Spasticity

Spasticity is the stiff or rigid muscles that result from a motor disorder. It may also be called unusual tightness or increased muscle tone. Reflexes (such as a knee-jerk reflex) are stronger or exaggerated. The condition can interfere with walking, movement, speech and many other activities of daily living.

Spasticity is often caused by damage to the part of the brain involved in movements under your control. It may also occur from damage to the nerves in the spinal cord. Any of the following may cause spasticity:

• Brain damage caused by lack of oxygen (as from near-drowning or near-suffocation)
• Cerebral palsy
• Cervical spinal stenosis
• Exposure to toxins (such as nitrous oxide or “laughing gas”)
• Head injury
• Infections of the brain or spinal cord (such as Lyme disease, syphilis, HIV, tuberculosis)
• Multiple sclerosis
• Neurodegenerative illness (causing damage to the brain and nervous system over time)
• Phenylketonuria (a disorder in which the body can’t break down the amino acid phenylalanine)
• Spinal cord injury
• Stroke
• Tumors in the brain or spinal cord
• Vitamin or mineral deficiency (vitamin B12, vitamin E, copper)

Any condition that damages the central nervous system pathways controlling muscle movement is a risk factor for spasticity. Metabolic disorders, neurological conditions, genetics and central nervous system infections can also increase the risk. Additionally, head trauma and oxygen deprivation can lead to spasticity.

If you have been diagnosed with spasticity, certain conditions can trigger symptoms, such as cold weather, stress, fatigue, constipation and infections (like urinary tract infections—UTIs). You can reduce symptoms with medications, stretching and stress management.

Symptoms of spasticity include:

• Abnormal posture
• Carrying the shoulder, arm, wrist and finger at an abnormal angle because of muscle tightness
• Exaggerated deep tendon reflexes (knee-jerk or other reflexes)
• Pain or deformity of the affected area of the body
• Repetitive jerky motions (clonus), especially when you are touched or moved
• Scissoring (crossing of the legs as the tips of scissors would close)

Spasticity may also affect speech. Severe, long-term spasticity may lead to muscle contracture, reducing the range of motion or leaving the joints bent.

Your doctor will perform a physical exam, establish a thorough health history and ask about your symptoms. The physical exam will determine the range of motion, muscle response, whether there are involuntary movements and the level of pain you are experiencing. Questions your physician may ask include:

• When was it first noticed?
• How long has it lasted?
• Is it always present?
• How severe is it?
• Which muscles are affected?
• What makes it better?
• What makes it worse?
• What other symptoms are present?

After determining the cause of your spasticity, your doctor will likely recommend physical and occupational therapy. Physical therapy involves a range of exercises, including muscle stretching and strengthening exercises.

Other treatments may include:

• Medicines to treat spasticity 
• Botulinum toxin that can be injected into the spastic muscles
• In rare cases, a pump that directly delivers medicine into the spinal fluid and nervous system
• Surgery to release the tendon or to cut the nerve-muscle pathway

Daily life with spasticity requires managing pain, muscle stiffness and involuntary contractions. Regular exercise, medication and in-home modifications can improve quality of life. Some may benefit from assistive devices, such as crutches, canes and walkers, to help with balance and getting in and out of bed.