Spasticity in MS: Friend, Foe, or Indifferent Acquaintance

What Is Spasticity in MS?

Spasticity in MS refers to increased tightness or “tone” in the muscles and/or involuntary muscle contractions. It’s a common MS symptom that may result when the nerves can no longer signal the muscles to maintain the balance between contraction and relaxation.  

Although spasticity usually occurs in the legs, it can affect any part of the body. Symptoms can range from very mild to serious and may cause painful spasms or interference with function.  

Spasticity can be worsened by stress (physical or emotional), extremes of temperature (hot or cold), humidity, infection, injury, a full bowel or bladder, constipation, or even tight clothing.  

MS Spasticity: Friend or Foe?

If you experience spasticity, the first question to ask yourself is whether your spasticity is your friend, foe, or indifferent acquaintance.  

• An indifferent acquaintance means that you have experienced spasticity that does not interfere with your function and does not cause pain or disruption in your sleep.  
• Sometimes, mild spasticity is a friend, meaning that it can help compensate for weakness.  The muscle tightness of spasticity can provide additional “support” in the legs to allow an individual to stand. Spasticity in the body can sometimes provide the “support” needed to sit up instead of in a slump. 
• Spasticity can become a foe when it causes pain or makes it difficult to advance the legs, making walking laborious. Too much spasticity in the trunk can create spasms that suddenly pull you out of a seated position or force you to sit with permanent scoliosis or flexed trunk. 

If spasticity is your foe, then it is time to consider speaking with your MS provider to discuss the options for management.  The goals of treatment are to (1) maintain function, particularly regarding mobility, (2) prevent or reduce pain and discomfort, and (3) prevent complications.  

How Is MS Spasticity Diagnosed?

Your MS provider can check for spasticity in your limbs using neurological testing. The neurologist or physical therapist bends your limb slowly or rapidly and measures the amount of resistance in that limb. The more spasticity you have, the more resistance your provider will feel in response to the passive movement of your limb.   

A physical therapist will take a careful history to determine the best management approach for you. Part of history-taking is to determine your assessment of your spasticity. You may be asked how frequently your spasms occur each hour and what tends to trigger them.  The PT will need to know if spasms cause you pain, wounds, or injury.  

How Do I Manage MS Spasticity?

Stretching and Positioning: Stretching is a hallmark of spasticity management. A PT will teach you stretching exercises that can reduce spasticity as well as the frequency of spasms. Positioning can also help counteract spasticity by helping to maintain range of motion and prevent the triggering of spasms.   

Consider the calf muscle. Sometimes a spastic calf muscle will cause the entire leg to become very stiff., which can lead to foot drag and overall difficulty in swinging the leg forward when walking.  

• Positioning the ankle in a brace/AFO might relax the spasticity in the rest of the leg to make it more functional.  
• For individuals who are less mobile, a standing table can be highly effective. Weight bearing through the legs can be highly effective in relaxing them as well as stretching them. . 
• Strengthening the opposing muscles can be very effective for inhibiting increased tone. 

Medications: Certain types of medications may be considered when stretching and positioning are not sufficient to control spasticity or spasms. There are several oral medications commonly used to improve muscle relaxation. These include baclofen, tizanidine, gabapentin, or diazepam. Ona botulinum toxin A (Botox®) injections into the involved muscles may also be of benefit in some cases.  

In situations when oral medications do not work well enough or cause too much sleepiness, a surgically implanted pump (Intrathecal Baclofen pump) may be an option to deliver baclofen directly into the spinal fluid. With a pump, small doses of baclofen are delivered to the spinal fluid space around the lower spine to impact muscle tightness more directly. Because the medication does not need to go through the gastrointestinal tract, a much lower dosage is needed. 

In addition to the FDA-approved medications, many people with MS try medical cannabis for relief of spasticity. This can be helpful for some but can cause drowsiness and confusion. State laws dictate the legality and access to medical cannabis. 

Management of spasticity is an important part of MS care. Your MS provider, physical therapist, and occupational therapist can work together with you to find the strategies that best help you.