It is very common for people with MS to experience “tightness” or stiffness in their muscles. Some people notice this stiffness more in the morning before their muscles warm up. Stiffness may be caused by a decrease in flexibility when activity levels decrease, or it may be due to spasticity, a neurological effect. If one becomes inactive due to extreme fatigue, a sedentary lifestyle, or pain related to limited movement, stiffness may occur.
MS-related spasticity occurs when there is an injury to the central nervous system. The injury results in abnormal messages being sent to the muscles which creates an increase in “tone” or muscle tightness. Everyone needs some muscle tone to maintain an erect posture and conduct daily activities; spasticity occurs when people have abnormally high tone which may interfere with movement. Generally the legs are more affected by spasticity than the arms or other muscles, and sometimes patients experience one side of their body being more affected than the other. Spasticity is often triggered by rapid movements and can be quite painful. Spasticity can also create difficulties with moving or walking and can contribute to foot drop, where an individual cannot flex the foot sufficiently to clear the toe while walking. Severe untreated spasticity can lead to contractures (restriction of movement in joints), skin breakdown, and pain. Therefore, spasticity should be treated aggressively. Spasms are strong muscle contractions that tend to be painful although brief.
Approximately 70% of people with multiple sclerosis (MS) experience difficulty due to spasticity. The legs are generally more affected than other muscles and patients may experience spasticity greater on one side of the body than the other. Signs of spasticity include stiffness, tightness or involuntary muscle spasms. Spasticity can make mobility difficult, interrupt sleep, as well as be uncomfortable and painful. Severe spasticity left untreated can lead to restriction of movement in the joints, pain and skin breakdown which may lead to pressure ulcers and infection. The overall result is a significant reduction in quality of life.
Fortunately, there are treatments available for the management of spasticity. These include physical therapy and drug therapy. There are several drugs that are approved for the treatment of spasticity.
For muscle and joint stiffness and mild spasticity, a physical therapist can design an exercise program to increase flexibility, activity level, and overall fitness. A stretching or range of motion program is also prescribed as an adjunct to medical management and may help to reduce the requirement for medications.
When spasticity and/or spasms cause discomfort or interfere with daily activities, there are several prescription medications available. For severe spasticity affecting function in a single joint or limb, nerve blocks may be considered in addition to medications. When medication options are not enough or if there are side effects preventing increasing doses, surgical implantation of a pump to deliver medication directly to the spinal cord may be an option. When there is complete loss of voluntary function such as paraplegia but with presence of spasticity causing chronic pain, joint contractures, and skin breakdown, other surgical procedures are considered.