Spasticity (high muscle tone)

Spasticity can occur alongside several different conditions, but it is common after stroke.

It happens when there is damage to the part of your brain that controls movement (the cerebral cortex) or the part of your brain that connects to the spinal cord (the brainstem). This damage causes a breakdown in communication between the brain, your muscles, and the nerves that move your muscles. This can result in muscles contracting when they want to relax).

Spasticity in your hand and arm can cause difficulty opening your hand, reaching for something up high or cleaning under your arm. This tightness and weakness in your muscles can also cause difficulty walking and you may struggle with taking a step. Spasticity can result in pain and, at times, can lead to contracture. If spasticity is left untreated contracture is more likely to be a problem for you. Other examples of problems caused by spasticity include:

• wrist and fingers bent, nails pressing into the palm of the hand
• being unable to straighten your elbow
• tightness in the muscles around the shoulder
• your arm moving up and away from your body when you walk
• difficulty bending or straightening the knee foot turning in and pointing down when walking
• shaking at the foot (clonus)
• toes clawing
• pain and muscle spasm when you move
• muscle tiredness

Spasticity (high muscle tone)

Treatment often depends on how severe the spasticity is and how it is affecting your day to day activities.

There is no one solution to treatment of spasticity. Your healthcare provider will work with you to find out what works best for you. Recovery takes time – slow, steady progress is best.

Physiotherapy and occupational therapy are often the first line of treatment for spasticity. Your physiotherapist and occupational therapist will work on controlling your movement, building your strength and repeatedly practising daily tasks. They may also teach a family member or carer to help position your arm or leg to prevent it getting tight and teach ways to help you move that prevent pain. They may advise using a splint and exercises to stretch the affected limb.

Exercise and being active can help reduce pain from spasticity and keep your muscles from tightening. Talk to your physiotherapist or occupational therapist about the types of exercise you enjoy and what might be most suited to you.

Getting into good positions is important (in lying and sitting) to support yourself and reduce as far as possible the changes in muscle caused by inactivity and altered muscle tone. Your physiotherapist can show you the correct positions to use to support your limbs and body.

The below diagrams provide details of the correct positions to use when sitting and lying down. It is important to support the arm and hand on a pillow. Keep your hand opened flat against the pillow, as show in the diagrams below.

If your spasticity is severe you may require medication to help manage pain and discomfort, and improve function. Your doctor can discuss medication options with you. Options may include:

• Botulinum toxin is a medicine that is injected into the muscles to reduce muscle tightness. It is injected every 3-4 months by a specialist health care professional and targets specific muscles that are tight and causing problems with function, pain or caring for the involved limb.
• Muscle relaxant medications can help with relaxing nerves and muscles.

Finally, if your spasticity has caused your muscles to become fixed in one position and is causing you a lot of problems, you may need to be referred to a spasticity clinic, a physiotherapist or an occupational therapist.

Spasticity (high muscle tone)

When considering what exercises may help your spasticity, it’s important that you consult a physiotherapist or occupational therapist for advice.

Here are some helpful tips for getting started:

• Exercise should not be painful. Pain can cause spasticity to get worse.
• Exercises that lengthen the spastic muscles are beneficial.
• Exercising in a swimming pool can combine the benefits of warm water to relax the muscles and allow gentle movement.
• Cycling on an exercise bicycle at a low gear without much resistance may help to stretch and keep the legs active.
• Don’t move too fast – if the muscle is very sensitive to stretching, fast movement may cause a spasm.
• Be mindful of triggers such as a pain, infection, lack of sleep, excessive heat and stress – these can often make spasms or spasticity worse.

Spasticity (high muscle tone)

People living with spasticity, often experience pain or discomfort, difficulty caring for their affected limb and difficulty with day to day function.

Mary describes her symptoms below:

“My fingers curl into a fist and at times it can be really hard to open my hand. I notice, especially in the morning, that I can have nail marks on my palm because my hand has been clenched so tight when I was asleep. I really have to make sure my fingernails are short so they don’t hurt me. This can make it difficult to reach for a door knob to open or to wash my hair with an open hand. I have found my hand is more relaxed since wearing a splint at night and if I do my stretching exercises every day.”

Tom describes how spasticity affects him:

“A few months after my stroke when my walking improved I noticed that my toes began to claw causing pain and pressure that was slowing me down. I discussed it with my physiotherapist and doctor and was given stretches and advice on exercise. This helped a little but my walking was still difficult so my doctor suggested a trial of botulinum toxin injections. This really helped relax the muscles and I was able to build my endurance and become fitter and stronger when walking. The medicine wears off after about three months and I have to go back and get the injections again. I don’t mind as anything that helps my walking is worth it.”

Spasticity (high muscle tone)

If you are concerned that you are developing spasticity, contact your doctor or healthcare provider for advice and support.

Spasticity (high muscle tone)

The Irish Society of Chartered Physiotherapists has a register of physiotherapists that can be contacted for the treatment of neurological disorders and further information on the role of the physiotherapist. See www.iscp.ie

The Association of Irish Occupational Therapists can offer similar information on finding an Occupational Therapist. See www.AOTI.ie

The Irish Heart Foundation has lots of information and advice on stroke. We also offer support via local stroke support groups. See www.irishheart.ie

Spasticity (high muscle tone)

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