Medical Features

Spasticity and the Stroke Survivor

Post on 28/02/17

 

One in three stroke survivors will experience stiffening of the muscles, a condition known as spasticity. Physiotherapist Jane Gee weighs in on what can help.


Patient with elbow ache has rehabilitation in physiotherapy clinic

Spasticity is a condition that can affect physical coordination and muscle movement, leading to difficulties with daily activities such as eating, dressing, walking and bathing.

The condition occurs when there is a change in the tone in your muscles.  If your stroke damages the part of the brain that controls movement of muscles, the messages between your brain and muscles will be disrupted. This means the body goes in to a form of “safety mode”, meaning the affected muscles are told to stiffen or spasm to protect the limb so your muscles do not get overstretched or torn. It can affect either your arm or your leg or both together. In your arm, it will often affect the muscles that bend your arm in towards your body. And in your leg, it will affect the muscles that straighten your leg and turn it out. It always occurs on the weaker side of your body and makes it difficult for you to move your body. If spasticity is not addressed properly the affected muscles can shorten, causing contractures.

So, what are your options?

Stretches and Exercises

It is important to keep your body moving to maintain your suppleness and prevent it from stiffening up. By stretching your muscles gently, a qualified health professional will place your affected limb into as many different positions as possible. This is called passive stretching and should be taught to your family and caregivers so that they can help you to practise your exercises.

Using massage and fully supporting your arm or leg when not in use can relax the tone and prevent contractures from developing. By repositioning and using your affected limb arm as much as possible your brain re-wires and the messages between your muscles and your brains improve making new connections.

Is it right for me? It depends on how spasticity affects you; how has it affected your function, and have you developed any contractures. Ultimately the aim is for easier and more efficient movement to allow you to be more independent during your daily activities of living. Some people use the spasicity, especially in their leg, to their advantage as it helps them to be more stable when walking. A Physiotherapist can advise on the right exercises, stretches and management for you.

How do I find out more? Contact your doctor or hospital to ask how you can access Physiotherapy.

Botox Injections

Botox (botulinum toxin A) injections are sometimes used if spasticity affects only one or two specific parts of your body. Botox works by blocking the action of the nerves on the muscle, reducing your muscle’s ability to tighten. It reduces your muscle tone, which can help you to straighten your arm or bend your leg. The muscle-relaxing effects of Botox usually last for about three months and you should not notice any changes in sensation in your muscles. Commonly, it is recommended that you participate in intensive physiotherapy after the injection to increase the potential of treatment.

Is it right for me? To qualify for this treatment you need to be assessed by a registered and qualified professional. The injection is delivered by a neurological consultant. There are, however, side effects of this treatment which would need to be discussed. For example, it can cause pain and/or temporary partial waekening of the muscle which would need to be planned for and managed. You should be assessed three to four months after the treatment to determine if further Botox treatments are helpful.

How do I find out more? Your GP may refer you to a Physiotherapy team or neurological consultant for specialist assessment.

Medications

If you experience significant limitations in your physical functions because of muscle spasms, or you have pain that accompanies muscles spasms you may be prescribed medications. There are different types of drugs that you could be given. They all work in slightly different ways, but they all help to relax your muscles. When your muscles are relaxed they can move more easily and you can stretch them further. You may also find that it becomes easier to straighten or bend your affected limbs, and you may notice fewer muscle spasms.

Is it right for me? These medications can be used short term while you stretch and strengthen your muscles or may be needed longterm to maintain the benefits. A qualified health professional can discuss the options with you and help you become aware of the benefits and side affects of these options. It is important that you are closely monitored when starting these medications, because they can also relax other muscles in your body (not just the ones affected by spasticity) and compromise your posture and function. 

How I can find out more? Contact your GP to discuss options and an onward referral if required.


As a teenager, Jane watched a close family member recover following a stroke. She developed a keen interest in supporting others to regain their full potential after a life-changing event such as a neurological diagnosis. On obtaining her physiotherapy degree in Scotland, she decided to specialise in Neurological Physiotherapy in Surrey and Central London. Jane has worked with a wide variety of clients from the sub-acute, rehabilitation and maintenance phases post-stroke. She has further qualifications in the Bobath Method and APPI clinical pilates. Jane is a UK registered Physiotherapist.

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