Spasticity & Spasms

Spasticity is a symptom that causes your muscles to feel stiff, heavy and difficult to move. A spasm is a sudden, involuntary tightening or contraction of a muscle. 

Muscles normally have an internal springiness, like a lightly wound spring. In a muscle with spasticity, it’s as if the spring is wound too tightly. 

Spasticity can affect your motor performance or skills – basically any action that involves muscle use. If untreated, spasticity can cause muscle shortening, tightness, stiffness and weakness which may further impact your movement. 

Spasticity can affect any muscle, but spasms and spasticity of the arms, legs or the trunk and back are most common. There are four types of spasm: 

• Flexor spasm – the limb bends, such as a leg moving upwards towards the body. 
• Extensor spasm – the limb extends, such as a leg straightening away from the body. 
• Adductor spasm – the limb is pulled towards the body, such as difficulty separating thighs.
• Spasms of the trunk – the back or trunk can arch off the surface you’re on, such as a bed or chair. 

Clonus is a symptom of spasticity and spasms and can be described as a repetitive, up and down movement, often seen as a constant tapping of the foot. You can reduce the effects of clonus by moving your leg or putting more weight through your leg by standing or perhaps leaning forward.

Spasticity and spasms can range from mild to severe and vary over time, even throughout the day. The symptoms can be annoying, uncomfortable and unpredictable and for some, painful.

Muscles are involved in every movement you make. They get longer and shorter to move and hold the body by increasing or decreasing muscle tone (the level of tension or resistance to movement in a muscle). 

Spasticity and spasms occur due to broken or damaged nerve pathways, caused by MS damaging the myelin coating around nerves. If these nerve signals between the brain and a muscle are interrupted or damaged, the muscle can remain in its shortened state, make the affected limb feel stiff or tight and often difficult to move. If a limb becomes fixed in one position it is called a contracture. 

Disrupted nerve messages can also cause over activity of muscles and loss of coordination leading to spasms. Depending on where in your brain or spinal cord MS affects your nerves, spasticity can affect any muscle in the body.

If you have spasticity or spasm issues and/or a worsening of this symptom, talk to your neurologist, MS Nurse or GP. This is particularly important if you experience pain, discomfort, posture issues, movement interference, inability to perform daily tasks, or emotional or sleep disturbance. 

Like MS, spasticity and spasm vary from person to person, so an individual approach is best. This symptom doesn’t always require medical treatment, but early recognition and management can help to prevent complications. Spasticity and spasms may worsen with MS progression, so it’s best to discuss any concerns with your healthcare team, who can help develop a management plan for your situation. 

Managing spasticity and spasms involves the need for movement or stretching and being aware of potential trigger factors that may worsen or exacerbate your symptoms. 

Movement or stretching 

It’s important to keep muscles, ligaments and joints as flexible as possible. This can be done through stretching, active movement (moving your limbs) or passive movement (your limbs are moved by a carer, physiotherapist or automated exercise machine). A physiotherapist can advise on how best to maintain flexibility, teach specific stretches to incorporate into your daily routine and also ways of moving and positioning your body to prevent muscle tightening/stiffness. Some people find yoga or Pilates helpful. 

Good posture while standing, sitting or lying down is also important. Physiotherapists can advise on posture. An occupational therapist can help you find adapted seating, aids to improve sleep positions and seating posture and advise on safe use of wheelchairs.

Managing triggers 

Identifying triggers to your spasticity and/or spasms will help you to manage the symptom and minimise its effects. Your MS Nurse or GP can help you develop a specific management plan. Some triggers include: 

• Other MS symptoms, such as bowel or bladder problems or pain
• Other health conditions, such as infections, colds, or an ingrown toenail 
• External triggers, such as tight-fitting clothes or being too hot or cold
• Overexertion and fatigue
• Increased anxiety or stress
• Medications 

Managing the trigger factor, maintaining good posture and incorporating stretches into your daily routine can help reduce the effects of spasticity or spasm, without needing any medication.

There are medications and other treatment options which can help manage spasticity in MS. Discuss these with your neurologist, MS Nurse or GP.

Using drugs to treat spasticity and spasms effectively is a balance between reducing stiffness and not reducing muscle strength. If you remove all spasticity from a limb, the muscles may be too weak to work properly. For instance, if you have spasticity in your leg, the stiffness may help to keep it rigid enough to help you walk. If all stiffness is removed, the muscles may be too weak to hold you up. 

Daily stretching and other exercises are often effective in relieving spasticity. They aim to improve muscle extension (stretched to their normal resting length and beyond to a limited degree), reduce muscle stiffness and improve function. 

A physiotherapist or exercise physiologist can help with muscle relaxation, stretching techniques and positioning. Some positions and movement patterns can trigger spasticity, while others may reduce it. Customised exercise programs improve your muscle strength, prevent muscle shortening and help maintain or improve fitness. An occupational therapist can advise on posture, seating and ways to make daily tasks easier.

For spasticity that is difficult to manage with the strategies listed above, referral to specialist proficient in botulinum toxin injections (Botox® or Dysport®) for spasticity may be helpful, in conjunction with a stretching and rehabilitation program.