What Everyone Should Know About Spasticity

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Spasticity may be a term that’s new to you, but it’s a condition that affects more than 12 million people around the world. [8] It’s a complicated condition, but simply put, it’s extreme muscle tightness that can cause spasms or pain that make it hard to move or speak normally.

Muscle movement is usually controlled by a complex system in the brain and spinal cord that allows some muscles to contract (tighten) while others relax. Damage to the brain or spinal cord—from conditions such as a stroke, spinal cord injury, or brain trauma—can disrupt the brain’s communication with the body, making the muscles contract all at once, causing spasticity. [5] The result of that lack of communication and tense muscles can mean stiff, rigid muscles that make movement, speech, and other daily-life functions difficult, [2] or, in more severe cases, joints that severely bend and will not unbend. [1]

As for who the condition affects: Approximately 70 percent of people with cerebral palsy, 50 percent of people with traumatic brain injury, up to 75 percent of people with spinal cord injury, 35 percent of people who’ve had a stroke, and up to 78 percent of people with multiple sclerosis experience spasticity. [3] Spasticity can happen to anyone regardless of age, ethnicity, or gender. [5]

While spasticity can be painful, interfere with how you move, or disrupt your sleep, there are many different treatment options, ranging from simple things like stretches to more involved treatments like surgery. [5]

Simply put, this condition occurs when the nerves that control movement are damaged, leading to excessive muscle tightening. The more detailed medical explanation is that “Movement is controlled by two types of neurons (nerve cells that transmit information within our bodies): Ones in the brain that go down into the spinal cord, and ones in the spinal cord that send messages to the muscles. Damage to the brain or spinal cord...can lead to excess muscle activity, which is spasticity,” says Dr. Michael Schulder, M.D., FAANS, professor and vice-chair of neurosurgery at the Zucker School of Medicine at Hofstra/Northwell. This damage can occur due to any of the following:

Spasticity can be mild, causing muscle stiffness—or severe, causing painful and uncontrollable muscle spasms. [4] The symptoms of spasticity include:

Identification of spasticity relies on a thorough history of your symptoms—when they first started, how they’ve progressed, and anything that alleviates or worsens each symptom. [2] [3] Your doctor will also ask about your family and personal medical history and complete a physical exam to check your muscle tone (tightness), strength, weakness, sensation, and reflexes. [3]

Doctors use different scales to determine the severity of spasticity, but most commonly they use the modified Ashworth scale, which measures resistance as your doctor moves and stretches your muscles. [10] For example, the testing includes having the doctor extend your wrist from maximum possible flexion to maximum possible extension, then repeating that test on your fingers, thumbs, elbows, hamstrings, quadriceps, and calves. [10] Then they assign a score for each, which ranges from zero (no increase in muscle tone) to four (the muscle is rigid in flexion or extension). Depending on the final score, you may be diagnosed with spasticity. [6]

Spasticity can lead to challenges with everyday functioning and increase the risk of other conditions. Complications include:

Unfortunately, no. If you have one of the conditions that can cause spasticity, you can’t do anything to prevent spasticity from developing, Dr. Schulder says. (But having a condition that can cause spasticity is not a given you will develop it.) While the underlying causes may be out of your control, he says you can take precautions to avoid potential injuries and complications by leading an overall healthy lifestyle (being active, eating a balanced diet, and managing stress).

It’s important to treat your spasticity so you feel more comfortable and can move better. [8] Which treatment is best for you depends on the severity and location of your symptoms. “We want to start with the least invasive treatment and, if necessary, move to increasingly invasive treatments,” Dr. Schulder says. That means that most often, doctors recommend a combination of physical therapy and medication; however, surgery is necessary in some cases.

Exercises to strengthen and stretch muscles can help train the limbs to be less stiff and not contract, Dr. Schulder says. This can help increase the range of motion, reduce the severity of symptoms, and reduce the risk of muscles becoming shorter, which can happen when they stay contracted. [4][8] In addition to showing you stretches and exercises, to help relax and retrain your muscles, a physical therapist may apply temporary casts or braces, or heat or cold. Another treatment is called electrical stimulation (or e-stim), which involves applying painless electrical impulses to the affected area in order to help reignite the muscles’ ability to contract. [8]