Spasticity and Stiffness as a Symptom of Multiple Sclerosis

Spasticity can slow us down, or stop us in our tracks

Muscle Stiffness and MS
Credit: Feliz Aggelos Collection/Photodisc/Getty Images

Spasticity is best understood as an increase in muscle tone. While that may sound good to the flabby among us, what it really means is that the muscles do not relax as much or as easily as they should. Because of this, spasticity affects movement, making it a motor symptom, as opposed to a sensory symptom.

What Does Spasticity Feel Like?

Spasticity tends to occur more often in the legs than in the arms.

It also tends to be asymmetrical, meaning it is worse or happens more often on one side of the body than the other.

There are few terms used to describe spasticity in people with multiple sclerosis (MS):

Extensor Spasms occur when a limb, usually a leg, stiffens and the person is unable to bend the joint. These cause the limb, usually a leg, to jerk away from the body. It usually affects the quadriceps—the large muscles on the front of the thigh—causing the lower leg to straighten. Spasms of the adductor muscles (located on the inside of the upper leg) are rarer but can cause a person’s legs to close together tightly, making it difficult to separate them.

Flexor Spasms cause a limb to contract, or bend, toward the body. This type of spasm almost always affects the legs, especially the hamstrings or hip flexors.

Clonus is when muscles jerk or twitch repeatedly. The most common forms of clonus are when a person’s foot taps rapidly and repetitively on the floor, or when a person's knee or ankle jerks repeatedly after stimulation (such as tapping at the joint), rather than the normal response of one tap or jerk.

Stiffness can be thought of as mild spasticity. While not as dramatic as some of the spasms described above, when muscles are slow to relax, it can cause problems walking or using the hands and fingers to perform delicate movements. In some cases, the stiffness may not pose a huge problem. In other cases, it can cause problems with mobility or be painful enough to interfere with daily life.

How Common is Spasticity in MS?

Most experts estimate that the majority of people with MS experience some degree of spasticity at some point. Even more, some research indicates that up to one-third of people with multiple sclerosis alter their daily activities because of spasticity.

What Causes Spasticity?

Like most other MS symptoms, spasticity is primarily caused by demyelination. Because of slow or interrupted nerve impulses, the muscles may do three things: not relax as quickly as they should, tighten involuntarily, or stay contracted for long periods of time or constantly.

Several things will aggravate spasticity, acting as a “trigger” for spasms. These triggers include:

  • Infections, such as respiratory, urinary tract or bladder infections
  • Pain
  • Sores or skin breakdown
  • An increase in internal temperature (for example, because of a fever or excessive exercise)
  • A full bladder
  • Binding, rubbing or otherwise irritating clothes
  • Constipation
  • Problems with posture
  • Stress, worry, or anxiety
  • Extreme environmental temperatures

How Severe Can Spasticity Get?

For many people, spasticity can be an annoyance or a passing problem that hinders smooth walking one day but is absent the next. It may just be that walking quickly or climbing stairs is harder than it was previously.

Others may actually benefit from mild spasticity or stiffness, as it can counteract some degree of muscle weakness and make it easier to stand—an interesting concept. 

That said, for some people, severe forms of spasticity or stiffness can cause a problem with mobility, as walking becomes difficult or impossible. For example, some spasms can be aggravated when moving from the bed into a wheelchair which makes getting up in the morning a tedious task.

In addition, some extensor spasms can be so sudden and strong that the person can fall out of a chair or bed. Flexor spasms can cause limbs to be held in painful positions and lead to secondary joint pain.

How Can Spasticity Be Treated?

There are many different treatments for spasticity, depending on the type of spasm, the severity, and its responsiveness to medication. However, the first thing to try is eliminating some of the triggers mentioned above to see if that helps, especially if the spasms seem to occur in particular situations.

Once you have done that, discuss with your doctor possible ways to manage it. The main treatments or management approaches of spasticity include:

  • Physical therapy in the form of stretching, either passively—someone stretches your limbs for you, or actively— you try to stretch your muscles, or hydrotherapy (exercising in water)
  • Use of mechanical aids, such as braces.
  • Oral medications, which include Baclofen, Zanaflex (tizanidine), and benzodiazepines (the type of drug depends on the location, type, and severity of the spasms)
  • Intrathecal baclofen, which is an implanted pump injecting the drug into space in the spinal column containing the cerebrospinal fluid
  • Botox injections
  • Surgery in which nerves are severed—this is used in the most severe cases.

Many people experiencing spasticity try different complementary and alternative methods to relieve it, including yoga, reflexology, biofeedback, massage, Tai Chi and others. While there is limited scientific evidence to back up their use, some people find it helpful—and these therapies may have other feel good benefits as well.

Finally, oral cannabis or an oral spray derived from cannabis (called Sativex) may be used to treat spasticity—note that Sativex is not currently approved in the United States.

A Word From Verywell

When managing your spasticity, try your best to keep moving, stretching, avoiding certain triggers, and engaging in therapies like physical therapy or hydrotherapy. Be sure to treat your mind too—let your doctor know how your spasticity is affecting your quality of life (if it is) and address that as well. 

Sources:

National MS Society. (2017). Spasticity.

 

Novotna A et al. A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols * (Sativex(®) ), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis. Eur J Neurol. 2011 Sep;18(9):1122-31.

Olek MJ, Narayan RN, Frohman EM, Frohman TC. (October 2016). Symptom management of multiple sclerosis in adults. In: UpToDate, González-Scarano (Ed), UpToDate, Waltham, MA.

Olek MJ, Narayan RN, Frohman EM, Frohman TC. (May 2016). Clinical features of multiple sclerosis in adults. In: UpToDate, González-Scarano (Ed), UpToDate, Waltham, MA.

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