<\/p>\n
Spasticity is a common side effect of certain neurological conditions. And while the word might make you think of muscle spasms, it\u2019s much different from what you might think. \u201cOftentimes, you may hear the word \u2018muscle spasm,\u2019 \u2018stiffness\u2019 or even \u2018rigidity,\u2019\u201d says physical therapist and clinical rehab specialist Randy Karim, PT, DPT, NCS, CBIS. \u201cHowever, spasticity has special nuances that make it different than those terms.\u201d<\/p>\n
\n\t\t\t\tCleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.\t\t\t\t\t\t\t\t\tPolicy\n\t\t\t\t\t\t\t<\/p>\n
To understand spasticity, it helps first to understand muscle tone. \u201cMuscle tone gives our body structure,\u201d says Dr. Karim. \u201cIn everyday terms, if we had zero muscle tone, we would resemble a wet noodle, or a pile of muscles and bones on the ground. But if we had too much tone, we would be as stiff as a board and find it extremely difficult to move.\u201d<\/p>\n
If you don\u2019t have enough tone, you have what\u2019s known as hypotonicity. Having too much tone is called hypertonicity. Spasticity falls under the category of hypertonicity, and is \u201cvelocity-dependent,\u201d says Dr. Karim. In other words, how quickly you move matters.<\/p>\n
\u201cThe faster that you move a muscle \u2014 or the faster that you stretch a muscle \u2014 the more that the tone reacts. In other words, the stronger the resistance, the more spastic a muscle becomes.\u201d<\/p>\n
But spasticity doesn\u2019t necessarily just refer to your muscle fibers and muscle tone. It\u2019s also related to the nerves that are connected to your muscles, says Dr. Karim. \u201cSpasticity is essentially more of a nervous system issue rather than a muscle issue.\u201d<\/p>\n
Imagine that your nervous system and your muscles are playing a game of tug-of-war. When the signals between your brain and muscles can go back and forth unimpeded, there\u2019s an equal amount of push and pull \u2014 the same amount of force coming from each side. \u201cEach side is equally strong, so you have good tension in your muscles,\u201d Dr. Karim explains.<\/p>\n
But an injury to your nervous system causes an imbalance, disrupting the signals from your brain to your muscles \u2014 which leads to a lopsided game of tug-of-war. \u201cSuddenly one side is pulling more,\u201d Dr. Karim says, \u201cand the other side can\u2019t push back enough.\u201d<\/p>\n
\u201cThe signals are inhibited from relaxing the muscle,\u201d he adds. \u201cYou have more signals being pushed into the muscle, causing tension. The other side is pulling and pulling unchecked. This overactivity leads to stiffness, tightness and spasticity.\u201d<\/p>\n
Your muscle tone can be affected by neurological conditions that cause damage to your central nervous system \u2014 your brain, your spinal cord and everything in between that connect them. \u201cSpasticity is caused by any condition that damages the motor neurons coming from your brain and spinal cord that connects to the muscle,\u201d says Dr. Karim.<\/p>\n
Your central nervous system includes your brainstem, which regulates essential functions such as breathing, or your cerebrum. This area of your brain has many jobs, including directing muscle movement.<\/p>\n
Common conditions that can have spasticity as a symptom include:<\/p>\n
The parts of your body affected by spasticity depend on where the damage occurs in your nervous system. In turn, this can affect what condition you develop. For example, traumatic brain injuries are typically associated with damage to the front or back of your skull.<\/p>\n
However, Dr. Karim says there are common muscle groups generally affected by spasticity, located in three general areas of your body:<\/p>\n
In your upper limbs, these are muscles that cause flexion movement. Examples of this kind of movement include bending your arm at the elbow or clenching a fist. Muscle groups affected by spasticity include:<\/p>\n
In your lower limbs and extremities, the muscles affected are involved with extension movement. This can involve things such as toe pointing or stretching your knee. Muscle groups affected by spasticity include:<\/p>\n
The muscles impacted here have \u201cside bending and rotation movement,\u201d says Dr. Karim. Think about the muscles you use rolling your head around to stretch, or bending your upper torso to one side. Muscles affected by spasticity here include:<\/p>\n
Dr. Karim says there are exceptions to the above muscle groups. \u201cHowever, when I evaluate people who have had a stroke, or are living with a spinal cord injury, multiple sclerosis or cerebral palsy, these are the patterns that are more common.\u201d<\/p>\n
Exercise can temporarily reduce spasticity. \u201cThis reduction can last anywhere from minutes to a few days, depending on the amount of spasticity present and the type of intervention performed,\u201d says Dr. Karim. \u201cWhether it\u2019s an exercise or treatment that a physical therapist does, it can have a very real, calming effect on the spasticity.\u201d<\/p>\n
However, this reduction is transient, meaning it\u2019s not permanent. \u201cStretching and strengthening the spastic muscles can\u2019t cure or heal spasticity, or may not bring it back down to a normal tone,\u201d notes Dr. Karim. \u201cUnfortunately, therapists cannot heal your spasticity. It\u2019s not like a muscle injury that\u2019s going to heal and go back to normal.\u201d<\/p>\n
That being said, exercise can help you manage the long-term impact of spasticity, such as muscle pain, stiffness or contracture. \u201cContracture occurs when the muscle becomes so stiff, and it doesn\u2019t move for a long time that there\u2019s actually a physiological change in the joints and in the muscle,\u201d explains Dr. Karim. \u201cThe tissue actually changes and cannot move anymore.\u201d<\/p>\n
When determining a good exercise routine, the first thing to keep in mind is that whatever physical activity you do, it shouldn\u2019t be painful. \u201cYou may have heard the saying \u2018no pain, no gain,\u2019\u201d says Dr. Karim. \u201cBut that\u2019s a very inaccurate and dangerous phrase, especially when spasticity is present.\u201d<\/p>\n
Soreness or a slight muscle ache is common and may even be expected. \u201cBut a pain that feels sharp, or a shooting pain that stops you in your tracks, that\u2019s a warning sign,\u201d Dr. Karim adds. \u201cYou should never push through that type of pain. Stop immediately and consult with your doctor or therapists. Feeling acute pain when performing a movement or exercise is a signal to your body that something\u2019s wrong.\u201d<\/p>\n
When it comes to exercises with spasticity, combining stretching with strength training, or resistance training, can help. Strength training has more benefits when you\u2019re in a weight-bearing position, adds Dr. Karim.<\/p>\n
\u201cYou might hear this technical term: closed kinetic chain. Basically, that means you don\u2019t have your limbs out in the air, maybe moving weights,\u201d he explains. \u201cInstead, you\u2019re actually closing your movement chain by putting your hands or your feet down on the ground or on a solid surface.\u201d<\/p>\n
One exercise Dr. Karim recommends is stretching your calves on what\u2019s called an incline board or a slant board. These are shaped like wedges and can be adjustable. \u201cYou hold on to a stable surface and step onto this incline board,\u201d he says. \u201cThis is something that\u2019s at an angle \u2014 roughly a 15- to 25-degree incline \u2014 and you stretch by stepping onto it.\u201d<\/p>\n
For the best impact, \u201cboth of your heels should be on the board or one should be on the floor,\u201d Dr. Karim adds. \u201cTo target your calves, your knees have to stay straight, and you lean your hips forward.\u201d A good comparison to this stretch is thinking about how your calves feel when you\u2019re walking up a hill or a steep incline.<\/p>\n
You can buy these incline boards online or even make your own at home, using wood, grip tape and nonslip material. However, the angle of the incline board is crucial. \u201cIf you have something less than 15 to 25 degrees, you won\u2019t feel much of a stretch,\u201d says Dr. Karim \u201cIf you have something a little bit higher of an angle, it may be uncomfortable.\u201d<\/p>\n
Dr. Karim recommends keeping this incline board in a room you visit a lot, such as your bathroom. \u201cEvery time that you\u2019re at your bathroom sink, as long as it\u2019s safe, you can lean on the sink as you\u2019re washing your hands,\u201d he says. \u201cYou can sneak in a stretch throughout the day, rather than just having a specific dedicated time in your day to stretch.\u201d<\/p>\n
To stretch your wrist muscles, Dr. Karim recommends what he calls a wall pushup. \u201cPlace your arms on a surface,\u201d he says. \u201cIf you\u2019re able to, I recommend putting your hands on the wall.\u201d<\/p>\n
Dr. Karim stresses not to skimp on balance or safety when doing this. \u201cYou shouldn\u2019t feel any discomfort either,\u201d he notes. \u201cYou\u2019re mostly stretching your wrist muscles by leaning into the wall and leaning your body forward.\u201d<\/p>\n
Studies have shown that aquatic exercises such as swimming are very beneficial for children living with cerebral palsy. \u201cThese showed that when researchers measured the muscle itself, swimming had an elastic effect,\u201d says Dr. Karim, \u201cmeaning it made the muscle a little bit more flexible after being in the water.\u201d<\/p>\n
There is some research showing that cycling and treadmill training can also help with spasticity. \u201cTo be clear, these also have a temporary effect on the spastic muscle,\u201d Dr. Karim states.<\/p>\n
Anyone exercising needs to be mindful of following best practices and listening to their body. For people living with spasticity, Dr. Karim says there are some specific considerations when exercising.<\/p>\n
First and foremost, before starting an exercise routine for spasticity, Dr. Karim says to consult with a physical or occupational therapist. \u201cA therapist can evaluate you and tailor a specialized program to meet your needs. This is by far my primary recommendation for anyone before starting with specific exercises.\u201d<\/p>\n
Different things can trigger spasticity. In studies, people have self-reported spasticity increases due to having a full bladder, having their period, being pregnant, a change in sleeping habits, colder weather or increased stress.<\/p>\n
Different times of day might be better for exercising. \u201cSome people may experience more spasticity in the morning,\u201d says Dr. Karim. \u201cThis is likely due to laying in bed asleep in the same position for a long time. That can make your muscles feel very stiff in the morning.\u201d<\/p>\n
Medication timing can also make a difference in your spasticity. \u201cIf you take medication that helps your muscles relax, you want to be mindful of that,\u201d says Dr. Karim. \u201cTherefore, it is wise to time your medication along with your exercise routine, so you\u2019re able to have more of an impact.\u201d<\/p>\n
Because spasticity is velocity-dependent, slow and steady wins the race when exercising. \u201cThe faster you move, the more that you can trigger spasticity,\u201d he says. \u201cDuring an exercise routine, if you\u2019re moving too fast, you may actually trigger a higher degree of spasticity versus moving in a slow and controlled fashion.\u201d<\/p>\n
Much like exercise, stretching can help you manage spasticity, not eliminate it completely or cure it. Dr. Karim says, \u201cIn the long term, stretching may not change objective measures for spasticity, but it\u2019s also not harmful. Stretching is a preventative intervention that may prevent issues in the future.\u201d Prolonged stretching is helping you maintain your range of motion and prevent contracture.<\/p>\n
If you live with spasticity, Dr. Karim says it\u2019s vital that you think of stretching as a healthy habit like brushing your teeth. \u201cBrushing your teeth is something that\u2019s been accepted as a part of our culture. From a young age, it\u2019s something that everyone understands you have to do for good long-term health.<\/p>\n
\u201cStretching is the same kind of daily health maintenance that everyone has to do,\u201d he continues. \u201cHowever, it\u2019s especially helpful for someone living with a condition where there is a high likelihood that your muscles can become stiff in the future.\u201d<\/p>\n
Combining stretching with calming, deep breathing exercises can be very effective for people with spasticity. \u201cAn example of an effective breathing pattern is one where your exhale lasts longer than your inhale,\u201d Dr. Karim explains. \u201cThis pattern has a calming effect on your central nervous system. And it will help you to have a better stretch, especially if you have spasticity.\u201d<\/p>\n
If you have more severe spasticity, a neurologist or a physiatrist can help you decide whether techniques or movements could work in tandem with exercise to decrease spasticity. Additionally, physical and occupational therapists have equipment, therapeutic techniques and treatments available to help. \u201cConsulting with a healthcare professional to determine the best plan can always help,\u201d advises Dr. Karim.<\/p>\n
This kind of assistive technology can help you \u201cachieve and maintain proper positioning of the joints and trunk\u201d while standing, says Dr. Karim. \u201cIf you are able to safely stand with the appropriate equipment, this is very important to prevent contracture.\u201d<\/p>\n
If you use a wheelchair, it\u2019s also important to have a wheelchair and seating assessment by a therapy professional so you\u2019re positioned correctly. Improper seating positions may lead to an increase in spasticity.<\/p>\n
\u201cSplinting your wrist and hand, or wearing orthotics, can both help manage spasticity,\u201d Dr. Karim says. \u201cThis provides a prolonged stretch throughout the day that can also help prevent contractures from occurring.\u201d<\/p>\n
There are several medications to manage spasticity. In addition to an oral medication, which has a general effect on your body, some options are more localized. \u201cIf you only have one or two areas in your body that are spastic, it may make more sense to put that medication directly in those areas,\u201d suggests Dr. Karim. \u201cDoctors can take medication and inject it right into the muscle that\u2019s being affected.\u201d<\/p>\n
Spasticity looks and feels different for everybody. Figuring out an approach to managing it also looks different for everyone \u2014 although taking into account multiple techniques and considerations can have a compounding effect on reducing spasticity.<\/p>\n
\u201cThere\u2019s the timing of your exercise, making sure that you\u2019re combining it with medical management,\u201d says Dr. Karim. \u201cFor example, maybe you\u2019ve taking oral medications or managing it with a focal injection to calm the muscle down. And then there\u2019s also deep breathing.\u201d<\/p>\n
Dr. Karim also says some people can even use spasticity to their advantage and maintain their quality of life. This happens with some conditions that affect muscle strength, as well as tone. \u201cYou may have weakness in your legs, but you might have a lot of spasticity as well,\u201d he notes. \u201cEven though you have weakness, the spasticity may allow you to stand or assist with transferring to different surfaces. Sometimes, your spasticity kicks in and can help perform functional tasks.\u201d<\/p>\n
In a case like this, consulting with a therapy professional can help. \u201cHealthcare providers can help you determine, \u2018Is it a good thing to decrease your spasticity? Or should we keep your spasticity in place so that you\u2019re able to function better?\u2019\u201d<\/p>\n
At the end of the day, you and your healthcare team can decide on the best way to approach managing your spasticity. \u201c<\/strong>Even though we may not be able to heal your spasticity, we do have treatment options to help improve your activities of daily living, mobility and quality of life,\u201d reassures Dr. Karim.<\/p>\n","protected":false},"excerpt":{"rendered":" Spasticity is a common side effect of certain neurological conditions. And while the word might make you think of muscle spasms, it\u2019s much different from what you might think. \u201cOftentimes, you may hear the word \u2018muscle spasm,\u2019 \u2018stiffness\u2019 or even \u2018rigidity,\u2019\u201d says physical therapist and clinical rehab specialist Randy Karim, PT, DPT, NCS, CBIS. \u201cHowever, […]<\/p>\n","protected":false},"author":1,"featured_media":1805,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[10],"class_list":{"0":"post-1804","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-ejercicio","8":"tag-ejercicio"},"_links":{"self":[{"href":"https:\/\/americanchiropractors.org\/es\/wp-json\/wp\/v2\/posts\/1804","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/americanchiropractors.org\/es\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/americanchiropractors.org\/es\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/americanchiropractors.org\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/americanchiropractors.org\/es\/wp-json\/wp\/v2\/comments?post=1804"}],"version-history":[{"count":1,"href":"https:\/\/americanchiropractors.org\/es\/wp-json\/wp\/v2\/posts\/1804\/revisions"}],"predecessor-version":[{"id":1806,"href":"https:\/\/americanchiropractors.org\/es\/wp-json\/wp\/v2\/posts\/1804\/revisions\/1806"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/americanchiropractors.org\/es\/wp-json\/wp\/v2\/media\/1805"}],"wp:attachment":[{"href":"https:\/\/americanchiropractors.org\/es\/wp-json\/wp\/v2\/media?parent=1804"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/americanchiropractors.org\/es\/wp-json\/wp\/v2\/categories?post=1804"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/americanchiropractors.org\/es\/wp-json\/wp\/v2\/tags?post=1804"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}