Spasticity

Spasticity is a group of involuntary muscle movements (dyskinesias) that happen when you have damage to nerves in your brain or spinal cord, or when you have an underlying neuromuscular disorder such as cerebral palsy.

What is spasticity?

Spasticity refers to involuntary contractions of your muscles that happen when you try to move a part of your body. When you have muscle spasticity, your muscles are stiff and have a lot of tension in them. The muscles don’t move smoothly and spasm more the faster you’re trying to move your body.

Is spasticity the same as hypertonia?

Hypertonia and spasticity are related because spasticity is a type of hypertonia. Hypertonia refers to having high muscle tone. Hypertonic muscles always have extra tension in them even when they’re not being used.

Hypertonia without spasticity causes resistance to movement that doesn’t depend on how fast the movement is. When you have hypertonia with muscle spasticity your muscles spasm more when movements are faster and less when movements are slower.

Is hypertonia a disability?

Hypertonia can cause disability if it becomes severe enough. Hypertonia with or without spasticity may cause you to have trouble with what’s known as activities of daily living, such as cooking, eating, bathing and walking. You may need help to perform these tasks in your home or you may need some kind of assisted living facility.

Symptoms of spasticity

Muscle spasticity may be mild with minor tightening of the muscles, or the tightening of muscles may lead to painful, uncontrollable muscle spasms. Some of the ways muscles with spasticity function abnormally are:

• Muscle spasms
• Abnormal postures
• Involuntary crossing of legs (also known as scissoring)
• A series of fast involuntary muscle contractions

In addition to the involuntary movements that happen when you have muscle spasticity, some other effects of spasticity are:

• Muscle, joint or bone deformities
• Pain or tightness in joints
• Muscle fatigue
• Trouble sleeping because of pain from muscle spasms or tightness

Complications of spasticity

When you’ve had spasticity symptoms for a long time, you may develop some of these complications:

• Urinary tract infections (UTI)
• Chronic constipation
• Fever or other systemic illnesses
• Pressure sores (damage to skin because of long-term pressure)
• Joints that can’t move
• Contracture (permanent contraction of the muscle and tendon)

Possible causes of spasticity

Spasticity is usually caused by damage to nerves within the brain or spinal cord that control muscle movement and stretching. Sometimes it happens because of an underlying condition such as:

• Spinal cord injury
• Multiple sclerosis
• Cerebral palsy
• Stroke
• Brain or head injury
• ALS
• Hereditary spastic paraplegias
• Adrenoleukodystrophy (ALD)
• Phenylketonuria (PKU)
• Krabbe disease (also known as globoid cell leukodystrophy)

Diagnosis of the cause of spasticity

When you have the symptom of spasticity, your doctor will look for an underlying cause. They’ll do a full physical exam, including checking your muscle tone and observing your posture and how you walk. They’ll move your joints manually to see whether they resist movement.

Since there are many conditions that include spasticity as a symptom your doctor will do a variety of tests, including lab tests on blood or urine as well as imaging tests to evaluate your bones, joints and muscles. They may also perform a spinal tap to test a sample of cerebrospinal fluid.

Spasticity treatment options

Treatment for potential causes of spasticity needs to be performed by a multidisciplinary team because there are so many conditions that may contribute to spasticity.

Your primary care provider may refer you to specialists such as a neurologist, physiatrist (a rehabilitation specialist), advanced practice clinician, physical therapist, occupational therapist, neurosurgeon, orthopedic surgeon, or speech and language pathologist.

There’s no cure for spasticity as a symptom, so you’ll receive treatment to ease your symptoms or to treat any underlying disorders.

Nonsurgical spasticity treatments

Nonsurgical treatments that can help spasticity include:

• Physical therapy for larger muscle groups to manage standing and walking
• Occupational therapy for smaller muscle groups to manage daily activities like bathing and cooking
• Speech therapy for when spasticity affects speech, eating or swallowing
• Casts or braces to provide sustained muscle stretching
• Assistive devices to help you move around and perform daily tasks more safely and efficiently
• Medications to help with sleep or everyday functioning

For more severe spasticity symptoms, your doctor may recommend Botox injections into specific parts of muscles to prevent the muscles from contracting.

Nonsurgical treatments are usually used together to improve quality of life and calm symptoms.

Surgical spasticity treatments

Surgical spasticity treatments are only used for severe symptoms.

An Intrathecal Baclofen (ITB) pump may be implanted in your abdomen so it can release the medication baclofen through a catheter into the spinal fluid. It provides relief from pain and spasticity with fewer side effects than when baclofen is taken orally. It’s been proven effective for arms and legs.

Selective Dorsal Rhizotomy (SDR) is a surgery that cuts selected nerve roots to relieve spasticity in the legs. It’s usually used for people who have cerebral palsy and can decrease muscle stiffness without affecting other functions.

Orthopedic surgery may be used to resolve problems with permanent contractions of muscles and tendons or any deformities of bones, muscles or joints. Your surgeon may perform a procedure to lengthen tendons or use a tendon transfer.