How to Manage Spasticity After Spinal Cord Injury

Spasticity happens when muscles continuously contract, causing tightness or stiffness.

It can affect:

• One muscle.
• A group of muscles.
• Movement.
• Speech.
• Walking.

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What Causes Spasticity in People with a Spinal Cord Injury (SCI)?

An SCI disrupts the normal flow of signals from the nerves of the spinal cord to the brain.

Since these signals help control muscle reflexes, disruption can cause a person with SCI to jerk, contract, or stiffen.

As many as 78% of people with SCIs have some degree of spasticity. It's more common with neck injuries than with chest or lower back injuries.

In people with SCIs, spasticity often affects places on the body that receive nerve signals below the level of injury.

For instance, spasticity may affect:

• The arms, trunk, and legs in a person with a C5 injury.
• Only the trunk and legs in a person with a T5 injury.

Learn more about levels of spinal cord injury.

What are the long- and short-term effects of spasticity in SCI?

Some spasticity can be helpful, especially when standing or transferring into and out of a wheelchair.

But it can cause problems too, such as:

• Falling out of your wheelchair or having problems transferring or driving.
• Sleeping poorly because muscle spasms keep you awake.
• Having a harder time with daily tasks, like eating or dressing.
• Losing some range of motion in your joints.

Over time, spasticity may decrease or be less of an issue for people with SCI.

This is often due to:

• Practice. You learn what triggers spasticity and make changes.
• Age. The aging process slows down nerve conductivity. This lessens how many signals get sent and rerouted.

Spasticity Symptoms

Spasticity can range from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms.

Other symptoms include:

• Increased muscle tone.
• Hyperactive reflexes.
• Clonus — a series of fast muscle contractions that cause movement.

What are spasticity symptoms from spinal cord injury?

Spasticity symptoms after SCI vary, but may include:

• Involuntary bending or straightening of an arm or leg.
• Muscle groups jerking, often in the chest, stomach, or back. This can also affect muscles in bladder or rectum.
• Spasms that happen after only a light touch, because of overactive reflexes.
• Muscles that feel stiff and resist relaxing or stretching.
• Trouble controlling muscles during activity because they randomly tighten.

Spasticity Treatments

The first step to treat spasticity is to look for a noxious stimulus — something bad or foreign to the body — such as:

• A urinary tract infection.
• Constipation.
• A pressure ulcer.

These can cause an increase in spasticity.

If there's a clear cause, doctors will treat that cause. If there's no clear cause, doctors will treat the spasticity directly.

What treatments can help spasticity in people with spinal cord injuries?

Maintaining flexibility can help reduce spasticity and prevent losing range of motion. Stretching at least twice daily can help reduce muscle stiffness.

People with SCI often work with a physical therapist, who can provide stretches and instruction.

Splints and braces also help. They can continuously stretch a muscle, so that it doesn't lose flexibility.

Medicine to treat spasticity

Stretching, splints, braces, and ice can only do much to help spasticity.

A spinal cord injury expert may need to prescribe medicine.

Oral drugs

First-line medications include Lioresal (baclofen) or Zanaflex (tizanidine).

Your doctor will start by prescribing a low dose and then gradually adjust based on your body's response.

Side effects of oral drugs to treat spasticity include:

• Drowsiness.
• Dizziness.
• Nausea, vomiting, or other types of belly discomfort.

Never stop taking your medicine without talking to your spine doctor.

BOTOX^® shots

Your doctor may suggest botulinum toxin (BOTOX) shots if the spasticity affects only one part of the body.

These shots block the nerve signals by paralyzing the muscle to help stop painful contractions.

A doctor trained in BOTOX shots to treat spasticity will:

• Use electromyography (EMG) to guide the shots to the proper muscle.
• Use a needle that can detect specific points of muscle hyperactivity.
• Inject only in the areas that are hyperactive.

Medication pump to treat spasticity

A pump may help some people since medicine gets directly to the spine — the source of their pain and spasms.

Through a small surgery, doctors place this pump near the abdomen. Via an attached catheter, the pump sends Lioresal (baclofen) — a muscle relaxer and anti-spasm drug — to the spinal cord.

A pump often works better than taking oral drugs because it delivers a steady dose of medication. It also has fewer and milder side effects.

Meet UPMC's Spasticity Experts

• Jessica Berry, MD
• Kevin Franzese, DO
• Gary Galang, MD
• Amanda Harrington, MD
• Natasa Miljkovic, MD, PhD
• Michael Munin, MD