Spasticity: Friend, Foe, or Indifferent Acquaintance
Spasticity, characterized by increased tightness or "tone" in the muscles and/or involuntary muscle contractions, may result when the nerves can no longer signal the muscles to maintain the balance between contraction and relaxation. It is a very common symptom in multiple sclerosis. Although spasticity usually occurs in the legs, it can affect any part of the body. Symptoms can range from very mild to very serious, causing painful spasms and interfering with function. The goals of treatment are (1) maintain function, particularly with regard to mobility, (2) prevent or reduce pain and discomfort, and (3) prevent complications.
The first question to answer for yourself is whether your spasticity is your friend, foe, or indifferent acquaintance. If it's your foe, then it's time to go through the options for management.
Timing can be critical for some. To avoid intervention is to risk a cascade of complications that can be costly financially, medically, and in terms of quality of life.
Spasticity can be beneficial for some. This can be particularly true for individuals with MS. Spasticity often provides needed additional "strength" to the legs, to allow an individual to stand and support themselves when walking. However, too much spasticity in the legs can make it difficult to advance the legs, making walking laborious. Spasticity in the trunk can sometimes provide "strength" needed to sit unsupported instead of in a slump. However, too much spasticity in the trunk can create spasms that suddenly pull you out of a seated position or force you to sit with a permanent scoliosis or flexed trunk.
Individuals will often choose to pursue non-invasive, non-pharmacological approaches first, i.e. physical therapy or occupational therapy (if the arms are primarily involved).
In PT, there are several areas we evaluate to determine the best approach. Part of our history-taking is to determine your assessment of your spasticity. We may ask you how frequent your spasms occur each hour and what tends to trigger them. Triggers may include certain movements or positions. Spasticity can also be exacerbated by stress (physical or emotional), extremes of temperature, humidity, infection, and even tight clothing. We also want to know if spasms cause you pain, wounds or other injuries. We'll assess your flexibility and amount of spasticity on our physical examination.
One approach to managing spasticity is to instruct you in stretches. Spasticity can easily lead to muscle tightness or even contractures. In turn, muscle tightness can increase spasticity. Positioning can also counteract spasticity nicely. Positioning can help maintain range of motion as well as prevent triggering a spasm. This can be very effective at times. A good example is the calf muscle. Sometimes a spastic gastroc muscle will cause the entire leg to become very stiff. This can lead to foot drag and an overall difficulty in swinging the leg forward when walking. Positioning the ankle in a brace/AFO might relax the spasticity in the rest of the leg to make it more functional. For individuals who are less mobile, a standing table can be very effective. Weight bearing through the legs can be very effective in relaxing them as well as stretching them. Nothing can stretch the calf muscles as effectively as your whole body weight going down through them. Strengthening the opposing muscles can be very effective as well at inhibiting tone.
When our spasticity is too strong or our muscles are too tight, we may feel that medications are necessary to control spasticity adequately. There are several oral medications commonly used to improve muscle relaxation, including baclofen, tizanidine, or diazepam. Botox injections into the involved muscles may also be of benefit in some cases. In situations when oral medications do not work well enough or cause too much sedation, a surgically implanted pump (an Intrathecal Baclofen pump) may be an option to deliver baclofen directly into the spinal fluid.
Management of spasticity is an important part of MS care. Your health care provider, physical therapist and occupational therapist can work together with you to find the best strategies to keep this symptom in check.