Spasticity: what it is, symptoms, causes and treatment

UCLH's National Hospital for Neurology and Neurosurgery describes spasticity as involuntary muscle stiffness. It can range from mild to severe and change over time. Symptoms can be unpleasant, but spasticity can sometimes be helpful: if someone's legs are very weak, the stiffness may actually help in transferring from bed to chair or even in walking.

The MS Trust says spasticity makes muscles feel tight and stiff, while spasms cause parts of the body to suddenly arc, bend, clamp together or kick out. Health professionals describe spasticity as an increase in muscle tone, which is the resistance felt when trying to move or stretch an arm or leg.

UCLH explains that nerve pathways connecting the brain, spinal cord and muscles work together to coordinate movement. These pathways can be disrupted in neurological conditions such as stroke, multiple sclerosis, and head or spinal cord injury, leading to loss of this coordination and overactivity of muscles, causing spasticity.

The MS Trust explains that in MS, damage interrupts nerve signals travelling to and from the central nervous system, so stretch reflexes become excessive, the muscles become hyperactive and tension increases. It says research suggests at least two thirds of people with MS will experience some degree of spasticity, and up to nine out of 10 at the highest estimate.

UCLH says the main feature of spasticity is stiffness or increased resistance when attempting to move a limb or joint. Other associated features include spasms, pain, weakness and clonus. The MS Trust says people often say that spasticity makes their muscles feel stiff, heavy and difficult to move and bend, with movements slower, and some liken it to wading through treacle.

UCLH says spasticity and its associated features can affect all aspects of daily life, including how you walk, transfer, sit in a chair, turn over in bed, carry out personal care, sexual activities, and your overall comfort and mood. Persistent spasticity can lead to poor postures in lying and sitting, which can lead to pain, pressure sores or contractures. UCLH stresses there are many steps you can take to minimise the impact.

UCLH and the MS Trust both say spasticity is easily aggravated. If it is becoming harder to manage, review these triggers first, as resolving them may help without needing to increase medicine.

• Urinary retention or urinary tract infection, constipation or bowel problems.

• Red or broken skin and pressure areas.

• Pain and infection, such as an ingrown toenail.

• Poor positioning when sitting, lying and standing.

• Tight-fitting clothes or splints that rub or cause irritation.

• Being too hot or cold, and other MS symptoms (MS Trust).

The MS Trust says treating spasticity includes a mix of self-management, physiotherapy, occupational therapy, medication and other specialist services. Regular exercise helps reduce spasticity, spasms and the chance of contractures forming, and even small amounts of exercise help if movement is restricted. UCLH says a physiotherapist can advise on stretches, positioning and ways of moving.

The MS Trust says to speak first to your MS team or GP, and that you are likely to need a referral for an assessment with a physiotherapist. Local teams managing spasticity often include a physiotherapist, doctor and nurse, and depending on your needs may involve occupational therapists, seating services, orthotists and continence services. UCLH says treatments such as botulinum toxin or intrathecal baclofen are considered if management strategies, therapy and oral drugs do not give adequate relief.

NICE's MS guideline says to suspect spasticity when a person presents with involuntary muscle movements, muscle stiffness, or pain and restriction with certain movements causing difficulty with activities, and to discuss the balance of benefits and harms, since some people use their spasticity to maintain posture and ability to stand, walk or transfer.

The UK sources read for this guide are written mainly for adults with MS, stroke or spinal cord injury, and do not describe treatment for children separately. If you are worried about stiffness or spasms in a child, ask their GP or paediatrician for an assessment and referral to a therapy or rehabilitation team.

Sudden worsening of stiffness or spasms can be a sign of a trigger such as a urinary tract infection, constipation, skin breakdown or pain, which UCLH and the MS Trust advise looking for first. Contact your GP, nurse specialist or district nurse promptly if spasticity suddenly worsens, if you develop pressure sores, or if you cannot move a joint.

On the NHS, spasticity is usually managed through a neurology, rehabilitation or MS team, with community physiotherapy and, where needed, a specialist spasticity clinic for botulinum toxin or pump treatments. Some people also use private physiotherapy or neurology, but intrathecal pump treatment and injections are decided by specialist teams.