Spasticity is a condition that occurs when muscles tighten abnormally, causing pain and impacting movement. It occurs as a result of injuries and diseases that impact the central nervous system.

Health conditions such as stroke, multiple sclerosis, cerebral palsy, and brain and spinal cord injuries, can disrupt communication from the brain or spinal cord to muscles.

“With a chronic disorder affecting the central nervous system, the muscle isn’t getting the right information, and the muscle tightens, resulting in spasticity,” said Dr. Tracy Vargas, a neurologist with UCHealth Neurology Clinic in Steamboat Springs. “Patients will talk about feeling tight, having muscle spasms and experiencing a reduced range of motion.”

These overactive muscles can have a broad impact on motion. Spasticity in hand muscles can result in a clenched fist that’s difficult to open, while spasticity in leg muscles can make it difficult to walk.

Various factors can cause symptoms of spasticity to worsen, such as stress, illness and lack of sleep.

While patients can reduce stroke risk factors through diet, lifestyle and regular follow-up with a primary care provider, most conditions that cause spasticity, such as multiple sclerosis, cannot be prevented.

Vargas encourages patients to seek treatment early on. Untreated spasticity can result in contractures, in which muscles, joints, tendons and other tissues tighten so much, movement is no longer possible.

“You can surgically release it, but you’ll never get more function,” Vargas said.

Various treatments can help prevent contractures and improve spasticity.

“We’re using these therapies not only to reduce the risk of joint contractures, but also to help improve function of the limb and improve overall quality of lifestyle,” Vargas said.

One option is medication. While medications can help relax muscles and reduce spasticity, patients can’t always tolerate side effects.

“There is the potential to have adverse side effects like sedation or cognitive changes,” Vargas said. “People will sometimes say they don’t like how they feel on these specific medications, which sometimes limits dosing and overall use.”

Targeted therapies, such as injecting Botox into affected muscles, have seen good success. Botox is a neurotoxin that paralyzes muscles for a limited time. Treating overactive muscles with the toxin can decrease spasticity and allow patients to experience more typical movement patterns.

For instance, Botox injections in spastic hand muscles may allow the hand to relax and open, making daily activities easier and allowing for improved hygiene. Injections in spastic leg muscle may result in more stability when walking and may help normalize someone’s gait.

Botox injections often work in conjunction with muscle relaxers: once Botox takes effect, patients may find a much lower dose of a muscle relaxer helps them reduce spasticity without the side effects.

While spasticity is a chronic condition, treatment can make a big difference in a patient’s life.

“The more we can treat it, the less progressive and debilitating it can become,” Vargas said. “A lot of patients have less discomfort. They often have an improved range of motion. We’re not going to cure it, but we can treat it and help manage it to improve people’s quality of life.”

Treating spasticity requires a team approach. A neurologist, a physical therapist, an occupational therapist and a speech therapist may all play a role.

“Having your team behind you is really important,” said Patty Bobryk, a neurologic physical therapist with UCHealth SportsMed Clinic in Steamboat Springs. “We can look at the whole person, understand the issues and help support the best outcomes.”

Initial assessment

When someone is referred to physical therapy for spasticity, one of the first steps is to assess muscle movements. Understanding which muscles have tightened abnormally helps determine next steps.

“The arm might be tight with a bent elbow and fisted hand, or the leg might be difficult to bend at the knee with a foot that’s turned in or positioned down,” Bobryk said. “It happens involuntarily and might limit you from being able to move out of that pattern of movement.”

Targeted medications for muscle spasticity

Oral medications and targeted Botox injections can help provide relief. A collaborative approach is key: a physical therapist may determine where the injection would be most useful, and then a neurologist injects the drug.

“We’re the movement and muscle people and really study anatomy and function of muscles,” Bobryk said. “If you’re trying to relax a flexed-back wrist, we can identify the muscles that flex it back and inject those. It’s very targeted.”

Three to four weeks after injection, Bobryk will reevaluate the patient and may suggest changes to the dosage or location of the next injection.

“We’re able to determine if this did what we wanted it to do,” she said. “It isn’t something that’s a one-and-done. The first set of injections may not give the person their optimal results.”

Though it can take time, results can be surprisingly good.

“One patient had a stroke many years ago, and we did injections in the upper body for a bent elbow and pain in the shoulder. The patient saw decreased pain, and the arm was more relaxed, so the patient wasn’t as self-conscious,” Bobryk said. “With lower extremities, I get a lot of feedback from patients that it makes a difference in their ability to move: their toe doesn’t catch as much, their ankle is in a better position. Those are all real wins for us.”

Physical therapy regimen helps with muscle spasticity

Stretching, strengthening opposing muscles, and rhythmical, reciprocal movements, such as riding a bike or walking, can help normalize movement patterns.

“Exercise and stretching are key,” Bobryk said. “Just putting weight on these muscles can send a message to the brain, which responds, ‘Oh, you want me to put weight on the leg? I can decrease spasticity a bit.’”

Splinting or bracing can keep the joint or extremity in more optimal positions, reducing pain and preventing structural changes.

Electrical stimulation may decrease tightness. Cold or heat sometimes help, though Bobryk cautions that effects vary and, in some cases, cold or heat can worsen the condition.

Pain from spasticity may increase at night, making it difficult to sleep. Stretching, rhythmic or reciprocal exercises, and getting into a position that opposes the spasticity can help.

An individualized approach for people with spasticity

Treatment is tailored to each patient.

“There’s not a one-size-fits-all treatment when it comes to spasticity,” Bobryk said.

One truth always holds: it’s easier to treat the condition sooner rather than later.

 “It’s a lot easier to treat something when it’s mild rather than when it has become so significant, it’s impairing your function,” Bobryk said.

But even if symptoms have been ongoing, it’s not too late to seek help.

“Whether you have had a recent injury or an old injury that’s causing spasticity, it’s never too late to investigate what options are available to have a better outcome and manage spasticity better,” Bobryk said.

This story first appeared in the Steamboat Pilot.