Multiple Sclerosis and Spasticity

Controlling Mild Spasticity

It is important to address problems with spasticity, as it can eventually lead to muscle shortening as well as posture and joint troubles. The best management methods are concerned with prevention, using stress management and gentle exercise. Other tools include physical therapy aids and medication.

You should involve your family, carer and health professionals in your treatment, as a team approach can provide both physical and motivational support.

Stress management

Mental and emotional stress can increase muscle tension and contribute to spasticity, so it is important to include stress management in your programme of spasticity control.

Some good ideas for managing stress include:

• yoga and relaxation classes;
• relaxed swimming;
• careful massage; and
• social and leisure activities.

Your local MS Society can help you arrange these.

Also, it is crucially important that you contact your Field Worker, your GP, or a psychologist if stress from family or financial pressures, or the challenges of living with MS, become overwhelming. Help is available.

Spasticity may be triggered by contraction of only one muscle, but relaxing the whole muscle group by slow, sustained stretching will ease the tightness. It is also good to use deliberate body positioning to prevent spasticity.

There are other activities that can help relax tight muscles, such as horse riding, swimming, massage and acupuncture.

Always talk to your doctor or a physiotherapist before starting any exercise programme. Don’t overdo it when exercising, particularly at first. One of the symptoms of MS is decreased endurance with early fatigue. Usually 3-5 repetitions of a given exercise are an effective number. Gradually increase the number as you feel able. Progress may be slow, but persevere—try to set yourself realistic exercise goals. Be prepared to rest after your exercise time.

Note: Some health professionals suggest ice packs or splinting for spasticity. However, you should be very careful as they can increase muscle tension, and the ice packs can damage your skin.

Stretching to control spasticity

Before starting any strengthening exercises, you should do some stretching:

• Slowly and gently, because any quick stretch could actually increase the spastic reaction. If stretching triggers spasms, either ease off the stretch slightly until it is comfortable again, or stop completely.
• Regularly, because left alone a spastic reaction shortens the muscle fibres, so spasms are then more easily triggered.

(a) Standing against a wall or chair, place one foot behind the other. With your front knee bent slightly, keep your back leg straight and your heel down. Lean your hips forward until you feel a stretch in your calf (Figure 1). Repeat with the other leg.

(b) Sit on the front of a chair or bench. Place your legs fairly wide apart, with your knees bent and feet flat on the floor, pointing in the same direction as your knees. Place your hands against your lower thighs near the knees. Lean gently forward, while pushing your thighs apart (Figure 2).

(c) Lying on your back, lift both knees to your chest. Wrap your arms around your legs just below your knees. Pull your knees to your chest while pushing your tailbone towards the ground (Figure 3).

 

Stretching with a helper

(d) Lie on your back while a helper bends your knee towards the body, making sure your knee does not turn outwards throughout the movement. Then move the leg back (Figure 4). Repeat with the other leg.

(e) With legs together and straight, have a helper move one leg apart, then back to the starting position (Figure 5).  Repeat with the other leg.

Strengthening exercises

You should consult with your doctor and physiotherapist to ensure these exercises are within your physical capabilities and can be performed safely. Take care not to push yourself too hard and pace yourself to avoid fatigue.

These exercises are suitable whether you are mobile or spend much of the day sitting. They are best performed once the muscles have warmed up and before any fatigue sets in, i.e. mid-morning.

Repeat each exercise five times to begin with and gradually increase the number, as you feel able:

(a)Sit, stand or lie with a one metre loop of wide elastic around knees (or ankles for a stronger exercise). Pull your legs apart against the resistance (Figures 6a and 6b).

(b) Sit with legs apart. Lift toes, then whole foot off the ground, one leg at a time. If this movement is very weak, give yourself some assistance with your hands. Try to hold your back straight and your stomach in. (Figure 7.)

(c) Sit with knees apart. Try to gently kick the underside of the seat, then straighten your knee out. (Figures 8a and 8b.)

(d) Hold the elastic band and use it like a chest expander. (Figures 9a and 9b.) Keep your knees apart with a pillow, as this will reduce the spastic reaction of stretching above your head.

Some suggestions for comfortable positions throughout the day:

Comfortable positions that oppose common spasticity patterns, and that can be held for one hour or more, can be beneficial. These include:

• Sleeping on your side with hips and knees slightly bent and a pillow between your knees to stretch inner thighs.
• Sitting with pillow/padding between your knees.
• Pillows or padding to keep legs slightly bent at hips and knees, legs apart, and your feet supported with a pillow, rather than a hard board. (Figure 10.)
• Lying on your stomach with small pillows under feet, to relax knee joints. A fully straightened knee is often too uncomfortable to maintain, especially as the quadricep muscles at the front of the thigh are usually a major trigger in leg spasticity. (Figure 11.)

Physical therapy aids

Some adaptive devices are available to assist your gait, posture and movements. A consultation with a physiotherapist, or an occupational therapist can be useful.

For example, they may suggest orthotics - which are lightweight shoe inserts used to position a spastic foot correctly. Additionally, orthotics can reduce fatigue and increase walking stability.

Medication

There are several drugs that can be valuable in controlling spasticity, but these drugs affect all the muscles of the body, not just the tight ones. The results can be increased weakness and fatigue.

Therefore, reducing the spasticity must be traded against other physical weakness and increasing your problems with standing, transferring from bed, chair, toilet, etc.

Your GP or neurologist will be able to discuss your options in appropriate detail.