involves involuntary muscle stiffness and/or spasms—sustained muscle
contractions or sudden movements. It is one of the more common symptoms of MS.
can be as mild as the feeling of tightness of muscles or so severe as to produce
painful uncontrollable spasms of extremities, usually of the legs. Spasticity
can also produce feelings of pain or tightness in and around joints and can also
cause low back pain.
people whose legs are very weak, find that spasticity makes the legs more rigid,
and actually helps them to stand, transfer, or walk.
are two types of severe MS-related spasticity:
flexor spasticity, mostly involving the hamstrings (muscles on the back of the
upper leg), the hips and knees are bent.
extensor spasticity, involving the quadriceps (muscles on the front of the upper
leg), the hips and knees remain straight, with the legs very close together or
crossed over at the ankles. Spasticity can also occur in the arms, but is less
may be aggravated by extremes of temperature, humidity, or infections.
It can even be triggered by tight clothing.
Be Treated With Exercise and Medication
are a number of therapeutic approaches to the management of spasticity. Because
spasticity varies so much from person to person, it must be treated on an
individual basis and demands a true partnership between the person with MS,
physician, nurse, physical therapist and occupational therapist. Treatment
begins with the physician recommending ways to relieve the symptoms. These could
include medication, exercise, changes in daily activities, or combinations of
these methods. The physician will track the progress and make referrals to other
health professionals such as occupational and physical therapists.
stretching and other exercises are often effective in relieving spasticity.
drugs are needed, there are two major antispasticity drugs:
(Lioresal®) is the most commonly used drug. It is a muscle relaxant
that works on nerves in the spinal cord. Common side effects are drowsiness and
a feeling of muscle weakness. It can be administered orally or by an implanted
pump. This method is called intrathecal baclofen and is used only for spasticity
that cannot be managed by oral medication.
(Zanaflex®) works quickly to calm spasms and relax tightened
muscles. Although it doesn’t produce muscle weakness, it often causes sedation
and a dry mouth. In some patients,
it may lower blood pressure.
baclofen and tizanidine have good safety records. Neither, however, can cure
spasticity or improve muscle coordination or strength. Other drugs less commonly
is not a “first choice” drug for spasticity because it is sedating and has a
potential to create dependence. However,
its effects last longer than baclofen, and physicians may prescribe small doses
of Valium® at bedtime to relieve spasms that interfere with sleep.
(Dantrium®), is generally used only if other drugs have not been
effective. It can produce serious side effects including liver damage and blood
a nerve block agent.
toxin and clonidine, still considered experimental.
Controlling Muscle Spasms
Many people with MS experience spasticity, or muscle stiffness and spasms. It
usually affects the muscles of the legs and arms, and may interfere with the
ability to move those muscles freely.
Spasticity can occur either as a sustained stiffness caused by increased muscle
tone or as spasms that come and go, especially at night. It can feel like a
muscle tightening or it can cause severe pain. Spasticity can also produce
feelings of pain or tightness in and around joints and can cause low back pain.
It may vary depending on your position, posture, and state of relaxation.
What Causes Spasticity?
Spasticity is the result of an imbalance in the electrical signals coming from
the brain and spinal cord, often caused by damage to these areas from MS. This
imbalance causes hyperactive muscle stretch reflexes, which result in
involuntary contractions of the muscle, and increased muscle tension.
What Triggers Spasticity?
Spasticity may be aggravated by extremes of temperature, humidity, or
infections. Tight clothing can even trigger it.
How Is Spasticity Diagnosed?
To diagnose spasticity your doctor will first evaluate your medical history,
including what medications you have taken and whether there is a history of
neurological or muscular disorders in your family. To confirm the diagnosis,
several tests can be performed to evaluate your arm and leg movements, muscular
activity, passive and active range of motion, and ability to perform self-care
How Is Spasticity Treated?
Spasticity can be treated using physical therapy, medications, surgery or any
combination of these treatments. Your doctors will consider the severity of your
condition, your overall health, and the following factors when prescribing an
appropriate treatment plan:
Is the spasticity impacting function or independence?
Is the spasticity painful?
What treatment options have already been tried, and how did they work?
What are the costs of the possible treatments?
What are the limitations and side effects of the treatment?
Will the benefits outweigh the risks? How Does Physical and Occupational Therapy
A basic physical therapy stretching program is the first step in treating
spasticity. A daily regimen of stretching can lengthen muscles to help decrease
An occupational therapist may prescribe splinting, casting, and bracing
techniques to maintain range of motion and flexibility.
If physical and occupational therapy do not adequately control the spasticity,
medications may be added to the treatment plan.
What Medications Are Used to Treat Spasticity?
Common medications used to treat spasticity include muscle relaxant Baclofen and
Zanaflex. Baclofen prevents the nerves in the spinal cord from sending a message
to the muscles to contract.
Another drug that might be used to treat spasticity is Valium, which is often
helpful when taken at night to relieve spasms that interfere with sleep.
If medications taken orally are not effective, a pump can be surgically
implanted to deliver the medication (such as the Baclofen pump). Botulinum toxin
can also be injected locally into the affected area to relax the muscles.
What Types of Surgery Are Available?
When other treatments fail, rhizotomy and tendon release are two surgical
procedures used to treat spasticity.
Rhizotomy involves surgically cutting away part of the spinal nerve. It is
performed to relieve pain or decrease muscle tension.
Tendon release, also called a tenotomy, may be performed to help reduce the
frequency or magnitude of the spasticity, depending on the age of the patient.
The surgery involves cutting severely contracted tendons away from the muscles
to which they're attached.
Tendon release may need to be repeated. It is usually only done in cases of
extreme pain that do not respond to other treatments.
Next: Tremors >
Reviewed by the doctors at the Mellen Center for Multiple Sclerosis Research at
The Cleveland Clinic.
Edited by Charlotte E. Grayson, MD, Nov. 2002, WebMD.
Copyright ©2002, The Cleveland Clinic.