Spasticity is a muscle control impairment (hypertonia) characterized by tight and/or stiff muscles, loss control of muscles and muscle spasms. Reflex actions may last for a short period or long time and can mild or strong enough to impact mobility. Spasticity is one of the more common symptoms of multiple sclerosis. Research reports that between 60% and 90% of people with MS will be affected by spasticity at some point at varied levels of severity.
A spasm that causes a limb to bend, such as causing the leg to move upwards towards the body, is called a flexor spasm.
A spasm that causes a limb to extend, such as causing the leg to straighten away from the body, is called an extensor spasm.
A spasm that causes a limb to be pulled in towards the body, such as making it difficult to separate the thighs, is called an adductor spasm.
Left untreated, spasticity can lead to serious complications, including contractures (frozen or immobilized joints) and pressure sores. Since these complications also act as spasticity triggers, they can set off a dangerous escalation of symptoms.
The cause of spasticity is an imbalance of signals from the central nervous system (CNS) resulting in the symptoms of spasticity.
Spasticity is often confused with a differing condition called dystonia. While the two conditions share some similarities they are different.
Spasticity is a movement disorder associated with a pathologically increased muscle tone. This creates stiffness and resistance to passive movement (the word ‘spasm’ originates from the Greek word, ‘spasmos’, which means to drag or pull). The frequently or constantly increased muscle tone leads to muscle stiffness; overall mobility might become limited. Painful body postures can occur and the quality of life is reduced. Spasticity is caused by disturbances to the central nervous system. Damages or defects in the spinal cord area or the brain can lead to spasticity. The most frequent causes of this condition are stroke, multiple sclerosis, brain and spinal cord injuries, as well as early childhood brain damage, cerebral inflammation or brain tumors. Post-stroke spasticity usually occurs a few months after the actual stroke event.
Dystonia on the other hand such as the neurological movement disorder focal dystonia, interaction between the activation and relaxation of the various muscle groups involved in a movement is disturbed. Muscle tensions (muscle contractions) occur which affect only individual muscles or muscle groups and cannot be voluntarily controlled by patients. Because of these involuntary muscle tensions, the person concerned adopts a cramped, unnatural posture of the body or head.
- Overactive muscle reflexes
- An increase in muscle tone
- Movements that are involuntary such spasms which is muscle contraction and clonus which means fast involuntary contractions
- Functional abilities that’s decreased and also delayed motor development
- Having difficulty with hygiene and care
- Posture becomes abnormal
- Contractures which is a permanent contraction of the tendon and muscle because of severe constant stiffness and spasms
- Joint and bone deformities
Spasticity and spasms are not always painful. If there is pain it may feel like a pulling or tugging of the muscles, particularly around joints, or a long lasting episode of cramp. Sometimes spasticity and spasms can lead you to alter how you sit or lie and this can also lead to pain. Movement and stretching exercise can help manage this. Pain that’s associated with spasticity can be mild such as the feeling of tight muscles or severe enough to produce very painful spasms of the arms and/or legs. Spasticity is usually more predominant in the legs. It may also contribute to low back pain resulting in feelings of pain and tightness around and in the joints.
The damage nerve pathways can make muscles stiff or weak. This can lead to some muscles being stiff and others weak in the same limb. Sometimes removing spasticity entirely is not helpful as it leaves just weakness and may make it harder for you to walk or move from bed to a chair. An assessment of your spasticity, perhaps by a physiotherapist, will identify if the stiffness in a limb is helping you function.
Clonus is a repetitive, up and down movement, often seen as a constant tapping of the foot. You can reduce the effects of clonus by moving your leg or putting more weight through your leg by standing or perhaps leaning forward.
What Causes Spasticity?
Nervous system pathways connect the brain, spinal cord and muscles and work together to control and coordinate movements. When signals within these pathways are misinterpreted, interrupted or weakened the muscles react accordingly. For example when signals are interrupted the muscle may result in its shortened or contracted state making a limb feel stiff, tight difficult or even impossible to move.
If a limb becomes fixed in one position known as contracture it can result in serious implications if not promptly managed. Nerve signals disrupted can cause over activity in muscles as will and a loss of control and coordination leading to spasms.
Spasticity can affect any muscles in the body. What and where brain or spinal cord damage occurs has a direct correlation to where spasticity may occur.
Your doctor performs certain test to confirm your diagnosis. The tests evaluate your leg and arm movements, muscular activity, active and passive ranges of motion, and your ability to achieve self-care activities.
If you encounter spasticity it is important to contact your health care professionals as soon as possible. The disorder left untreated can result in serious complications such as immobility, pressure sores and injury. Further left untreated they can also set off more spastic symptoms or worsen as they may trigger an array of more dangerous symptoms.
Managing spasticity and spasms requires recognizing as many potential trigger factors as can be and keeping as flexible as possible.
Triggers can make spasms worse. If you have spasms or spasticity try and remember what you were doing when the symptom began and document it. Symptoms such as pain, bladder or bowel problems, tight clothing, being too hot or too cold are some of the more common triggers.
It is important to try maintain good posture whether standing, sitting or laying down. Spasticity often occurs while attempting to sleep or during sleep. Sleeping aids and posture can assist in helping manage spasms or spasticity during sleep.
Working with a physiotherapist to help with stretching exercises to maintain flexibility, posture and more is an important aspect of managing this symptom.
Managing the trigger factor, maintaining good posture and incorporating stretches into you daily routine can help reduce the effects of spasticity or spasm without needing any medication. If you are taking medication, it will not be fully effective unless any trigger factors for spasticity are also being addressed.
Treatment of spasticity begins with an assessment with a physician who will advise ways to help reduce or relieve symptoms. These may include medications, exercise, massage therapy, changes in activities or any combination thereof. Progress is tracked and referrals made to other healthcare professionals will normally occur such as physical or occupational therapy. Stretching and other exercises are often recommended to help relieve the condition.
Treatment can include medications such as clonazepam, dantrolene, diazepam , baclofen or tizanidine. The most common of these medications used with spasticity are baclofen and tizanidine.
Treatment usually starts with a low dose and gradually increases until a level is reached that helps you best.
It is important that you consider when you take them during the day to maximise their effect. For instance if you struggle to get up, washed and dressed, taking your medication 10-20 minutes before you get out of bed may ease the effort of your morning routine. If you need some stiffness in your legs to help you get out of bed safely, you may prefer to take your treatment after you have got up.
Medicinal marijuana has also shown positive impacts on spasticity but is not available everywhere in the world presently for prescription. A variety of medicinal marijuana cannabis delivery mechanisms exist and more are in research development such as pills, chewing gum and more.
Physical therapy and occupational therapy programs directed towards exercises involving muscle stretching, training range of motion exercises, at times the use of braces, can help to stop problems such as tendon shortening. This type of rehabilitation can help to stabilize how severe the symptoms are and improve performance and thus quality of life.
Botulinum toxin (Botox)
Local injections of botox has at times been more effective than the oral medications for the different types of spasticity since the level of impact of the condition varies so much from person to person. When botulinum toxin is injected into muscles it temporarily weakens them for about three months. During this period a physiotherapist can advise you on moving and stretching exercises that you can do to reduce the effects of spasticity in the longer-term
Intrathecal baclofen therapy involves having surgery to place a small pump in your abdomen. The pump delivers baclofen through a fine tube (called a catheter) into the fluid space around your spinal cord (called the intrathecal space). The pump uses much smaller doses of baclofen than when you it take it as tablets and so causes fewer side effects.
Treatment with phenol is usually only used if you have severe spasticity that hasn’t responded to other treatments. Phenol is given via a lumbar puncture into the space around the spinal cord. Intrathecal phenol is an irreversible, destructive treatment that permanently stops nerve messages. This can greatly reduce spasticity in the legs but will also reduce skin sensation, affect sexual function and alter how your bladder and bowel work. If your doctor is considering treatment with phenol, you will already be aware of these symptoms and may have a suprapubic catheter, a skin management programme to avoid pressure ulcers or be using suppositories regularly.
Surgery is sometimes recommended to release tendons cutting the nerve to muscle pathway, or even to implant of a baclofen pump therapy may be suggested.