Spasticity is a neurological condition that causes stiff or tight muscles. Faulty brain-to-nerve signals affect your movement and activities.
What is spasticity?
Spasticity is a medical condition that affects the body’s muscles, causing stiffness or tightness for extended periods of time. This condition is caused by a breakdown in how the brain and nervous system relay messages to your muscles.
Spasticity affects more than 12 million people around the world.* It is a common symptom of certain medical conditions, such as cerebral palsy, stroke, and multiple sclerosis. Spasticity symptoms can make everyday tasks difficult due to muscle stiffness. But you don’t need to live with this frustration. There are treatments available that can improve symptoms for many people. At AHN, we can help.
AHN Neuromuscular Program
The AHN Neuromuscular Program is focused on providing our patients with the most comprehensive care that addresses and aims to improve conditions affecting your nerves and muscles. We put you at the center of everything we do. As our patient, your care will focus on focus on:
- Getting the right diagnosis
- Treating you effectively
- Team-based care
Why choose AHN for your spasticity
People with muscle stiffness and pain from spasticity choose AHN because of our:
- Expert team: AHN has some of the nation’s foremost experts in the diagnosis and treatment of movement disorders. Our network includes several physicians who have received special training in spasticity and related conditions. We treat more patients with muscle spasticity than most hospitals in the area. We are committed to helping you find symptom relief and improving your quality of life.
- Wide range of treatment options: We use oral medications and botulinum toxin — Botox®, Dysport®, and Xeomin® — injection therapy to help many people move past muscle rigidity symptoms. For more severe types of spasticity, our neurosurgeons perform a specialized procedure, called intrathecal baclofen pump surgery, which can provide significant relief.
- Customized treatment plans: We develop a thoughtful care plan that addresses your symptoms and challenges. Your treatment plan may include medication, injection therapy, physical therapy, surgery — or a combination of these treatments.
- Long-term follow-up: Many people with muscle spasticity experience challenges with movement for years to come. We stay in regular contact with our patients, helping you maintain your overall health and well-being.
Find us
AHN Neurology
GET DIRECTIONS
Spasticity symptoms and signs
Spasticity can cause different problems that you might feel or that a doctor might notice. It can range from just a little stiffness to painful, strong spasms that make it hard to move. Some common symptoms and signs of spasticity often include:
- Stiff or tight muscles: Your muscles might feel rigid, making it hard to stretch or move them easily.
- Trouble moving: You might find it hard to start movements, or your actions might feel slow and clumsy.
- Sudden muscle spasms: Your muscles can suddenly contract or jerk without you wanting them to, sometimes causing pain.
- Pain or discomfort: The constant muscle tightness or unexpected spasms can lead to aches or pain.
- Difficulty with daily tasks: Everyday activities like walking, dressing, or holding objects might become harder.
- Unusual body posture: Your body might be pulled into odd positions, such as a fisted hand or a bent elbow.
Causes and risk factors
Many neurological issues can cause the muscles to stiffen. Our team evaluates and manages people who have spasticity due to a wide range of conditions, including:
- Traumatic brain injury
- Spinal cord injury
- Stroke
- Multiple sclerosis
- Cerebral palsy
- Dystonia
- Essential tremor
- Parkinson’s disease
Spasticity screening and diagnosis
Screening for spasticity usually includes several steps and diagnostics. Your AHN care team will determine what tests, exams or assessments might be needed to determine if spasticity is present.
Detailed medical history and physical exam
Your doctor will usually begin with a thorough discussion about your medical history. This often includes understanding when your symptoms started, how they affect your daily life, and any past medical conditions like stroke, multiple sclerosis, or spinal cord injury. Your doctor will then perform a physical exam, specifically looking at your muscles and how you move. They will check your muscle tone, reflexes, and how easily your joints can be moved. They'll also observe your posture and gait (how you walk).
Special assessments
Doctors often use specific rating scales (like the Modified Ashworth Scale) to measure the severity of your muscle stiffness and resistance to movement. This helps them measure your spasticity. Then, rehabilitation therapists might assess how spasticity impacts your ability to perform daily activities, such as reaching, grasping, walking, or balancing. This helps tailor treatment to your personal needs and improvement goals.
Ruling out other conditions
While the physical exam can strongly suggest spasticity, doctors might order:
- Imaging scans (MRI, CT scan): Using the images from scans, your care team can look for damage or abnormalities in the brain or spinal cord (e.g., to confirm a stroke, MS lesions, or spinal cord injury).
- Electromyography (EMG) or Nerve Conduction Studies (NCS): These tests measure the electrical activity of muscles and nerves and can help identify nerve damage, though they are less directly used to diagnose spasticity itself, more its underlying cause.
- Other tests: Sometimes additional tests might be needed to confirm the underlying neurological cause or to rule out other conditions that might look similar.
Types and stages of spasticity
Spasticity can vary in its types and severity over time. Understanding both helps doctors and therapists create the most effective treatment plan.
Types of spasticity
The types of spasticity relate to its underlying cause or affected area of the body.
They include:
- Spastic Hemiplegia: This affects one side of your body, like an arm and a leg on the same side.
- Spastic Diplegia: This type mainly impacts both of your legs, causing stiffness and difficulty with movement.
- Spastic Quadriplegia: This means spasticity is present in all four of your limbs (both arms and both legs).
- Spastic Dysarthria: This makes it hard to speak clearly because the muscles used for talking (like your lips, tongue, and jaw) are stiff and weak.
- Spastic Paraplegia: This refers to spasticity primarily affecting both of your legs.
- Spastic Dysphonia: This causes your voice to sound strained or broken due to involuntary muscle spasms in your voice box when you speak.
Measuring spasticity stages
Spasticity is typically measured using clinical scales that assess muscle tone and resistance to movement. The most common is the Modified Ashworth Scale (MAS), which scores spasticity from 0 to 4:
- Grade 0 (no increase in muscle tone): This means there is no spasticity.
- Grade 1 (slight increase in tone, catch and release): A slight feeling of resistance when a limb is quickly moved, but it quickly relaxes.
- Grade 1+ (slight increase in tone, catch followed by minimal resistance): A slight catch, followed by continued, but mild, resistance through less than half of the limb's range of motion.
- Grade 2 (more marked increase in tone, through most of range): A noticeable increase in muscle tone throughout most of the range of motion, but the limb can still be easily moved.
- Grade 3 (considerable increase in tone, passive movement difficult): The muscle tone is significantly increased, making it hard to move the limb passively.
- Grade 4 (limb rigid in flexion or extension): The limb is stiff and cannot be moved (rigid).
Spasticity treatment
Managing spasticity involves a personalized approach tailored to your specific symptoms and needs. The goal of treatment is to reduce muscle stiffness, relieve pain, improve movement, and enhance your quality of life. Treatment options range from nonsurgical therapies to surgical interventions.
Nonsurgical treatment options for spasticity
Many people find significant relief through a combination of nonsurgical treatments:
- Physical and occupational therapy (PT/OT): The focus is on improving strength, flexibility, balance, and coordination through exercises, stretching, and gait training. OT helps you adapt and regain skills for daily activities, such as dressing, eating, and hygiene, by using adaptive equipment or modifying tasks.
- Assistive devices: Tools like braces, splints, or casts can help support affected limbs, prevent contractures (permanent tightening of muscles), and improve posture and walking. Walkers or wheelchairs can also provide mobility support.
- Oral medications: Muscle relaxants like Baclofen, Tizanidine, and Diazepam can help reduce overall muscle tone throughout the body. These medications are taken by mouth and can be effective for widespread spasticity, but they may cause side effects like drowsiness.
- Injectable medications: Botulinum toxin (Botox) injections are very effective for treating spasticity in specific muscles or muscle groups. The medication is injected directly into the overactive muscle, blocking the nerve signals that cause muscle contractions. The effects typically last for several months.
- Intrathecal baclofen pump (ITB): For severe spasticity that affects many muscles and doesn't respond well to oral medications, a small pump can be surgically placed under the skin of your abdomen. This pump delivers liquid Baclofen directly into the fluid surrounding your spinal cord (the intrathecal space), providing targeted and continuous relief with fewer systemic side effects compared to oral Baclofen.
Surgical treatment options for spasticity
When nonsurgical approaches are not enough, surgical options may be considered to provide more lasting relief:
- Selective Dorsal Rhizotomy (SDR): This procedure is primarily used for severe spasticity in the legs, often in children with cerebral palsy. During SDR, a surgeon carefully identifies and cuts specific sensory nerve roots in the spinal cord that are sending abnormal signals to the muscles, thereby reducing spasticity without significantly affecting motor function.
- Intrathecal baclofen pump implantation: As mentioned above, this involves surgically placing a pump that delivers medication directly to the spinal cord. It's considered a surgical option because it requires an implant.
Spasticity FAQs
Given the broad scope of conditions that spasticity encompasses, questions are common and expected. Your AHN care team wants to be your personal resource so you can get your questions answered and feel more confident in your care plan. To help you get started, we’ve included some of our patients’ most frequently asked questions. Many find these to be helpful in guiding conversations with their healthcare providers.
What causes spastic movements?
Spastic movements are a common symptom across a range of neurological conditions that affect the brain and spinal cord. Some of the most prominent diseases that cause spasticity include:
- Cerebral palsy (CP): This is a group of disorders that affect a person's ability to move and maintain balance and posture. It's caused by abnormal brain development or damage to the developing brain. Spastic cerebral palsy, the most common type, is characterized by increased muscle tone and spasticity.
- Multiple sclerosis (MS): An autoimmune disease that affects the brain and spinal cord, leading to a variety of symptoms including spasticity due to damage to the myelin sheath that covers nerve fibers.
- Stroke: Damage to the brain from a stroke can disrupt the signals that control muscle movement, oft
- Spinal cord injury (SCI): Damage to the spinal cord can interrupt the communication between the brain and muscles, resulting in spasticity below the level of the injury.
- Traumatic brain injury (TBI): Similar to stroke, brain damage from a TBI can cause spasticity.
- Amyotrophic lateral sclerosis (ALS): While primarily characterized by muscle weakness, some individuals with ALS can experience spasticity as the motor neurons degenerate.
- Hereditary spastic paraplegia (HSP): A group of inherited neurological disorders that cause progressive weakness and stiffness (spasticity) in the leg muscles.
- Adrenoleukodystrophy (ALD): A genetic disease that damages the myelin sheath of the brain and spinal cord, often leading to spasticity.
What happens if spasticity is left untreated?
Leaving spasticity untreated can lead to a number of significant and often debilitating complications, impacting a person's quality of life and physical function. These can include:
- Contractures: Persistent muscle stiffness can cause muscles and tendons to shorten permanently, leading to fixed joints (contractures). This can severely limit range of motion and make daily activities very difficult.
- Pain: Chronic muscle spasms and stiffness can be very painful, leading to discomfort and reduced participation in activities.
- Impaired mobility: Untreated spasticity can make it challenging to walk, stand, sit, and even move limbs voluntarily, significantly impacting independence.
- Pressure sores: Limited mobility and altered positioning due to spasticity can increase the risk of developing pressure sores (decubitus ulcers).
- Bone and joint deformities: Over time, spasticity can pull joints out of alignment and contribute to bone deformities, especially in growing children.
- Difficulty with hygiene and dressing: The inability to fully extend or bend limbs can make personal care tasks like bathing, dressing, and toileting extremely challenging.
- Sleep disturbances: Muscle spasms and discomfort, particularly at night, can disrupt sleep patterns and lead to fatigue.
- Caregiver burden: For individuals requiring assistance, untreated spasticity can increase the physical and emotional demands on caregivers.
- Functional limitations: Overall, untreated spasticity can severely limit a person's ability to perform activities of daily living (ADLs) and participate in social and recreational activities.
What causes muscle spasticity?
Muscle spasticity is caused by damage to the central nervous system (brain or spinal cord) pathways that control voluntary movement. Normally, nerve signals travel from the brain, down the spinal cord, to the muscles, instructing them to contract or relax. There are also inhibitory signals that help regulate muscle tone and prevent overactivity.
When there's damage to these pathways, particularly the upper motor neurons, the balance between excitatory and inhibitory signals gets disrupted. This disruption leads to an overactive stretch reflex. Essentially, the muscles become overly sensitive to stretching, causing them to contract involuntarily and continuously. Common causes of this central nervous system damage include:
- Stroke: Brain tissue damage from a lack of blood flow or bleeding.
- Spinal cord injury: Trauma to the spinal cord that disrupts nerve signals.
- Multiple sclerosis: Demyelination (damage to the protective covering of nerve fibers) in the brain and spinal cord.
- Cerebral palsy: Brain damage that occurs before or during birth, or in early childhood. • Traumatic brain injury: Injury to the brain from an external force.
- Certain neurodegenerative diseases: Conditions like Amyotrophic Lateral Sclerosis (ALS) can affect motor neurons.
- Infections and inflammation: Brain or spinal cord infections (e.g., meningitis, encephalitis) or inflammatory conditions can also lead to damage.
- Lack of oxygen to the brain (hypoxia): Can cause brain damage and lead to spasticity.
Is muscle spasticity serious?
Yes, muscle spasticity can be very serious and significantly impact a person's life, depending on its severity and the underlying cause. While mild spasticity might cause only minor stiffness or discomfort, moderate to severe spasticity can lead to a range of debilitating issues. Here's why it's considered serious:
- Significant functional impairment: Spasticity can severely limit a person's ability to move, walk, dress, eat, and perform other activities of daily living, leading to a loss of independence.
- Pain and discomfort: Chronic muscle contractions and spasms can be intensely painful and disruptive.
- Development of contractures: If untreated, persistent spasticity can cause muscles and tendons to shorten permanently, leading to fixed joints (contractures) that can make movement impossible and require surgical intervention.
- Bone and joint deformities: Especially in children, spasticity can lead to the abnormal development of bones and joints, causing deformities.
- Increased risk of falls: Impaired balance and uncontrolled muscle movements can increase the risk of falls and subsequent injuries.
- Pressure sores: Limited mobility due to spasticity can lead to the development of pressure sores.
- Impact on sleep and quality of life: Spasms can disrupt sleep, and the overall physical and emotional burden of spasticity can significantly reduce a person's quality of life.
Therefore, while the seriousness varies from person to person, spasticity is generally considered a serious condition that often requires ongoing medical management and therapies to mitigate its effects and improve a person's function and well-being.
Contact us
To schedule an appointment for the first time or learn more about services at the AHN Neurology Clinic, call 412-359-8850. If you are in Erie, please call 814-452-7575.
If you're an existing patient, you can also call (412) DOCTORS 412-362-8677 in Pittsburgh or request an appointment with AHN neuroscience services.