About Muscle Spasticity
Muscle spasticity is caused by damage to the nerve pathways that control muscle movement. This damage can be a result of various conditions and diseases such as brain injury, spinal cord injury, stroke, cerebral palsy, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), hereditary spastic paraplegias, adrenoleukodystrophy (ALD), phenylketonuria, and Krabbe disease.
Risk factors for muscle spasticity include:
- Neurological conditions: Spasticity is often a result of neurological conditions like multiple sclerosis (MS), cerebral palsy, or stroke, which affect the central nervous system.
- Age: Spasticity can worsen with age as muscles and nerves become less flexible and more prone to tightness and spasms.
- Injury to the brain or spinal cord: Damage from a traumatic brain injury, stroke, or spinal cord injury can lead to long-term spasticity, as the nervous system’s ability to control muscle movement is impaired.
- Genetics: Some people may be genetically more likely to develop conditions that cause spasticity, such as hereditary spastic paraplegia.
Muscle spasticity can cause a range of symptoms that can vary in severity. In the early stages, the most common symptoms of muscle spasticity include muscle stiffness, ranging from mild to severe, and an inability to complete daily tasks, such as cooking or getting dressed. Additionally, muscle spasms and painful muscle contractions are also common early symptoms.
As muscle spasticity progresses or becomes more severe, other symptoms may occur. These can include:
- Fatigue after mild activity: People with muscle spasticity may experience increased fatigue even after performing simple tasks.
- Involuntary crossing of the legs: This refers to the legs involuntarily crossing over each other, resembling the action of a pair of scissors.
- Difficulty controlling the muscles used to speak: Muscle spasticity can affect the muscles involved in speech, making it difficult to control and articulate words.
- Limited range of motion or joint extension: Muscle contractions and stiffness can limit the ability to move joints fully or extend them completely.
- Pain in the affected muscles and joints: Muscle spasticity can cause pain in the muscles and joints that are affected by the condition.
- Abnormal posture or positioning of limbs: Muscle spasticity can lead to unusual positioning of fingers, wrists, arms, or shoulders.
- Back pain: Some individuals with muscle spasticity may experience back pain as a result of abnormal muscle contractions and posture.
To diagnose muscle spasticity, doctors commonly perform the following examinations, tests, and procedures:
- Physical examination: Doctors will conduct a thorough physical examination to assess muscle tone, reflexes, and movement patterns. They may ask you to perform certain movements and observe your muscle response.
- Medical history: Your doctor will ask you about your medical history, including any previous injuries or conditions that may contribute to muscle spasticity.
- Pendulum test: The pendulum test is a commonly used test to measure knee extensor spasticity. It involves inducing a rapid stretch of the muscle and assessing the response. This test helps quantify the severity of spasticity in patients with neurological injury or disease.
- Modified Ashworth scale (MAS): The MAS is a clinical tool used to measure an increase in muscle tone. It assesses the resistance felt when a joint is moved through its range of motion. This scale helps determine the level of spasticity.
- Tardieu scale: The Tardieu scale is another clinical tool used to assess spasticity. It measures the angle at which a muscle stretches during passive movement at different speeds. This scale provides information about the velocity-dependent increase in muscle-stretch reflexes associated with spasticity.
To determine the stage or severity of muscle spasticity, additional examinations, tests, and procedures may include:
- Reflex testing: Doctors may test reflexes such as biceps, triceps, patellar tendon, and Achilles tendon reflexes. Abnormal reflex responses can indicate the presence of upper motor neuron injury.
- Functional evaluations: Gait analysis and an active range of motion/strength assessment can help quantify the severity and functional impact of spasticity on a patient. These evaluations provide insights into how spasticity affects daily activities and mobility.
- Hoffman reflex: The Hoffman reflex is a clinical examination maneuver that can uncover signs of an upper motor neuron injury. It involves tapping a specific tendon to observe for abnormal reflex responses.
- Babinski maneuver: The Babinski maneuver involves stroking the sole of the foot to assess for an abnormal response known as an upgoing toe. This maneuver can confirm an upper motor neuron injury.
It's important to note that these examinations, tests, and procedures are performed by healthcare professionals to diagnose and assess muscle spasticity accurately. If you have concerns about muscle spasticity or any related symptoms, it's best to consult with a healthcare provider for proper evaluation and guidance based on your specific situation.
The goals of treatment for muscle spasticity are to increase movement and reduce the severity of symptoms. Treatment can help relax muscles, reduce pain and stiffness, encourage muscle growth in children, and improve independence.
There are different types of treatments that can be used to achieve these goals:
- Medication: Medications such as baclofen and botulinum toxin A (BTX-A) can be used to reduce muscle spasticity. Baclofen works by acting on the nervous system to relax muscles, while BTX-A modulates the release of acetylcholine, reducing muscle tone. These medications are often used in combination with other rehabilitation strategies.
- Muscle relaxant medications, such as baclofen and diazepam, come in different medication classes and can have serious adverse effects and abuse potential. It’s important to talk to your doctor about safer treatment options for managing chronic pain over time. Speak with a healthcare professional about specific medication dosing and potential side effects.
- Therapeutic procedures: Therapeutic procedures like extracorporeal shock wave therapy (ESWT) have shown positive effects in treating musculoskeletal disorders associated with spasticity. ESWT is a non-invasive procedure that uses shock waves to stimulate healing and reduce pain. The specific mechanism of how ESWT works is still unknown, but it has been shown to be effective in improving function and reducing complications.
- Physical therapy: Physical therapy plays a crucial role in managing muscle spasticity. A physical therapist may use a series of stretches aimed at improving muscle length and joint mobility. They may also use modalities to reduce muscle tension and alleviate pain. Strengthening exercises for antagonist muscle groups (muscles that perform the opposite movement of the spastic muscle) can further improve joint mobility and function. Physical therapy focuses on improving functional tasks like walking, standing from sitting, and getting out of bed.
- Psychotherapy techniques: Cognitive behavioral therapy (CBT), alongside other treatments for muscle spasticity, can be useful for managing the psychological and behavioral aspects of chronic conditions, such as stress management, improved sleep and reframing negative though patterns about pain.
- Self-care and health behavior changes: Making certain lifestyle behavior changes can also help manage muscle spasticity. This may include maintaining a healthy weight, practicing good posture, staying active with regular exercise, and avoiding triggers that worsen spasticity, such as extreme temperatures or stress.
It's important to note that treatment for muscle spasticity is individualized based on each person's specific symptoms and goals. A combined knowledge and skills from several academic disciplines involving healthcare professionals like doctors, physical therapists, and occupational therapists is often recommended to develop personalized treatment plans that address the unique needs of each individual.
These treatments work together to achieve the goals of reducing muscle spasticity, improving function, minimizing complications, relieving pain, and maximizing independence for individuals with muscle spasticity.