Spasticity

What is spasticity?

Spasticity is a disruption in muscle movement patterns that causes certain muscles to contract all at once when you try to move or even at rest. The muscles remain contracted and resist being stretched. It interferes with movement and can also affect your speech and gait (walk).

Spasticity can vary greatly in how it affects someone — it may be as mild as the feeling of tightness of your muscles or may be so severe that it causes painful, uncontrollable stiffness and spasms of your extremities.

Spasticity can involve the following:

• Increased muscle tone (hypertonia).
• Muscle spasms (quick and/or sustained involuntary muscle contractions).
• Clonus (series of fast involuntary muscle contractions that may feel like a tremor, most often experienced in your ankles).
• Involuntary crossing of your legs.
• Pain or discomfort.
• Abnormal posture.
• Contracture (permanent contraction of the muscle and tendon due to severe lasting stiffness and spasms).
• Muscle, joint and/or bone deformities.
• Difficulty performing daily activities, and difficulty for others to help with activities such as dressing and bathing.
• Sleep disruption due to, for example, painful spasms or muscle tightness.

Muscle movements are normally controlled by a complex system that allows some of your muscles to contract (tighten) while others relax. Damage to nerves in your central nervous system (brain and spinal cord) can disrupt this pattern. As a result, many muscles may contract all at once (sometimes called co-contraction), which makes it difficult to perform voluntary movement.

What’s the difference between muscle spasticity and rigidity?

Muscle rigidity and muscle spasticity are both hypertonic states (a state of abnormally high muscle tone), but they’re different.

Rigidity is most commonly associated with basal ganglia injuries, and it’s often seen with Parkinson’s disease. The basal ganglia is a group of structures linked to the thalamus in the base of your brain that are involved with coordination of movement.

Rigidity, unlike spasticity, affects all muscles surrounding a particular joint equally. In addition, with spasticity, more rapid movement triggers a stronger involuntary contraction or “catch” of the affected muscles. With rigidity, the increased muscle tone remains constant throughout the range of movement of the affected joint.

What are the possible complications of spasticity?

Complications of spasticity can vary. In a severe state, spasticity can interfere with daily function and cause extreme pain. It can also make it more difficult to perform hygiene tasks and basic care. This, in turn, can increase the risk of developing pressure injuries (bedsores), which can lead to infection and sepsis.

Left untreated, moderate to severe spasticity can also lead to:

• Contractures (frozen or immobilized joints).
• Bone fractures.
• Partial or full dislocation of joints.
• Urinary tract infections (UTIs).
• Chronic constipation.

What causes spasticity?

Spasticity is usually caused by damage to nerve pathways within your brain or spinal cord that control movement and stretch reflexes.

Spasticity may occur due to several conditions, including:

• Spinal cord injury.
• Multiple sclerosis (MS).
• Cerebral palsy.
• Stroke.
• Brain or head injury.
• Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.
• Hereditary spastic paraplegias.
• Adrenoleukodystrophy (ALD).
• Phenylketonuria.
• Krabbe disease.

How is spasticity treated?

There are several treatment options for spasticity. People who have spasticity usually undergo more than one treatment at a time. Though there’s no cure for spasticity, these treatments can help alleviate symptoms and improve quality of life.

The most effective way to treat spasticity is with a team of healthcare professionals with different specialties. Members of this team may include one or more of the following:

• Neurologist.
• Physiatrist (a rehabilitation specialist).
• Advanced practice clinician.
• Physical therapist.
• Occupational therapist.
• Speech and language pathologist.
• Neurosurgeon.
• Orthopaedic surgeon.

Nonsurgical treatments for spasticity

Nonsurgical treatments for spasticity include:

• Physical therapy: A physical therapist generally focuses on lower extremity stretching and strengthening exercises and mobility training (transfers, standing and walking).
• Occupational therapy: An occupational therapist generally focuses more on upper extremity stretching, strengthening and training to perform daily activities, such as grooming, bathing and cooking.
• Speech therapy: If you have spasticity that affects your mouth, face and throat muscles, a speech therapist can help with your speech, communication and swallowing.
• Casting or bracing: Using casts or braces for affected regions of your body can help provide a sustained stretch of spastic muscles to improve range of motion and can facilitate function.
• Assistive devices: A wide variety of assistive devices can help a person with spasticity move around and perform daily tasks more efficiently and more safely.

Healthcare providers typically prescribe oral medications in combination with other therapies. They usually only prescribe medications if your spasticity disrupts daily functioning or sleep. Common medications for spasticity include:

• Baclofen (Lioresal®).
• Tizanidine (Zanaflex®).
• Dantrolene sodium (Dantrium®).
• Diazepam (Valium®).
• Clonazepam (Klonopin®).
• Gabapentin (Neurontin®).

Oral medications for spasticity are often effective but may cause side effects such as drowsiness and weakness.

Botox treatment for spasticity

Local injections of botulinum toxin (Botox®) or phenol into spastic muscles can be very effective for treating spasticity. These shots can selectively reduce tone in muscles causing the most tightness or spasm.

During botulinum toxin injections, your provider injects the toxin into carefully selected sites in your muscle, causing spastic muscles to relax. This may improve comfort, positioning and function. The effects usually take seven to 10 days to become noticeable, and typically last around three months.

This therapy is usually a consideration when spasticity needs to be relieved in only a few muscle groups. It can be used in addition to other treatments for spasticity.

Surgical treatments for spasticity

Healthcare providers typically only recommend surgical treatments for spasticity in severe cases. These types of treatment include:

• Intrathecal baclofen (ITB) therapy: This treatment involves surgically placing a pump in your abdomen that can release a steady dose of the medication baclofen directly to your spinal fluid through a catheter connected to the pump. This can lead to a significant reduction in spasticity and pain with a lower risk of drowsiness compared to taking baclofen orally.
• Selective dorsal rhizotomy (SDR): Spasticity can be caused by an imbalance in electrical signals to certain muscles. SDR rebalances the electrical signals sent to your spinal cord by surgically cutting carefully selected nerve roots. Surgeons only perform this procedure for severe spasticity affecting your legs. Precise cutting of problematic nerve roots can decrease muscle stiffness while maintaining other functions. Providers most commonly recommend SDR for people with cerebral palsy.
• Orthopaedic surgery: This involves surgery that deals with treating the consequences of spasticity on muscles, bones and connective tissue, such as contractures and deformities. Examples include tendon lengthening and tendon transfer procedures.

When should I see my healthcare provider about spasticity?

It’s important to seek medical care if you experience spasticity for the first time with no known cause, since spasticity may be a sign of damage to your brain or spinal cord.

If you’ve been diagnosed with spasticity, see your healthcare provider if the spasticity is worsening and/or becoming more frequent or if it’s interfering with everyday tasks.

A note from Cleveland Clinic

Spasticity is a common symptom and feature of several neurological conditions. The severity of spasticity can range from a minor inconvenience to a significant disruption of your day-to-day life. The good news is that there are several treatment options for spasticity. Together, you’ll work with your healthcare team to determine the best treatment plan for you.