What Is Spasticity? Symptoms, Causes, Diagnosis, and Treatment

Some common causes of spasticity include cerebral palsy, multiple sclerosis (MS), stroke, and traumatic brain or spinal injuries. But there are other possible causes as well.

RELATED: MS Muscle Spasticity: What It Is and What to Do About It

While there’s no cure for spasticity, treatments are available to help ease discomfort and improve quality of life.

Signs and symptoms associated with spasticity include:

• Increased muscle tone
• Pain or discomfort
• Muscle spasms
• Muscle stiffness
• Muscles that feel heavy and are difficult to move
• Contractures (permanent contraction and shortening of muscles and tendons)
• Involuntary crossing of the legs (called scissoring)
• Abnormal posture
• Bone and joint deformities
• Difficulty walking
• Difficulty speaking, eating, and drinking

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While spasticity most commonly affects the leg muscles, it can also occur in the arms, neck, torso, or trunk. Some people with spasticity only have mild pain and stiffness, while others have severe and disabling symptoms.

Specific symptoms vary from person to person and may depend on the underlying condition leading to spasticity.

For example, someone with MS is likely to experience spasticity of the leg and hip muscles, which can lead to flexor spasticity (the legs and hips lock in a bent position) or extensor spasticity (stiff muscles keep legs straight and sometimes crossed at the ankles).

A person with cerebral palsy can have spasticity in both their arm and leg muscles. Children with cerebral palsy might not show symptoms of spasticity when they’re babies, but it can become apparent during childhood.

Muscle Spasticity vs. Muscle Spasms

A muscle spasm, which is a sudden, involuntary tightening or contracting of a muscle, is a normal, if painful, occurrence that can happen to anyone.

Muscle spasms in otherwise healthy people are believed to be caused by muscle fatigue, dehydration, sitting for long periods, or engaging in too much high-intensity exercise.

Spasticity, on the other hand, is caused by an underlying neurological condition.

Spasticity occurs when there’s damage to nerve pathways in the brain or spinal cord that control muscle movement.

This damage can result from a variety of injuries or diseases, such as:

• Multiple sclerosis
• Cerebral palsy
• Traumatic brain injury
• Spinal cord injury
• Stroke
• Amyotrophic lateral sclerosis (ALS)
• Certain metabolic diseases
• Hereditary spastic paraplegias
• Other conditions that affect the brain or spinal cord

Research suggests about 80 percent of people with MS and cerebral palsy will experience spasticity.

Doctors use a variety of tests to diagnose spasticity and the condition that could be causing it.

Additionally, physicians may order imaging tests, such as magnetic resonance imaging (MRI), to figure out what’s causing the person’s spasticity and the extent of the damage.

Medical Experts That Diagnose and Treat Spasticity

People with spasticity and related diseases will likely see a team of doctors that may include the following experts:

• Neurologist
• Rehabilitation specialist
• Physical therapist
• Occupational therapist
• Speech-language pathologist
• Neurosurgeon
• Orthopedic surgeon

Prognosis of Spasticity

A person’s prognosis will depend on the underlying condition they have, the severity of their disease, the treatments they receive, and other factors.

Treatment for spasticity can help improve a person’s mobility and independence.

For some people, such as those who experience spasticity due to a traumatic brain injury, symptoms can improve over time as the injury heals.

However, people who experience spasticity caused by other conditions, such as cerebral palsy, have damage that isn’t reversible, which means the spasticity symptoms won’t go away on their own. Still, certain treatments may relieve pain and improve functioning.

Symptoms might worsen at night or while performing certain activities.

A person is more likely to experience spasticity when they:

• Have a urinary tract infection (UTI)
• Have a full bladder
• Are constipated or have hemorrhoids
• Stretch or move an arm or leg
• Are stressed
• Have an injury to muscles, tendons, or bones
• Wear tight clothing
• Have skin irritation
• Are exposed to extreme temperatures

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Spasticity doesn’t have to be treated if it’s not causing bothersome symptoms.

However, if symptoms interfere with daily activities or lead to a loss of function, doctors have a number of therapies they can recommend.

Oral Medications

Some oral medicines that are used to treat spasticity symptoms include:

• Baclofen (Lioresal)
• Tizanidine (Zanaflex)
• Gabapentin (Neurontin)
• Dantrolene sodium (Dantrium)
• Diazepam (Valium)
• Clonazepam (Klonopin)

Injections

Doctors can inject phenol, alcohol, anesthetic medicines, or neurotoxins — onabotulinumtoxina (Botox), abobotulinumtoxina (Dysport), rimabotulinumtoxina (Myobloc), or incobotulinumtoxina (Xeomin) — directly into muscles and nerves to control spasticity. The results usually last three to six months.

Physical, Occupational, and Speech Therapy

Physical therapy (PT) and occupational therapy (OT) can be useful for helping people with spasticity manage their symptoms.

With PT, therapists teach patients how to perform specific stretching and strengthening exercises that can improve mobility and range of motion.

OT typically involves exercises that focus on improving coordination and strength, so individuals can better perform daily activities.

Some people with spasticity also benefit from speech therapy.

Surgery

Surgical options for treating spasticity include:

• Intrathecal Baclofen Therapy (ITB) With ITB therapy, a programmable pump is implanted under the skin of the abdomen, and a catheter connected to it delivers baclofen directly to the spinal cord. It’s sometimes used to treat spasticity that’s severe.
• Selective Dorsal Rhizotomy (SDR) SDR involves cutting selected nerve roots to reduce severe spasticity in the legs. It’s most commonly done in people with cerebral palsy.

Assistive Devices

Assistive devices, such as splints, braces, or casts, can help people with spasticity maintain continuous muscle stretching and flexibility.

• Canes, walkers, or wheelchairs
• Grab bars
• Shower benches
• Raised toilet seats
• Ramps

Complementary Approaches

Some people with spasticity turn to alternative or complementary approaches to ease their symptoms. While not all these therapies have been proven to work, they might be helpful for certain individuals.

• Acupuncture
• Biofeedback
• Chiropractic treatment
• Massage therapy

Home Remedies

Activities performed at home that may help ease symptoms of spasticity include:

• Engaging in regular exercise
• Stretching
• Using cold packs
• Drinking plenty of water
• Eating a high-fiber diet

In most cases, there’s no way to completely prevent spasticity, but there are ways to improve symptoms. For example, exercising weak muscles and performing daily stretches can help avert a spasticity episode. Regularly taking prescribed treatments can also ward off symptoms.

Without proper treatment, spasticity can lead to certain complications, such as:

• Frozen or immobilized joints
• Extreme discomfort
• Disrupted sleep
• Difficulty performing tasks of daily living
• Falls
• UTIs
• Chronic constipation
• Pressure sores, which can lead to infection

Some conditions that are related to spasticity or that might resemble it include the following:

• Dystonia is a movement disorder that causes muscles to contract involuntarily, causing slow, repetitive motions or abnormal postures.

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• Hypertonia is a condition that occurs when someone has too much muscle tone, making it difficult to move. Spasticity is a type of hypertonia.

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• Rigidity is a type of hypertonia in which the muscles remain stiff regardless of the type of movement a person is engaging in. Parkinson’s disease, in particular, is associated with rigidity as a symptom.
• Tremor is uncontrollable shaking, caused by rhythmic muscle contractions, in one or more parts of the body.

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• Ataxia is a degenerative disease of the nervous system that’s characterized by poor muscle control, resulting in balance and coordination problems.

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• Tardive dyskinesia is a neurological syndrome, usually brought on by taking certain drugs, that causes repetitive, involuntary muscle movements in the face and sometimes in the neck, arms, and legs.