What is Spasticity?
Spasticity is when muscles contract involuntarily and have difficulty relaxing. It causes a sense of stiffness and difficulty moving the affected limb or controlling the movement of the limb. Normal movement is usually fluid and smooth. Muscle movement is controlled by a complex system in which the brain "commands" some muscles to contract while "commanding" others to relax.
When there is an interruption in the mechanisms involved in this complex system, appropriate messages do not travel as they were designed, causing abnormal muscle movement, spasticity, and changes in muscle tone. This may occur after an injury or disease of the brain or spinal cord, which is the central nervous system. Examples of injuries or diseases that may cause spasticity include stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, and other conditions of the brain or spinal cord.
What are the symptoms of spasticity?
- Increased muscle tone
- Involuntary movements
- Spasms (quick and/or sustained involuntary muscle contractions)
- Clonus (series of fast involuntary contractions)
- Pain or discomfort
- Less ability to function
- Difficulty walking
- Impaired balance in sitting or standing
- Problems with care and hygiene
- Abnormal posture
- Contracture (a permanent contraction of the muscle and tendon due to severe lasting stiffness and spasms)
- Bone and joint deformities
- Decreased quality of life
What can be done about spasticity?
Spasticity usually does not develop immediately after an injury but may progressively develop during the first 6 months and may dramatically change throughout the first year. Once spasticity develops, there are treatment options that are aimed at management, as spasticity often does not completely resolve. Because of the negative effects of spasticity, it can and should be addressed. Your physician, physical therapist, and occupational therapist can work together to determine what treatment is the best option for you. In general, starting with the least invasive treatment is the best place to start, progressing to more invasive options as needed. Sometimes, your therapist may determine that your spasticity is beneficial to you; for example, if you have severe weakness in your leg, but you have spasticity that causes some stiffness in your leg, you may be able to use that spasticity to help you maintain standing for functional activities. If the spasticity is painful and interferes with your function, then your medical team may recommend treatment.
Treatment Options
Exercise
Stretching the muscles that are spastic and strengthening the antagonistic muscles (the muscles that move your limb in the opposite direction of the spasticity). Your physical therapist and/or occupational therapist will work with you to determine the right combination of exercises for you. Bracing, casting, splinting: These techniques are used to maintain range of motion and flexibility, as well as to help prevent falls when walking or stepping.
Moist Heat or Ice
This option may help temporarily reduce spasticity in a muscle. Oral medications: these can be used to reduce spasticity in a large group of muscles and the dosage can be easily adjusted; however, many of these require tapering to stop and may cause drowsiness or dizziness. Oral Baclofen is one example.
Injections
Medication injections can be used to reduce spasticity in a more specifically chosen muscle group. Botulinum toxin (Botox) is one commonly used neurotoxin. Effectiveness generally is noticed after 5-7 days and can last up to 3-6 months with gradual wearing off of noticeable effects. Injections can be administered approximately every 3 months. Dosage of neurological toxins is limited and may not be effective enough if large and/or multiple muscle groups are spastic.
Intrathecal baclofen pump
This involved insertion of a pump underneath the skin of the abdomen; a catheter runs from the pump to where it is inserted into the spinal canal. This system delivers a preset controlled amount of Baclofen directly into the spinal area at the site of action and does not have the systemic effects of oral baclofen. This allows for increased effectiveness with lower doses of the medication. If your treatment team believes that this may be a good choice for managing your spasticity, you would meet with your doctor, neurologist, or spasticity management physician to undergo a trial before the pump is implanted by a neurosurgeon; implantation requires a short surgical procedure followed my check-ups at least monthly to every 3 months.
No one method works for all people, just like no shoe fits all people the same way. It takes you working together with your team of healthcare providers to determine the best method for treating and managing your spasticity. Managing your spasticity is important to help you achieve your highest level of function possible. Talk with any member of your healthcare provider team if you think you are experiencing spasticity so that you can get on the road to better living.
Additional Resources