Spasticity is a common post-stroke condition that causes stiff or rigid muscles. It occurs when a muscle involuntarily contracts when you move and commonly affects the elbow, wrist and ankle. When a muscle can’t complete its full range of motion, the surrounding tendons and soft tissue can become tight.
This makes stretching the muscle much more difficult. If left untreated, spasticity can also lead to joints in the arm and leg to be stuck or frozen in an abnormal and possibly painful position. This is called contracture.
Some of the more common symptoms include:
- Painful muscle spasms
- Difficulty stretching the muscle
- Stiffness in the arm, hand, leg and ankle
- Arm in a folded position pressed against the chest with a curled wrist and fingers
- Tight fist Pointed foot
- Curled toes
- Bent elbow Decreased function
- Overactive reflexes
About 25% to 43% of survivors will have spasticity in the first year after their stroke. It’s more common in younger stroke survivors.
Spasticity may cause significant difficulty with daily living tasks, such as bathing, eating and dressing. These limitations can increase the burden on caregivers and reduce quality of life.
Talk to your health care professional about the best treatment option for you. Treatments are often combined to manage spasticity based on your goals, the severity of your spasticity and your overall health. Assessment and diagnosis are critical in developing a treatment plan, and it’s important to evaluate progress and outcomes.
Treatment may include:
- Physical exercise and stretching: Stretching helps maintain full range of motion and prevents permanent muscle shortening.
- Injections of botulinum toxin: Some medications can be injected to block nerves and help relieve spasticity in a muscle group. This treatment weakens or paralyzes the overactive muscle. Side effects are minimal, but there may be soreness where injected.
- Oral medications: These can help relax the nerves so that they don’t send a continuous message to the muscles to contract. Side effects may be weakness, drowsiness or nausea.
- Functional Electrical Stimulation/Neuromuscular Electrical Stimulations (NMES) or vibrations: This treatment delivers a shock to your affected muscle, activating nerves and causing more movement. The shock can range from a mild tingling sensation to almost a burning sensation depending on the intensity level. NMES combined with therapy may improve spasticity, but there is insufficient evidence that it improves functional gait or hand use.
- Intrathecal baclofen therapy (ITB): Delivers medication when it’s most effective and minimizes side effects that often accompany oral medications. A small pump is surgically implanted to supply baclofen to the spinal cord. Appropriate for patients who didn’t respond well or had adverse reactions to other interventions.
- Braces: These can hold a muscle in a normal position to keep it from contracting. Serial casting and splinting: It’s not recommended for the hand to reduce wrist and finger spasticity; may be considered for mild to moderate elbow and wrist contractures.
- Surgical procedures: These may be considered with contractures and associated pain.
Managing spasticity with assistive devices, aids and home adaptations can enhance your safety. Physical and occupational therapists can recommend appropriate aids, safety procedures, maintenance and proper fit.
Modifications in your home to improve safety include:
- Grab bars
- Raised toilet seats
- Shower or tub bench
- Plastic adhesive strips on the bottom of the bathtub
- Braces, canes, walkers and wheelchairs
Always follow your rehabilitation therapist’s recommendations about limitations and safety.
Topic idea for a group discussion
Are you a stroke support group leader looking for a topic idea for your next meeting? Check out our spasticity lesson module, which contains a presentation and discussion questions, video and a handout.