
The MS hug commonly feels like squeezing and pain in the chest. It can also be accompanied by a sensation of difficulty breathing, which is why it may be perceived as a heart attack or a panic attack.
The MS hug is caused by nerve damage and muscle spasms. Common triggers include heat, stress, and fatigue.
There is no medication that can completely avoid having MS hugs, but there are ways to treat the pain. Doctors may prescribe medication or a combination of medications, such as muscle relaxants, antispastic drugs, or antiseizure medication.
