Spasticity is a common side effect of certain neurological conditions. And while the word might make you think of muscle spasms, it’s much different from what you might think. “Oftentimes, you may hear the word ‘muscle spasm,’ ‘stiffness’ or even ‘rigidity,’” says physical therapist and clinical rehab specialist Randy Karim, PT, DPT, NCS, CBIS. “However, spasticity has special nuances that make it different than those terms.”
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What is spasticity?
To understand spasticity, it helps first to understand muscle tone. “Muscle tone gives our body structure,” says Dr. Karim. “In everyday terms, if we had zero muscle tone, we would resemble a wet noodle, or a pile of muscles and bones on the ground. But if we had too much tone, we would be as stiff as a board and find it extremely difficult to move.”
If you don’t have enough tone, you have what’s known as hypotonicity. Having too much tone is called hypertonicity. Spasticity falls under the category of hypertonicity, and is “velocity-dependent,” says Dr. Karim. In other words, how quickly you move matters.
“The faster that you move a muscle — or the faster that you stretch a muscle — the more that the tone reacts. In other words, the stronger the resistance, the more spastic a muscle becomes.”
Spasticity and nerves
But spasticity doesn’t necessarily just refer to your muscle fibers and muscle tone. It’s also related to the nerves that are connected to your muscles, says Dr. Karim. “Spasticity is essentially more of a nervous system issue rather than a muscle issue.”
Imagine that your nervous system and your muscles are playing a game of tug-of-war. When the signals between your brain and muscles can go back and forth unimpeded, there’s an equal amount of push and pull — the same amount of force coming from each side. “Each side is equally strong, so you have good tension in your muscles,” Dr. Karim explains.
But an injury to your nervous system causes an imbalance, disrupting the signals from your brain to your muscles — which leads to a lopsided game of tug-of-war. “Suddenly one side is pulling more,” Dr. Karim says, “and the other side can’t push back enough.”
“The signals are inhibited from relaxing the muscle,” he adds. “You have more signals being pushed into the muscle, causing tension. The other side is pulling and pulling unchecked. This overactivity leads to stiffness, tightness and spasticity.”
Who has spasticity?
Your muscle tone can be affected by neurological conditions that cause damage to your central nervous system — your brain, your spinal cord and everything in between that connect them. “Spasticity is caused by any condition that damages the motor neurons coming from your brain and spinal cord that connects to the muscle,” says Dr. Karim.
Your central nervous system includes your brainstem, which regulates essential functions such as breathing, or your cerebrum. This area of your brain has many jobs, including directing muscle movement.
Common conditions that can have spasticity as a symptom include:
- Multiple sclerosis.
- Brain injury (traumatic or non-traumatic).
- Cerebral palsy.
- Spinal cord injury.
- Hereditary conditions, such as hereditary spastic paraplegia.
What parts of the body are affected by spasticity?
The parts of your body affected by spasticity depend on where the damage occurs in your nervous system. In turn, this can affect what condition you develop. For example, traumatic brain injuries are typically associated with damage to the front or back of your skull.
However, Dr. Karim says there are common muscle groups generally affected by spasticity, located in three general areas of your body:
In your upper limbs, these are muscles that cause flexion movement. Examples of this kind of movement include bending your arm at the elbow or clenching a fist. Muscle groups affected by spasticity include:
- Shoulder adductors.
- Elbow flexors.
- Forearm supinators (the muscles wrapped around your forearm).
- Wrist and finger flexors.
In your lower limbs and extremities, the muscles affected are involved with extension movement. This can involve things such as toe pointing or stretching your knee. Muscle groups affected by spasticity include:
- Hip adductors (inner thigh muscles).
- Knee extensors.
- Knee flexors.
- Plantar flexors (these help you point your toes down).
- Ankle inverters (these help you point your toes inward).
- Toe flexors (muscles that cause your toes to flex).
Head, neck and trunk
The muscles impacted here have “side bending and rotation movement,” says Dr. Karim. Think about the muscles you use rolling your head around to stretch, or bending your upper torso to one side. Muscles affected by spasticity here include:
- Sternocleidomastoid (a major neck muscle).
- Upper trapezius (a muscle covering the base of your neck over the tops of your shoulders).
- Scalenes (muscles found on the side of your neck).
Dr. Karim says there are exceptions to the above muscle groups. “However, when I evaluate people who have had a stroke, or are living with a spinal cord injury, multiple sclerosis or cerebral palsy, these are the patterns that are more common.”
Does exercise help with spasticity?
Exercise can temporarily reduce spasticity. “This reduction can last anywhere from minutes to a few days, depending on the amount of spasticity present and the type of intervention performed,” says Dr. Karim. “Whether it’s an exercise or treatment that a physical therapist does, it can have a very real, calming effect on the spasticity.”
However, this reduction is transient, meaning it’s not permanent. “Stretching and strengthening the spastic muscles can’t cure or heal spasticity, or may not bring it back down to a normal tone,” notes Dr. Karim. “Unfortunately, therapists cannot heal your spasticity. It’s not like a muscle injury that’s going to heal and go back to normal.”
That being said, exercise can help you manage the long-term impact of spasticity, such as muscle pain, stiffness or contracture. “Contracture occurs when the muscle becomes so stiff, and it doesn’t move for a long time that there’s actually a physiological change in the joints and in the muscle,” explains Dr. Karim. “The tissue actually changes and cannot move anymore.”
Best exercises to reduce spasticity
When determining a good exercise routine, the first thing to keep in mind is that whatever physical activity you do, it shouldn’t be painful. “You may have heard the saying ‘no pain, no gain,’” says Dr. Karim. “But that’s a very inaccurate and dangerous phrase, especially when spasticity is present.”
Soreness or a slight muscle ache is common and may even be expected. “But a pain that feels sharp, or a shooting pain that stops you in your tracks, that’s a warning sign,” Dr. Karim adds. “You should never push through that type of pain. Stop immediately and consult with your doctor or therapists. Feeling acute pain when performing a movement or exercise is a signal to your body that something’s wrong.”
When it comes to exercises with spasticity, combining stretching with strength training, or resistance training, can help. Strength training has more benefits when you’re in a weight-bearing position, adds Dr. Karim.
“You might hear this technical term: closed kinetic chain. Basically, that means you don’t have your limbs out in the air, maybe moving weights,” he explains. “Instead, you’re actually closing your movement chain by putting your hands or your feet down on the ground or on a solid surface.”
Calf stretches on an incline board
One exercise Dr. Karim recommends is stretching your calves on what’s called an incline board or a slant board. These are shaped like wedges and can be adjustable. “You hold on to a stable surface and step onto this incline board,” he says. “This is something that’s at an angle — roughly a 15- to 25-degree incline — and you stretch by stepping onto it.”
For the best impact, “both of your heels should be on the board or one should be on the floor,” Dr. Karim adds. “To target your calves, your knees have to stay straight, and you lean your hips forward.” A good comparison to this stretch is thinking about how your calves feel when you’re walking up a hill or a steep incline.
You can buy these incline boards online or even make your own at home, using wood, grip tape and nonslip material. However, the angle of the incline board is crucial. “If you have something less than 15 to 25 degrees, you won’t feel much of a stretch,” says Dr. Karim “If you have something a little bit higher of an angle, it may be uncomfortable.”
Dr. Karim recommends keeping this incline board in a room you visit a lot, such as your bathroom. “Every time that you’re at your bathroom sink, as long as it’s safe, you can lean on the sink as you’re washing your hands,” he says. “You can sneak in a stretch throughout the day, rather than just having a specific dedicated time in your day to stretch.”
Arm exercises using a wall pushup
To stretch your wrist muscles, Dr. Karim recommends what he calls a wall pushup. “Place your arms on a surface,” he says. “If you’re able to, I recommend putting your hands on the wall.”
Dr. Karim stresses not to skimp on balance or safety when doing this. “You shouldn’t feel any discomfort either,” he notes. “You’re mostly stretching your wrist muscles by leaning into the wall and leaning your body forward.”
Studies have shown that aquatic exercises such as swimming are very beneficial for children living with cerebral palsy. “These showed that when researchers measured the muscle itself, swimming had an elastic effect,” says Dr. Karim, “meaning it made the muscle a little bit more flexible after being in the water.”
Cycling or treadmill
There is some research showing that cycling and treadmill training can also help with spasticity. “To be clear, these also have a temporary effect on the spastic muscle,” Dr. Karim states.
Best practices for exercising and spasticity
Anyone exercising needs to be mindful of following best practices and listening to their body. For people living with spasticity, Dr. Karim says there are some specific considerations when exercising.
Work with a physical or occupational therapist
First and foremost, before starting an exercise routine for spasticity, Dr. Karim says to consult with a physical or occupational therapist. “A therapist can evaluate you and tailor a specialized program to meet your needs. This is by far my primary recommendation for anyone before starting with specific exercises.”
Be mindful of things that trigger spasticity
Different things can trigger spasticity. In studies, people have self-reported spasticity increases due to having a full bladder, having their period, being pregnant, a change in sleeping habits, colder weather or increased stress.
Exercise at a time of day that’s good for you
Different times of day might be better for exercising. “Some people may experience more spasticity in the morning,” says Dr. Karim. “This is likely due to laying in bed asleep in the same position for a long time. That can make your muscles feel very stiff in the morning.”
Be aware of medication timing
Medication timing can also make a difference in your spasticity. “If you take medication that helps your muscles relax, you want to be mindful of that,” says Dr. Karim. “Therefore, it is wise to time your medication along with your exercise routine, so you’re able to have more of an impact.”
Don’t move too fast
Because spasticity is velocity-dependent, slow and steady wins the race when exercising. “The faster you move, the more that you can trigger spasticity,” he says. “During an exercise routine, if you’re moving too fast, you may actually trigger a higher degree of spasticity versus moving in a slow and controlled fashion.”
Does stretching reduce spasticity?
Much like exercise, stretching can help you manage spasticity, not eliminate it completely or cure it. Dr. Karim says, “In the long term, stretching may not change objective measures for spasticity, but it’s also not harmful. Stretching is a preventative intervention that may prevent issues in the future.” Prolonged stretching is helping you maintain your range of motion and prevent contracture.
If you live with spasticity, Dr. Karim says it’s vital that you think of stretching as a healthy habit like brushing your teeth. “Brushing your teeth is something that’s been accepted as a part of our culture. From a young age, it’s something that everyone understands you have to do for good long-term health.
“Stretching is the same kind of daily health maintenance that everyone has to do,” he continues. “However, it’s especially helpful for someone living with a condition where there is a high likelihood that your muscles can become stiff in the future.”
Combining stretching with calming, deep breathing exercises can be very effective for people with spasticity. “An example of an effective breathing pattern is one where your exhale lasts longer than your inhale,” Dr. Karim explains. “This pattern has a calming effect on your central nervous system. And it will help you to have a better stretch, especially if you have spasticity.”
Therapeutic equipment and spasticity
If you have more severe spasticity, a neurologist or a physiatrist can help you decide whether techniques or movements could work in tandem with exercise to decrease spasticity. Additionally, physical and occupational therapists have equipment, therapeutic techniques and treatments available to help. “Consulting with a healthcare professional to determine the best plan can always help,” advises Dr. Karim.
Tilt table or standing frame
This kind of assistive technology can help you “achieve and maintain proper positioning of the joints and trunk” while standing, says Dr. Karim. “If you are able to safely stand with the appropriate equipment, this is very important to prevent contracture.”
If you use a wheelchair, it’s also important to have a wheelchair and seating assessment by a therapy professional so you’re positioned correctly. Improper seating positions may lead to an increase in spasticity.
Splinting or orthotics
“Splinting your wrist and hand, or wearing orthotics, can both help manage spasticity,” Dr. Karim says. “This provides a prolonged stretch throughout the day that can also help prevent contractures from occurring.”
There are several medications to manage spasticity. In addition to an oral medication, which has a general effect on your body, some options are more localized. “If you only have one or two areas in your body that are spastic, it may make more sense to put that medication directly in those areas,” suggests Dr. Karim. “Doctors can take medication and inject it right into the muscle that’s being affected.”
Spasticity is different for everybody
Spasticity looks and feels different for everybody. Figuring out an approach to managing it also looks different for everyone — although taking into account multiple techniques and considerations can have a compounding effect on reducing spasticity.
“There’s the timing of your exercise, making sure that you’re combining it with medical management,” says Dr. Karim. “For example, maybe you’ve taking oral medications or managing it with a focal injection to calm the muscle down. And then there’s also deep breathing.”
Dr. Karim also says some people can even use spasticity to their advantage and maintain their quality of life. This happens with some conditions that affect muscle strength, as well as tone. “You may have weakness in your legs, but you might have a lot of spasticity as well,” he notes. “Even though you have weakness, the spasticity may allow you to stand or assist with transferring to different surfaces. Sometimes, your spasticity kicks in and can help perform functional tasks.”
In a case like this, consulting with a therapy professional can help. “Healthcare providers can help you determine, ‘Is it a good thing to decrease your spasticity? Or should we keep your spasticity in place so that you’re able to function better?’”
At the end of the day, you and your healthcare team can decide on the best way to approach managing your spasticity. “Even though we may not be able to heal your spasticity, we do have treatment options to help improve your activities of daily living, mobility and quality of life,” reassures Dr. Karim.