Resources > Understanding Spasticity: A Simple Guide for Patients and Families
Understanding Spasticity: A Simple Guide for Patients and Families
What is spasticity?
Spasticity is a condition where muscles become unusually stiff or tight after damage to the brain or spinal cord.
Think of your muscles like springs. In spasticity, those springs are wound too tightly, making them harder to stretch and more difficult to control. This tightness can interfere with movement and comfort in everyday life.
Why does it happen?
To move muscles smoothly, your brain sends a mix of “go” signals that activate muscles and “calm down” signals that keep those muscles from overreacting. You can think of it like adjusting two dials: one to start movement and another to keep it controlled.
One of the key systems your brain regulates is the stretch reflex, the same one your doctor checks with a knee tap. It helps you stay balanced by quickly responding to muscle stretch.
When there’s damage to the brain or spinal cord, the “calm down” signals become weaker, and the stretch reflex becomes overactive. At the same time, other nerve pathways that excite the muscles may become more active. This results in muscles that become overly sensitive to stretching, like a spring that is wound too tightly, leading to the stiffness and tightness we call spasticity.
Who gets spasticity?
Spasticity can occur after damage to the brain or spinal cord. The causes include stroke, spinal cord injury (SCI), multiple sclerosis (MS), cerebral palsy (CP), brain injury, and other neurologic conditions.
What does spasticity feel like?
Common symptoms include:
- Muscle stiffness or tightness
- Muscle spasms or cramps (like a charley horse)
- Jerky or poorly controlled movements
- Joints that are difficult to bend or straighten
These symptoms can affect the muscles of the arms, legs, and trunk. There is a wide variety of ways that spasticity can present and affect quality of life. One person may experience tightness in the wrist that prevents them from cleaning their hand; another can have difficulty bending their legs.
Why is it important to treat spasticity?
The two main reasons for treating spasticity are:
(1) prevention of contractures, and
(2) improving quality of life.
A contracture is a permanent shortening of the muscle and soft tissues, leading to joint stiffness and loss of range of motion. This is dangerous because it can lead to unwanted secondary complications such as bed sores, infections, and muscle wasting.
While not all spasticity leads to contracture, it significantly raises the risk, especially when combined with immobility or poor management. Early treatment and movement can help prevent this from happening.
Spasticity can interfere with many aspects of life and effective treatment allows patients to do things that were previously unavailable to them. This could range from picking up a glass of water, reducing the time required for caregiving, or decreasing the risk of bed sores.
How is it treated?
Spasticity can be managed with one or more of the following treatments, depending on your goals, symptoms, and response to therapy.
Physical & Occupational Therapy
Often the first step. Therapy helps improve range of motion, prevent contractures, and maintain flexibility using guided exercises, splints, braces, and positioning. Some programs also use neuroplasticity-based treatments to help the brain relearn control over movement.
Oral Medications
These can reduce overall muscle tone for a few hours. However, because they affect the whole body, they may cause drowsiness, weakness, or confusion. They’re best for widespread symptoms or when other treatments aren’t enough.
Injections
Targeted injections are used to relax specific muscles.
Diagnostic injections (like lidocaine) help identify which muscles are contributing to tightness.
Therapeutic injections (such as Botox or phenol) reduce spasticity for weeks to months. These are often repeated every few months and tailored to your movement goals.
Intrathecal Baclofen (ITB) Pump
When spasticity is widespread and other treatments aren’t enough, a baclofen pump surgery may be recommended. A small device is implanted under the skin of the abdomen and delivers medication directly to the spinal cord. This helps reduce tightness with fewer side effects than oral medications.
Surgery
Surgery is rarely the first option but may help when other treatments haven’t worked.
- Selective dorsal rhizotomy involves cutting overactive nerve roots to reduce spasticity in selected cases.
- In some contexts, surgical placement of a baclofen pump is also considered part of surgical management.
Does spasticity last forever?
For most people, spasticity is a long-term condition that needs ongoing management with the treatments listed above. While it may change over time, it usually doesn’t go away completely.
Some people with mild spasticity may see improvement without treatment, especially in the early stages of recovery. Others may find their spasticity to be helpful. For example, it could provide extra support when standing or walking. In this case, it may not need continuous treatment but may be manageable with a home stretching program.
Still, regular monitoring is important to prevent it from worsening or causing complications over time.
Key Takeaways
- Spasticity is caused by damage to the brain or spinal cord.
- It can lead to stiffness, spasms, and loss of movement.
- Treatment is available and can improve comfort, function, and quality of life.
- Most people benefit from ongoing management to prevent complications.