Complications of Multiple Sclerosis-Related Immobility

If you have multiple sclerosis (MS)-related immobility, your lack of physical activity puts you at high risk for developing problems like pressure sores, stiff muscles and joints, and bone weakness. These issues can cause serious medical complications, such as infections and injuries, but there are steps you can take to help prevent them and early signs that can indicate that they might be developing.

Pressure Sores

Pressure sores (also called bed sores, pressure injuries, or pressure ulcers) are areas of frail or raw skin that develop after sitting or lying in one position for a prolonged period of time. The excessive pressure interrupts blood flow to the skin and the tissue beneath it. Without adequate oxygenation, the skin breaks down and a sore forms.

Pressure sores form on bony parts of the body, most commonly the tailbone, hip, and sacrum, which is the lowest area of your spine above your buttocks. They may also form on the heel, shoulder blade, inner knee, elbow, and back of the head.

Recognizing Pressure Sores

The tricky thing about pressure sores is that they do not start out looking bad. They can begin as a small area of red skin and can quickly progress if the pressure is not relieved.

One of the first telltale signs of a pressure sore is a reddened area of skin that when pressed, stays red instead of going back to its normal color. This is called a stage one pressure ulcer.

As the pressure sore progresses, the red area of skin may begin to swell, blister, and eventually slough off. The sore can deepen, extending to the fat layer underneath the skin, and eventually to the muscle and possibly the bone. This is called a stage four pressure ulcer.

Complications

One of the biggest concerns with pressure sores is the risk of infection, which can cause fever and may spread or even become life-threatening.

Prevention

Prevention is key when it comes to pressure sores. Staying active, when and if possible, is important, even if you are not very motivated.

Pressure-relieving support devices include a special mattress for your bed and/or cushion for your chair or wheelchair. You can get recommendations and a prescription for the right products from your physical therapist or physiatrist.

If you are not able to maintain any mobility, (you are bed-bound or chair-bound), it's important to change your position at least every two hours. This may require the care of a nursing aid or caretaker.

Contractures and Spasticity

MS-induced immobility causes joint and muscle stiffness to develop, restricting your range of motion. And MS often causes muscles to stiffen and contract, with or without immobility.

Muscle contraction is the shortening of a muscle during movement, which is normally followed by relaxation (lengthening of the muscle). Contractures may develop when the muscles remain contracted even in the absence of movement.

Spasticity is an abnormal increase in muscle tone or muscle stiffness that interferes with movement and can be associated with muscle spasms and pain. Spasticity commonly occurs if you have contractures, but it can occur in the absence of them.

Recognizing Contractures and Spasticity

If you notice sudden jerking movements, you may have spasticity. If you hold your hands, arms, legs, or feet in an unusual position while at rest, you could be developing contractures. Pain when moving your muscles is another sign of contractures.

Complications

Contractures and spasticity can both be associated with pain. They also interfere with muscle control, potentially even causing an injury when you try to use your muscles.

Prevention

Managing joint stiffness, contractures, and spasticity helps stop this cycle of events and prevents injuries.

Several strategies can help with prevention, including:

• Getting regular exercise, such as walking
• Stretching your muscles every day
• Physical therapy
• Caregiver-directed passive movements if your muscle control is very limited
• Muscle relaxants, for example Lioresal (baclofen) and Ozobax or Fleqsuvy (baclofen oral suspension)
• Botox injections into the affected muscle

Rarely, surgery is needed to lengthen the muscle and tendon and improve range of motion.

Osteoporosis

Being mobility-impaired or sedentary due to MS-related problems can also contribute to the development of osteoporosis—a condition of bone loss and weakening that increases your risk of bone fracture.

The deceptive part about osteoporosis is that it's a silent disease. In fact, osteoporosis is typically diagnosed by X-ray, usually after a fracture has already occurred.

Prevention

Before starting a bone-strengthening regimen, it's best to see a physical therapist who has experience working with decreased mobility. You will be given a weight-bearing exercise program that takes into account your other MS-related problems, like muscle weakness, fatigue, and spasticity.

Examples of weight-bearing activities include tennis, dancing, lifting weights, speed walking, and jogging.

It is best if you can do your exercises for 30 minutes a day. But if this is too much, do what you can—a few minutes is far better than nothing.

In addition to exercise, eating well is important. Meals that are rich in fruits, vegetables, lean protein, and calcium are good for maintaining strong bones. Check with your healthcare provider to see whether or not a calcium supplement is right for you. Vitamin D is important for calcium absorption, so make sure you are getting enough of it through your diet and sun exposure.

A Word From Verywell

Living with MS is a journey, so take each day one at a time, be kind to yourself in the down moments, learn what you can, move forward, and treasure all the ups. You may have to deal with bouts of immobility, but they may improve as an exacerbation resolves. During your most severe stages of immobility, it is important to try to avoid complications, which can last well beyond the exacerbation itself.