Tone, Tightness, & Spasticity

Spasticity is tight, stiff muscles that make movement difficult or even impossible. Also called tone or tightness, spasticity can cause pain, abnormal posture, and uncontrollable movements. 

Spasticity can occur anywhere in the body, but it is most common in the arm typically with a closed fist, bent wrist, and flexed elbow. Needless to say, this can make common activities like dressing and eating very difficult.

In legs, spasticity causes a stiff knee and a pointed foot. It can also cause involuntary movements, which may include spasms and clonus (a series of fast involuntary contractions). Orthotics, such as ankle-foot braces (AFOs), are sometimes used to limit spasticity in legs.

Nearly one out of every three patients may have spasticity after a stroke, and approximately 40% of them still have spasticity at 12 months post-stroke. In a survey done by the National Stroke Association, while 58% of survivors in the survey experienced spasticity, only 51% of those had received treatment for the condition. 

The cause of spasticity is not totally understood, but basically it is associated with increased activity of the muscle stretch reflex (a contraction that occurs in response to stretching within the muscle). Normally when you moves, this stretch reflex fires and then deactivates. But with spasticity, the stretch reflex is never released and muscles stay in a constant state of contraction. Spasticity is velocity dependent, meaning it is worsened by rapid movement.

Without daily physical rehab, the muscles will remain contracted and joints become immobile. For best results during stroke rehab, therapy such as stretching and strengthening exercises work best and are typically the first line of treatment.

What you can do about the symptoms:
  • Strategies include moving of the affected limb early in rehabilitation and sustained stretching
  • Splinting and ice packs are other strategies that can be used to temporarily decrease the extent of spasticity. 
  • Oral medications for spasticity include medications such as Valium or Baclofen, which relaxes muscles by acting on the central nervous system. They can decrease muscle spasms, tightness, and pain and improve range of motion. The problem with oral medications is their side-effects like sleepiness.
  • Baclofen can also be given as an injection within the space surrounding the spinal cord (this is called intrathecal injections). However, this this requires surgical implantation of a pump that delivers the drug to the spinal cord.
  • Injections are administered directly into the spastic muscle by blocking chemicals that make muscles tight. Commonly used is the botulinum toxin (Botox) or Phenol. These injections usually improve muscle stiffness within two to four weeks. 
  • In severe cases, surgery is an option. This includes includes lengthening or releasing of muscle and tendons and cutting selective sensory nerve roots.
First Step: Stretching
A muscle-stretching program done at least two times daily is the key technique for spasticity. The spastic limb should be moved through the full range of motion or to the point where a person starts to feel discomfort. The stretch should be held for at least 30 seconds. (Muscles have injury prevention structures in them that prevent you from getting much of a benefit out a stretch that last less than 20 seconds.) Some range-of-motion exercises:

See also:  

Also, consider yoga. Research suggests that adding yoga to stroke rehabilitation therapy improves the speed and extent of recovery. Not only does yoga improve balance and flexibility, it has also been shown to result in a stronger and faster gait, longer steps, and increased strength and endurance.  Traditional yoga classes involve a variety of floor exercises, but chair and wheelchair yoga are also options: yoga-for-wheelchair-users-8-poses.

But "the Holy Grail for spasticity reduction is a melding of doctor-prescribed medical interventions and therapist-delivered neuroplastic treatment options," as Peter Levine says.

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