Spasticity and Multiple Sclerosis: Not Just A Knot in the Muscles
The topic of spasticity has been on my mind since I’ve been experiencing it more lately. Four years ago, I did not understand what was spasticity and what was not. I complained of really tight muscles to my neurologist who suggested that I exercise more. His advice was logical but it didn’t directly solve my problem.
For many months I lived with this excess tightness which no amount of stretching seemed to resolve. Yoga was nice, as was swimming, but I never seemed to achieve that blissful level of release in my muscles which I so desired.
It wasn’t until a year later (or so) that the tightness and stiffness in my legs got to the point where I just had to complain about it in an appointment. During this appointment, I was consulting with the nurse practitioner who prescribed a trial of Baclofen. I started at a low dose as she suggested and gradually increased it every few days ever so much.
Within about a week, I began to feel a difference. Thank goodness!
The message from my brain and through my spinal cord had been misinforming my leg muscles to pull against themselves. Or rather the spasticity was the result of an imbalance between hyperactive muscle stretch reflexes and muscle contractions. The prescription medication served to disrupt this incorrect message and to break the cycle of stretching and pulling which tied up the muscles in knots.
Keep in mind that my experience with spasticity is just that…..my personal experience. Many MS patients have spasticity which is much more dramatic and disabling than I have had. My spasticity primarily effects my calves and hamstrings. However, it is actually more common in MS patients to have spasticity in the thighs (front of the leg) and dorsiflex muscles (on the shins).
With the tightness and resistance to stretching showing up on the back of my legs, it becomes important to try to strengthen the muscles on the front of my legs in addition to gently stretching the calves and hamstrings. My physical therapist recommends a few simple stretches.
One stretch involves sitting in a chair and placing your foot on another chair (or sitting along side the edge of your bed with one leg hanging off and your torso facing the head/foot board). If you cannot reach your foot in the straightened leg, use a towel or yoga strap to wrap around your foot. Keep your knee straight (or as straight as you can get it) and pull on your flexed foot. Hold the stretch for a full minute and repeat with the other leg. Repeat this cycle at least three times.
Currently, the knot in my outer calf muscle is causing me some minor grief. To isolate that particular muscle, I repeat the above stretch but pull my foot to point toward the opposite leg (a bit pidgeon-toed). Sometimes I will even use my other hand to massage the tight muscles and to rub on the “sore spots” for additional relief.
Another stretch which can be rather effective involves the use of the stairs. Admittedly, you would need to be able to stand securely and maintain your balance for this one. Also you MUST have hand rails as I don’t really need to warn you twice about safety.
Place your foot on the step which allows you to straighten your leg completely (perhaps the 2nd or 3rd step from the ground). Do not round your back or “tuck” your pelvis forward; if you do, move your foot to the next lower step and start again. With your flexed foot against the back of the next higher step, make sure that the foot on the ground is facing forward (not outward) and place your hands on the railings.
Look toward the top of the stairs and slide your hands UP. Do not try to move forward or bend down to your raised leg, keep your focus on going UP. Keep your back as straight as possible by pulling your tailbone backward. I find that keeping the leg upon which I am standing as straight as possible will help to increase the stretch. Hold for a full minute and focus on relaxing your entire body, including your legs.
This stretch can be intense and will sometimes make me feel lightheaded and dizzy. It is important to have a chair nearby upon which to sit as soon as it becomes necessary.
I know that if I were to engage in these (and other) stretches at least three times each day, my legs would feel much better for it. Relying on baclofen alone doesn’t cut it (for me) and I need to use other means to break the cycle of misfiring muscle contractions.
And yes, exercise does indeed help to combat the tightness and stiffness. My neurologist was correct in his initial assessment. I just didn’t quite understand how to properly isolate and stretch (or strengthen) the necessary muscle groups. That awareness was taught to me by my physical therapist.
If you haven’t consulted a physical therapist who specializes in neurological disorders, I highly recommend it.
How about you - Is there something which your neurologist told you early on which didn’t make sense to you, but which you later came to understand and appreciate in a different way? Please tell us your story.