Loosening the Grip: Understanding and Managing Spasticity in MS

Spasticity can feel like your muscles are no longer fully under your control—tightening unexpectedly, resisting movement, or locking into positions that make simple tasks harder. For people living with multiple sclerosis (MS), this hidden “resistance” can affect walking, hand use, sleep, and everyday routines. Although it can be frustrating and unpredictable, spasticity is a treatable symptom that often improves with targeted rehabilitation, medication, and consistent management strategies. 

What Spasticity Feels Like

Spasticity can look and feel different from person to person. For some, it presents as constant muscle tightness or stiffness that makes movement slow and effortful. For others, it may appear as sudden spasms where a limb “jumps” or moves on its own. You might notice difficulty walking, bending a joint, or opening your hands. Some people also experience pain or aching in the affected muscles. These symptoms can affect any part of the body, including the trunk, and may vary in intensity from day to day. 

Spasticity may interfere with sleep because of nighttime spasms or discomfort. Over time, persistent muscle tightness can become exhausting. Because muscles are working harder than they should, the body uses more energy, which can worsen fatigue—one of the most common symptoms in MS. This combination of stiffness and fatigue can make daily activities increasingly challenging.

Why Spasticity Happens in MS

Spasticity occurs because MS disrupts the balance of nerve signals that control muscle activity. In a healthy nervous system, the brain sends coordinated messages that tell muscles when to contract and when to relax. When MS damages these pathways, muscles may not relax properly and can remain partially activated even when they are not needed. 

Spasticity is not a primary muscle problem—it is a communication problem between the nervous system and muscles. 

Spasticity Can Change Over Time

Spasticity is not a static symptom—it is often considered a “moving target.” 

Common triggers include: 

• Fatigue or overexertion 

• Emotional stress 

• Infections, such as urinary tract infections 

• Pain from another condition or even tight clothing 

• Sudden movements or quick changes in position, including rolling over in bed 

• Heat (and for some people, cold) 

Recognizing your personal triggers can help you better anticipate and manage spasticity, while also making it easier to describe changes in your symptoms to your healthcare team. 

Why Early Recognition Matters

Recognizing spasticity early is important because timely treatment can help prevent long-term complications and preserve function. When muscles remain tight for prolonged periods, they can shorten and reduce joint mobility. Over time, this may contribute to pain, changes in posture and balance, weakness, or contractures (permanent loss of motion). 

Early management may also reduce secondary effects such as fatigue, falls, and loss of independence. Addressing symptoms sooner often provides more treatment options and can lead to better outcomes. Even subtle increases in stiffness are worth discussing with your healthcare team.

Treatment: A Team-Focused Approach

The good news is that spasticity is manageable. Most people benefit from a combination of rehabilitation, medication, and lifestyle strategies. Rehabilitation is often the foundation of treatment because it improves function, positioning, and independence. A physical or occupational therapist familiar with spasticity can help develop a program tailored to your needs. 

Rehabilitation strategies may include: 

• Daily stretching for specific muscle groups, such as calf stretching to improve walking, hamstring stretching to improve posture, or finger stretching to improve hand opening and grasping. 

• Positioning and postural strategies, such as adjusting sitting or lying positions, supporting the ankles, or placing pillows between the knees to reduce muscle tightness. Avoiding staying in one position too long is important, as this can increase stiffness. 

• Task-specific training, such as repeated sit-to-stand practice or stepping activities, to improve coordination and reduce abnormal movement patterns. 

• Repetitive movements that work against the stiffening pattern. For example, cycling may help when the leg tends to stiffen and straighten. 

• Aquatic therapy, where water-supported exercise allows smoother, more coordinated motion. 

• Strength and balance training to improve stability and walking. Strengthening opposing muscles may help reduce tightness and improve coordination. As spasticity decreases, underlying weakness may become more noticeable. Balance training is also important for reducing falls. 

• Bracing or splinting, such as an ankle-foot orthosis (AFO) or hand splint, to improve positioning and support more normal movement. 

• Electrical stimulation in selected cases to support weak muscles and improve muscle balance. 

• Energy conservation strategies, including pacing activities and scheduling rest breaks to reduce fatigue-related symptom worsening. 

Medications for Spasticity

Medications are often used alongside rehabilitation to reduce excessive muscle activity. Common medications include Baclofen (Lioresal) and Tizanidine (Zanaflex). These medications may cause drowsiness, dizziness, fatigue, or weakness, so dosing is adjusted gradually. Other medication options may also be recommended based on your symptoms and your healthcare provider’s guidance. 

For focal spasticity, botulinum toxin injections can temporarily relax overactive muscles, while severe or widespread spasticity may sometimes be treated with an intrathecal baclofen pump for more targeted medication delivery. 

While spasticity is often viewed as limiting, it can sometimes provide functional benefit. In people with weakness, mild stiffness may help with standing, transfers, posture, or weight-bearing. However, this balance is delicate. When spasticity becomes excessive or poorly controlled, it can interfere with movement, comfort, and safety, making ongoing management important.

Partnering With Your Healthcare Team

Managing spasticity is not a one-size-fits-all process. Open communication with your healthcare providers is essential. Be specific about what you are experiencing, when symptoms occur, what makes them better or worse, and how they affect your daily life. This information helps your team create a treatment plan that aligns with your goals and lifestyle.

Final Thoughts

Spasticity can be frustrating and unpredictable, but it is treatable. With the right combination of rehabilitation, medication, and support, you can reduce its impact on daily life. Staying proactive and working closely with your care team can help you continue doing the things that matter most to you.