Top Expert Tips for Controlling MS Spasticity
Spasticity, a condition where muscles stiffen, spasm, contract, and resist normal movement, is a common symptom of relapsing-remitting multiple sclerosis (RRMS), the most diagnosed type of MS. Though symptoms of spasticity can affect your arms, back, and other parts of your upper body, it’s your lower body (like your quadriceps and hip flexors) that is most often targeted, says neurologist Tirisham Gyang, M.D., who specializes in treating MS at The Ohio State University Wexner Medical Center in Columbus. And that can mean major mobility issues.
Why Spasticity Happens With MS
Scarring from MS on the nerves in the brain or spinal cord that control movement can lead to nerve malfunction—and disability, including spasticity. “It’s a prominent feature of diseases like MS that affect the central nervous system,” explains Dr. Gyang. “Walking becomes difficult because you can’t flex your knees or hips. A lot of falls happen.” In addition, spasticity can make everyday tasks tough to do. (If it affects your hands, for example, you may not be able to write.) Fortunately, there are things you can do to improve your symptoms.
Physical Therapy for Spasticity
If you have chronic spasticity, your first Rx will likely be for physical therapy, says Dr. Gyang. A physical therapist (PT) primarily helps with mobility, but you may benefit from PT even if you don’t have walking issues. “You need education,” she maintains. “A physical therapist can tell you what exercises are best for you and how often you should do them. I encourage everyone to see one” to help with stiffness and to make walking less difficult, she adds. If spasticity creates difficulties with daily tasks, like dressing or writing, you’ll be referred to an occupational therapist (OT), too.
A Customized Approach
There is no core set of exercises or stretches for spasticity, says physical therapist Grace Schaffner, D.P.T., an MS specialist who also works at The Ohio State University Wexner Medical Center. What works for someone else may not work for you. “It takes a detailed evaluation to see what you would benefit most from,” she explains. To assess you, your PT will move an affected joint through its range of motion to see how freely it moves and whether or not the muscle catches due to spasticity. You’ll also discuss any other MS symptoms affecting your mobility, like weakness, fatigue, and balance issues.
Calf Stretches for Knee Joints
Still, you may benefit from a few specific, gentle stretches that help the joints, according to Schaffner. Stiffness caused by spasticity can shorten an affected muscle, which restricts how well joints (like your knee) can function. So your PT may recommend you stretch your calf muscles, for example. If your right leg is affected, place your right foot behind you, then lean your weight forward until you feel your lower right leg muscle and ankle stretch. This helps lengthen muscles and may restore some or all of your range of motion, and prevent muscles and joints from becoming tight and stiff.
Hamstring Stretches for Spasticity
Stretching is also beneficial for your hamstrings, the muscles in the back of your upper leg. To start, lie flat on your back with your legs bent. Lift one leg at a time and gently pull it towards your chest to feel your hamstring stretch. If you need a little help, loop a belt, towel, or bedsheet around your foot and use it to help pull into the stretch. Remember: Only do stretches that your PT recommends, never stretch to the point of pain, and be sure you understand how to do them correctly to avoid injury.
Yoga Moves for Strength
“I love getting people involved in a yoga program, whether it’s sitting yoga or traditional standing yoga, because it provides core stability, it builds strength, and it’s typically very slow and very meditative, which reduces the likelihood of spasticity kicking,” says physical therapist Matthew Caraher, PT, who specializes in neuromuscular diseases like MS at the University of Miami Hospital. As with other exercise, ask your PT to recommend the best yoga positions for your needs. “That requires an in-depth assessment,” says Caraher. “The right pose for someone else might be too difficult for you or simply the wrong position.”
Water Exercises Without Worry
Another favorite of Caraher’s: Pool exercises. “Pools are great, because the buoyancy of the water makes you lighter. Your muscles don’t have to work so hard,” says Caraher. “That makes it less likely for spasticity to kick in, but there’s still resistance that you have to push through as you move.” Pool workouts help with strength-building in an environment where falls during exercise are not a worry. You can exercise in a pool whether or not you use a wheelchair, walker, or cane on land. Be sure to wear a flotation device, like a life vest or buoyancy belt.
Strengthen Multiple Joints
In addition to stretching, your PT also may advise you to do some strengthening exercises to counter weakness, increase balance, and to build or maintain range of motion in your joints. Schaffner particularly likes the kind of workout that engages multiple joints at once. This helps with functional movement, the type required for everyday tasks at home and at work, such as lifting a bag of groceries or grabbing something from a high shelf. What does she recommend? “Squats and lunges are two exercises that get multiple joints moving,” she says.
The Benefits of a Stretching Regimen
Do at least three repetitions whenever you stretch. Hold each for 30 seconds to one minute. Anything less and you won’t see a benefit, says Schaffer. How often you stretch depends on the severity of your spasticity and how many joints and muscles it affects but “daily maintenance stretching can be very helpful,” she adds. Track when during the day you have energy and when your muscles feel most able to move—a great time to incorporate a stretching routine. As much as possible, keep your routine consistent to sustain the fullest range of motion.
Slow and Steady Wins
Plan to take a slow and gentle approach to exercise. “If you do an exercise too quickly, you may get resistance to that movement from your stiffened muscle,” says Schaffner. “But if you move a bit more slowly, it may be easier for you.” Why? Reducing the pace can help to get a spastic muscle to gently lengthen, and that allows it to be stretched, she explains. That can temporarily help to lessen the impact of spasticity. Moving too quickly, on the other hand, could trigger a spastic response in your affected muscle.
Some Triggers Lead to Spasticity
Symptoms of spasticity can come and go, so in addition to exercise, learn and avoid some common triggers. Cold weather can make you feel worse, so make sure to keep your environment at an even, comfortable temperature, says Schaffner. She also says that pain may make your spasticity act up. Talk to your doctor about managing your pain in order to make your spasticity less challenging. Her final tip: get quality sleep as often as possible to decrease spasticity symptoms. Bonus: Staying pain-free and scoring ZZZs’s makes it easier to stick to your exercise routine.
Get Others Involved
If you have a willing family member or friend, bring them to at least one PT appointment so that they can learn the moves, says Caraher. That’s more difficult to do with COVID, but there are workarounds. If restrictions mean they can’t come in person, ask your PT to set up a Zoom video so your helper can watch and ask questions. Alternately, your PT could make and send a video to your helper. “I’ll make a video of me doing the stretch on their loved one or demonstrating on another therapist,” he says.
Multiple Sclerosis Spasticity: Multiple Sclerosis Association of America. (2019). “Spasticity (stiffness).” mymsaa.org/ms-information/symptoms/spasticity/
Multiple Sclerosis Spasticity: National Multiple Sclerosis Society. (n.d.). “Spasticity.” nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Spasticity
Multiple Sclerosis Spasticity: MS Focus. (2016). “Spasticity and MS.” msfocus.org/Magazine/Magazine-Items/Exclusive-Content/2019/Spasticity-and-MS