Health & Fit What Everyone Should Know About Spasticity
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Table of ContentsOverview | Causes | Symptoms | Diagnosis | Treatment & Rehabilitation | Complications | Prevention
What is spasticity?
Spasticity may be a term that’s new to you, but it’s a condition that affects more than 12 million people around the world.  It’s a complicated condition, but simply put, it’s extreme muscle tightness that can cause spasms or pain that make it hard to move or speak normally.
Muscle movement is usually controlled by a complex system in the brain and spinal cord that allows some muscles to contract (tighten) while others relax. Damage to the brain or spinal cord—from conditions such as a stroke, spinal cord injury, or brain trauma—can disrupt the brain’s communication with the body, making the muscles contract all at once, causing spasticity.  The result of that lack of communication and tense muscles can mean stiff, rigid muscles that make movement, speech, and other daily-life functions difficult,  or, in more severe cases, joints that severely bend and will not unbend. 
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As for who the condition affects: Approximately 70 percent of people with cerebral palsy, 50 percent of people with traumatic brain injury, up to 75 percent of people with spinal cord injury, 35 percent of people who’ve had a stroke, and up to 78 percent of people with multiple sclerosis experience spasticity.  Spasticity can happen to anyone regardless of age, ethnicity, or gender. 
While spasticity can be painful, interfere with how you move, or disrupt your sleep, there are many different treatment options, ranging from simple things like stretches to more involved treatments like surgery. 
What causes spasticity?
Simply put, this condition occurs when the nerves that control movement are damaged, leading to excessive muscle tightening. The more detailed medical explanation is that “Movement is controlled by two types of neurons (nerve cells that transmit information within our bodies): Ones in the brain that go down into the spinal cord, and ones in the spinal cord that send messages to the muscles. Damage to the brain or spinal cord...can lead to excess muscle activity, which is spasticity,” says Dr. Michael Schulder, M.D., FAANS, professor and vice-chair of neurosurgery at the Zucker School of Medicine at Hofstra/Northwell. This damage can occur due to any of the following:
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- Cerebral palsy
- Traumatic brain injury
- Spinal cord injury
- Multiple sclerosis (MS)
- Lack of oxygen to the brain, such as with a near-drowning or suffocation
- Neurodegenerative illnesses (illnesses that damage the brain and nervous system over time, for example, Alzheimer’s and Parkinson’s) 
- Head injury
- Phenylketonuria (a disorder where the body can’t break down the amino acid phenylalanine)
- Adrenoleukodystrophy (a disorder that disrupts the breakdown of certain fats)
What are the symptoms of spasticity?
Spasticity can be mild, causing muscle stiffness—or severe, causing painful and uncontrollable muscle spasms.  The symptoms of spasticity include:
Repetitive, rapid muscle contractions
Exaggerated deep tendon reflexes (such as knee or elbow jerks)
Involuntary crossing of the legs (called scissoring)
Carrying the shoulder, arm, wrist, and finger at an abnormal angle because of muscle tightness
Contracture (permanent contraction of a muscle)
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How is spasticity diagnosed?
Identification of spasticity relies on a thorough history of your symptoms—when they first started, how they’ve progressed, and anything that alleviates or worsens each symptom.   Your doctor will also ask about your family and personal medical history and complete a physical exam to check your muscle tone (tightness), strength, weakness, sensation, and reflexes. 
Doctors use different scales to determine the severity of spasticity, but most commonly they use the, which measures resistance as your doctor moves and stretches your muscles.  For example, the testing includes having the doctor extend your wrist from maximum possible flexion to maximum possible extension, then repeating that test on your fingers, thumbs, elbows, hamstrings, quadriceps, and calves.  Then they assign a score for each, which ranges from zero (no increase in muscle tone) to four (the muscle is rigid in flexion or extension). Depending on the final score, you may be diagnosed with spasticity. 
What are the possible complications of spasticity?
Spasticity can lead to challenges with everyday functioning and increase the risk of other conditions. Complications include:
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Discomfort and pain
Difficulties with walking, talking, and daily activities
Difficulties with walking, talking, and daily activities
Contractures (permanent contraction of a muscle)
Challenges maintaining good hygiene
Dislocation of bones, due to excessive muscle contraction
Can you prevent spasticity?
Unfortunately, no. If you have one of the conditions that can cause spasticity, you can’t do anything to prevent spasticity from developing, Dr. Schulder says. (But having a condition that can cause spasticity is not a given you will develop it.) While the underlying causes may be out of your control, he says you can take precautions to avoid potential injuries and complications by leading an overall healthy lifestyle (being active, eating a balanced diet, and managing stress).
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What are the treatments for spasticity?
It’s important to treat your spasticity so you feel more comfortable and can move better.  Which treatment is best for you depends on the severity and location of your symptoms. “We want to start with the least invasive treatment and, if necessary, move to increasingly invasive treatments,” Dr. Schulder says. That means that most often, doctors recommend a combination of physical therapy and medication; however, surgery is necessary in some cases.
Exercises to strengthen and stretch muscles can help train the limbs to be less stiff and not contract, Dr. Schulder says. This can help increase the range of motion, reduce the severity of symptoms, and reduce the risk of muscles becoming shorter, which can happen when they stay contracted.  In addition to showing you stretches and exercises, to help relax and retrain your muscles, a physical therapist may apply temporary casts or braces, or heat or cold. Another treatment is called electrical stimulation (or e-stim), which involves applying painless electrical impulses to the affected area in order to help reignite the muscles’ ability to contract. 
- Oral treatments: Prescriptions such as baclofen, tizanidine, clonazepam, and diazepam can help relax muscles and decrease pain by acting on the overactive nerves in the spinal cord, Dr. Schulder explains. The upside is that these oral medications can relax a large number of muscles at once; the downsides are that they may cause drowsiness, dizziness, or liver inflammation. 
- Botulinum toxin injections: In more severe cases, “Botulinum toxin injections can be dramatically effective,” Dr. Schulder says. The upside is that rather than treating your whole system, the treatment is delivered directly to the affected muscles and can help them relax, improving function.  However, the effect wears off after 3 to 6 months, so you will need to repeat the injections .
- Intrathecal baclofen therapy (IBT) pump: For severe spasticity that other medications have failed to help, a programmable pump and catheter may be used to deliver baclofen (a muscle relaxant) directly into the spine. The upside is that because the drug is placed directly where it’s needed within the spinal cord there are fewer side effects than oral alternatives. 
To improve spasticity, surgeons may:
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- Lengthen a tight tendon by making cuts in it. As it heals, it lengthens. [3, 7]
- Perform a tendon transfer, moving a tendon from one area of the body to another. 
- Cut the nerve-muscle pathway to decrease muscle stiffness.  Cutting a nerve means you cannot move the joint, “but with such severe contraction of a joint, you typically couldn’t move it anyway,” Dr. Schulder says.
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