MS Symptom Management: Spasticity
What is spasticity?
Spasticity is defined as a velocity-dependent increase in tonic muscle stretch reflexes resulting from damage to descending motor pathways. Clinically, we describe spasticity as an abnormal increase in muscle tone, muscle spasm, and loss of motor function. Spasticity is the result of the demyelination of the nerves that regulate muscle tone. People with Multiple Sclerosis (MS) may have spasticity, which occurs when there is a quick stretch to the muscle, causing it to spasm. An example of spasticity would be during the walking cycle when the foot is flexed quickly by the ground; this can apply the quick stretch to the muscle causing the foot to "jump" a few times. The muscle spasm can lead to imbalance or even falls.
What is tone?
On the other hand, increased muscle tone is a constant limitation in flexibility or stiffness. The cause could be mild spasticity/demyelination of the nerves responsible for regulating muscle tone, or it could be due to the inactivity of a muscle. For example, if someone with MS has very high fatigue levels, they may spend much more of their day sitting than they used to. This position shortens the hip flexor muscles leading to tightness in the front of the hip. In addition, this position can pull the pelvis anteriorly, causing increased low back pain or a forward flexed posture when walking.
Typical Management with Medication
Mild spasticity and tone can be managed with physical therapy; however, moderate to severe spasticity are typically managed by medications, the most common being Baclofen. Baclofen can be taken orally, or if not tolerate well or needed in a higher dose, an intrathecal baclofen pump can be placed surgically. Side effects of Baclofen include sleepiness, confusion, weakness, and ataxia. Other medications that can be used to treat spasticity include tizanidine, gabapentin and benzodiazepines, all have a side effect of sedation. Botox (botulinum toxin type A) is an intramuscular injection that can reduce muscle contraction and typically lasts 3-6 months.
Muscles Most Commonly Affected by Spasticity
The muscles that are most commonly found to have spasticity in individuals with MS are the antigravity muscles. The calf muscles, thigh muscles, and groin tend to be most affected but may also be present in the back and glutes. Spasticity may be worse on one side than the other and may change throughout the day depending on levels of fatigue or activity. Some common symptoms associated with spasticity include:
Joint stiffness or difficulty moving a joint
Pain or aching in a joint
A feeling of heaviness
Fatigue
Cramping
Stretches for Spasticity
Physical therapists can help you to set up a daily stretching program based on your level of spasticity, muscles affected, and mobility level. It is important to stretch slowly as a quick stretch motion activates spasticity. You should feel a stretch, but it should not be painful to maintain that stretch for 30-60 seconds. Your physical therapist should customize your program because there are many different positions or ways to stretch a muscle. However, these are some of my go-to stretches for people with MS:
Hamstring/Gastroc Stretch
Start seated at the edge of a chair with one leg bent and one leg out straight. To stretch your calf simultaneously, you can loop a belt or dog leash around your foot.
Keeping your back straight, lean your chest forward until you feel a stretch in the back of your thigh. Then pull up on the belt/leash until you feel a stretch down the entire back of your leg. Hold.
Gastroc Stretch
Stand with 1 foot in front of the other, bracing yourself on a wall or countertop, making sure both toes are pointed straight ahead.
Keeping your back leg straight, bend your front knee until you feel a stretch in the calf muscle of your back leg. Hold.
Hip Adductor (Butterfly) Stretch
Lay on your back with your legs bent. The closer your feet are to your glutes, the deeper the stretch will be.
Gently let your legs fall out to the side until you feel a stretch on the inside of your thighs. You can rest your knees onto pillows to manage the stretch or gently push down on your knees for a deeper stretch. Hold.
Prone Rectus Stretch
Lay on your stomach with a belt or dog leash looped around 1 foot.
Bend your knee and use the strap to pull your foot closer to your glutes. Hold.
Stretching is best with warm muscles. If you can, walk for a few minutes around your home or stretch after you have already done the warm-up for your exercise program. Hold each stretch 30-60 seconds at a time and perform three repetitions.
Over the coming weeks, we will continue to discuss different symptoms commonly associated with MS. We will provide specific stretches, exercises, and guidance for maintenance from a physical therapy perspective. Next up will be Gait Impairments.
You can find more information on my website at:
https://movementmatters-pt.com/multiple-sclerosis
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Articles related to Management of Spasticity for individuals with MS
Spasticity management in multiple sclerosis - PubMed (nih.gov)
Disclaimer
This blog is provided for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition.
