A Guide to Muscle Spasticity

Muscle spasticity is not something you feel following a long gym session. Rather, it's a chronic ailment most frequently associated with neurological damage or disruption, which affects the pathways responsible for muscle contraction and relaxation.

"Muscle spasticity is simply muscle stiffness that impacts a person's mobility or speech, and can even cause discomfort or pain," said Yessar Hussain, M.D., a board-certified neurologist with the Austin Neuromuscular Center and an assistant professor at Dell Medical School at the University of Texas.

Cases can be mild or severe, ranging from a general feeling of muscle stiffness to painful and debilitating muscle spasms. If spasticity starts occurring without a clear underlying cause, or it gets worse or more painful or interferes with daily life, it's important to be evaluated by a doctor promptly. A combination of pharmacological and physical interventions may help you manage your symptoms.

It's also important to understand that while spasticity most commonly affects the legs, depending on the cause of the condition and the part of the brain or spinal cord affected, any single muscle or group of muscles can experience spasticity symptoms.

'Muscle spasticity is simply muscle stiffness that impacts a person's mobility or speech, and can even cause discomfort or pain.'

Muscle spasticity can typically be traced to a disorder, illness or event that damages or disrupts neurological signaling between the brain and the muscles. People who have experienced head injuries or spinal cord injuries or individuals with neurological conditions, including cerebral palsy and multiple sclerosis (MS), can end up with muscle spasticity.

But there's one cause that stands out.

"The most common cause of muscle spasticity stems from a stroke," Hussain said.

When a person experiences a stroke, blood flow gets cut off to a portion of the brain, causing damage. If this damage interferes with the brain's ability to efficiently and effectively send messages to the muscles, those muscles may "lock" in a contracted state, rather than relaxing with inhibitory signals.

Symptoms and diagnosis

If you've had a stroke, spinal cord injury or head injury, or you've been diagnosed with cerebral palsy, MS, amyotrophic lateral sclerosis (ALS) or hereditary spastic paraplegia, you're at a greater risk for muscle spasticity. Less common metabolic diseases, including adrenoleukodystrophy, phenylketonuria and Krabbe disease, may also lead to spasticity.

If you're experiencing muscle stiffness or fatigue—even if mild—that makes your movements harder to control, reduces the range of motion at the joints, or causes painful muscle spasms or cramps, involuntary crossing of the legs (also known as "scissoring"), poorer walking balance or muscle deformities that may affect the joints, it's time to get evaluated by your doctor.

"Muscle spasticity is usually diagnosed by a physical, neurological examination to test for the severity of it," Hussain explained. "An MRI can also provide important information such as the source of the spasticity as well as the severity."

One important detail to note about muscle spasticity is it doesn't appear only in major muscle groups. For instance, the quadriceps or glutes can be affected. The muscles that control other daily functions, like urination, can also experience spasms. The American Association of Neurological Surgeons noted common complications for people with muscle spasticity can include urinary tract infections, chronic constipation, fever or systemic illnesses, pressure sores and frozen joints.

Each of these complications can affect quality of life and, in some cases, lead to a "snowball effect" of spasticity symptoms. For example, spasticity that leads to frozen joints can make it harder to move, resulting in severe spasticity and greater pain and problems with daily movement. Untreated spasticity is likely to get worse and result in other complications.

"Patients should always seek a neurological evaluation during the early stages to prevent their symptoms from worsening," Hussain advised.

Managing your medical treatment

"The prognosis depends on the cause, but unfortunately, in the majority of cases, the condition will continue even though a patient may have improved with proper treatment," Hussain said.

A thorough evaluation and diagnosis determines the best treatment protocols. For instance, some forms of treatment may be associated with positive outcomes in adult stroke patients, but may not be effective or proven for pediatric cerebral palsy patients or people who have suffered a traumatic brain injury.

Most treatments fall into two categories: pharmacological or physical, movement-based therapy. Typically, a combination of treatments is most likely to render positive results.

Given that muscle spasticity is associated with increased muscle tone and contraction, with muscle cramping as a major symptom, some of the medications used to treat symptoms are muscle relaxers. According to a 2018 review of treatments for post-stroke spasticity published in the International Journal of Gerontology, the most common oral drugs prescribed to manage muscle spasticity include:

• Baclofen, which inhibits the muscle stretch reflex.
• Tizanidine, which inhibits the release of excitatory neurotransmitters.
• Benzodiazepines, which inhibit and reduce synaptic reflexes.
• Dantrolene, which interferes with the release of calcium in the muscles.
• Gabapentin, which works in the brain to prevent seizures and relieve pain.

These drugs affect different parts of the process that help signal muscle contraction or release. Oral medications are typically tried before injectable medications, such as phenol/alcohol or Botox injections, which also help inhibit muscle contraction.

Although more research is needed, cannabinoids may also help with muscle spasticity. In a 2019 review of studies published in Developmental Medicine & Child Neurology, researchers found cannabinoids to have modest efficacy in reducing multiple sclerosis in the study population. Given the limited amount of research available using cannabinoids, there's not much evidence that supports the use of cannabinoids for other conditions. Cannabinoids may have other effects, especially in younger patient groups, which should be evaluated by a physician.

Physical treatments for muscle spasticity

"Exercise is very important to decrease the severity of stiffness," Hussain said. "Also, physical therapy and a mobility assistance device, like a cane or walker, are helpful to avoid falls."

As the saying goes, "Use it or lose it." If your muscles are stiff and tight due to spasticity and, as a result, you avoid moving them, they'll become stiffer and tighter over time. Engaging in regular physical activity can help increase blood flow to the muscles, tendons and ligaments, "lubing up" your joints as you test the limits of your range of motion.

A specific treatment protocol depends on the underlying cause and severity of the symptoms. For instance, people with mild spasticity may have more freedom to choose from a wide variety of cardiovascular or strength-training exercise programs, while people with severe spasticity may need to work closely with a physical therapist to perform slow and long stretches to best ease muscle cramping and tightness.

Physical treatment interventions that may improve symptoms (depending on the root cause) include:

• Whole body vibration. More research is needed, but a 2015 systematic review published in the journal Clinical Rehabilitation found whole-body vibration exercise may help reduce muscle spasticity in the legs of patients with cerebral palsy. Evidence is lacking for this treatment method in other underlying conditions, such as stroke, MS or spinocerebellar ataxia.
• Exercise, especially aquatic exercise. In a 2017 study published in the Turkish Journal of Physical Medicine and Rehabilitation, researchers found land-based and aquatic exercise each had a positive impact on spasticity and motor function in children with cerebral palsy, but people who participated in aquatic exercise enjoyed a greater improvement in quality of life scores than people who performed land-based exercises.
• Stretching of the involved muscle group(s). In stroke patients, prolonged and regular stretching programs can help maintain or improve muscle length in spasticity-affected muscle groups, according to research published in 2018 in the International Journal of Gerontology.
• Dry needling and acupuncture. Both of these treatments, which use needles to provide a therapeutic effect for patients (although in somewhat different ways), appear to be beneficial to stroke patients with muscle spasticity. A 2020 systematic review published in the journal Complementary Therapies in Medicine found adults who received dry needling after a stroke experienced improvements in spasticity, pain and range of motion. Likewise, a 2015 review published in Evidence-Based Complementary & Alternative Medicine found acupuncture significantly decreased spasticity after a stroke.
• An overall healthy lifestyle. If an ounce of prevention is worth a pound of cure, one of the best steps you can take is to exercise regularly and eat right. Given that strokes are the leading cause of spasticity, working to reduce your risk of stroke can also help reduce the likelihood that you'll experience spasticity. "A healthy lifestyle, including managing high blood pressure, cholesterol and diabetes, will be helpful in preventing a stroke," Hussain emphasized.

Once you've been diagnosed with muscle spasticity and your doctor has assessed the underlying cause, you'll be given a variety of treatment options. It's important to think hard about these options and consider all potential side effects. Generally, outcomes are better when you combine several physical and pharmacological treatments, but only you can assess how each treatment affects your daily life. Remember, it's better to seek treatment early, before symptoms significantly interfere with daily life, than to wait until you've been sidelined by pain.

Living and loving with muscle spasticity

Stiff muscles, spasms and pain are not conducive to sex. Imagining all the things that could go wrong and feeling self-conscious won't help, either. Worse still, sexual activity, especially orgasm, can cause a flare in your spasticity.

The most important strategy is to have an open and honest conversation with your partner and explain and educate them about muscle spasticity. Talk to a physical therapist or your doctor about safer positions for sex that won't worsen symptoms. Talk to your partner, too. This doesn't have to be a long, medical discussion and can be much more effective if it centers on you: how spasticity affects you, how it's changed the way you like to have sex. You can dovetail into a conversation about what turns on your partner, too.

The notion that the best sex is spontaneous is not necessarily true. Try scheduling sex for when you feel at your best, perhaps when your medications are starting to kick in or after completing a daily exercise.

Finally, take it nice and slow. Think about a massage to get things moving or extended foreplay where you each take turns. Don't feel bad about taking breaks if you need to regroup and recover. It's not a race. It's about enjoying yourself and your partner.