Managing Your Spasticity After Stroke, Brain Injury, and Spinal Cord Injury [Video Transcript]

If you are watching this video, it is likely that you have spasticity and know what it is and want to know how to treat it and get rid of it. After things like a stroke, brain injury, or spinal cord injury, some people may experience impaired movement. One of these is called spasticity. The technical definition and commonly accepted one for spasticity is a velocity-dependent increase in muscle resistance. Put in everyday words, spasticity is a condition that results in an abnormal increase in muscle stiffness. And this can be problematic if it continues as it can interfere with movement, speech, and even pain.

In terms of the big picture, spasticity can impact someone like you negatively in terms of function so physically, but also mentally, and spiritually. Spasticity can result in difficulty with movements and coordination and lead to limited arm use. Further complications of spasticity left unmanaged could lead to a reduced quality of life, and joint contractures (which means even further limited body part movements) that can be even more painful.

In this video, I’ll be teaching you some practical things you can do to help manage your spasticity. 

According to the NIH, the national institute of neurological disorders and stroke, treatment may include medications such as baclofen. There is also direct injection with things like botox into the muscles to weaken these muscles to improve your function. Then there is also surgery to release or sever some pathways associated with your muscle stiffness. As some of these treatments may be costly and some such as surgery come with potential complications, you should know that there are more conservative approaches. Overall, the prognosis of spasticity depends on the severity and the associated symptoms that come with it.

Everyone is different. But you should know and this is what this video is primarily about is that there are also non-pharmacological ways to treat spasticity. In general, these include muscle stretches, range of motion exercises, and functional activities. As this is not personal medical advice and just general educational information, I highly encourage you to speak to and continue to speak with a physician or someone who is familiar with complications after a stroke such as spasticity or to also get a referral to an occupational therapist.

Starting at home, the first thing I will talk about for helping you and your spasticity is triggers. You are probably already familiar with the term triggers, but did you know that there are potential triggers for spasticity? One thing to note is that triggers can be different for everybody. Potential triggers mentioned in some research studies include menstrual cycles, pregnancy, certain postures such as laying down or sitting, colder weather, muscle fatigue, stress, tight clothing, or even something else entirely such as loud noises. For example, some patients report that spasticity was greater for them laying down compared to sitting. Many also reported changes in postures such as moving from say, a bed to a chair caused an increase in muscle stiffness.

So by being aware of potential triggers for your spasticity, it can help you gain insight into either avoiding those things, minimizing them, or finding ways to address them immediately after. I get that life is life and there are some things you can’t avoid such as certain positions, menstrual cycles, and so on. But many others you can, such as the cold – by wearing warmer, but less tighter fitting clothing, having the thermostat turned up a little more, or even something like managing your stress. There’s even a portable electrical jacket you can wear that can keep you warm when you go out in the cold – i’ll post an affiliate link for that.

After life-changing things like a stroke, brain injury, or spinal cord injury, adjustment to your disability can be difficult. It can affect your mental health as well. Unfortunately, your rehabilitation may or may not have included therapy to address your mental health. But some quick tips to help you is to find acceptance and look at your strengths. So what can you still do? Also, just something as simple as regularly slowing down and breathing deeply and slowly can help to reduce your stress. Like this…

If you are anxious or depressed, consider talking with your provider for a prescription of medication and or therapy to specifically address your condition. As there may be a financial barrier or even limited access, I understand this may be possible. What has personally helped me with my prior depression is looking at what is meaningful to me, what I value in life, and finding ways to move towards those goals in life without judgment. This is based on ACT therapy and CBT, cognitive behavioral therapy. Or put simply, just not being so hard on myself or talking down on myself and my life. So hopefully these quick tips inspire you to find ways to manage your mental health, anxiety, depression, or stress, all of which can be triggers for spasticity.

I wanted to leave you guys with a practical exercise you can use at home to manage your spasticity. According to one research article, stretching the involved muscles is a commonly used way to manage one’s spasticity. But full transparency, some research studies from systematic reviews which I will include in the description show that stretching alone does not work for everyone. But I don’t see doing stretches as a completely wasted effort compared to more extreme measures like surgery which come with its risks. Stretching is simply a requirement of your time and minimal physical effort.

When it comes to stretches, don’t rush to force a stretch. Oftentimes, you’ll find it easier if you relax and breathe as you stretch. If you have done yoga before, the same concepts apply as you go into these stretches. Also, don’t over stretch the joint, as in hyperextend them. Only stretch as far as you were able to before your injury.

The key to managing your spasticity though is the concept of 1) prolonged and 2) regular, keyword prolonged, so long time, and 2) regularly, not just like once and done. Stretching is also beneficial as it helps you to maintain the flexibility of your muscles and to prevent things like potential pain from muscle stiffness and limited flexibility. So if your provider or therapist provided you with a splint or brace, it may be a good idea to continue wearing it, even if just at night when you sleep. And if they showed you some specific stretches, continue to do those too.

And as for the stretching, it’s basically nothing complicated at all. Just stretching each individual muscle and holding it there for a long time, like several minutes. Studies show that stretches should be maintained for at least 30 seconds, with three to four repetitions, five or more times per week. But in general, there is no set consensus on how long or how much to stretch. I recommend doing what is comfortable and avoiding stretching to the point where you start to feel pain. Is there such as thing as stretching too long? One studied looked at maintaining muscle stretches in the affected parts of the arm for 10 minutes and participants noticed a significant reduction in spasticity in their elbow, hand, and fingers.

The mantra, no pain no gain is bad advice that I don’t think you should follow because in general pain is your body’s way of telling you to stop. If you have spasticity in your fingers, stretch all of your fingers. Your wrist, stretch your wrist. Your forearm, shoulder, and so on? Stretch all of those too using your other hand, or get some help from a caregiver like a loved one or a friend.

I don’t want to give false hope because based on my experience and the research, avoiding triggers and stretching alone does not help to get rid of spasticity. Studies show that continued therapy such as with an occupational therapist or physio/physical therapist is more beneficial than these 2 approaches alone. As I know this is not possible for everyone due to finances and limited access around the world, my goal is to create more educational videos with tips on how to manage your spasticity at home on YouTube.

But to point you guys in the right direction though, other things to try for your spasticity include improving your motor control and function for routine daily activities like brushing your teeth and eating. Also you can try applying electrical stimulation such as with a TENS unit, heat therapy, and strengthening weaker muscles through exercise. So see you guys in future videos. Take care of yourselves, I wish you the best in your recovery, and thanks for watching!

References

NIH Article on Spasticity – https://www.ninds.nih.gov/health-information/disorders/spasticity

Heated Jacket – https://amzn.to/3I6QQOX

Phadke, C. P., Balasubramanian, C. K., Ismail, F., & Boulias, C. (2013). Revisiting physiologic and psychologic triggers that increase spasticity. American Journal of Physical Medicine & Rehabilitation, 92(4), 357-369.

Francisco, G. E., & McGuire, J. R. (2012). Poststroke spasticity management. Stroke, 43(11), 3132-3136.

Kuo, C. L., & Hu, G. C. (2018). Post-stroke spasticity: a review of epidemiology, pathophysiology, and treatments. International Journal of Gerontology, 12(4), 280-284.

Bovend’Eerdt, T. J., Newman, M., Barker, K., Dawes, H., Minelli, C., & Wade, D. T. (2008). The effects of stretching in spasticity: a systematic review. Archives of physical medicine and rehabilitation, 89(7), 1395-1406.

Salazar, A. P., Pinto, C., Mossi, J. V. R., Figueiro, B., Lukrafka, J. L., & Pagnussat, A. S. (2019). Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis. Annals of Physical and Rehabilitation Medicine, 62(4), 274-282.

Hummelsheim H, Munch B, Bütefisch C, et al: Influence of sustained stretch on late muscular responses to magnetic brain stimulation in patients with upper motor neuron lesions. Scand J Rehabil Med 26(1):3–9, 1994.

Cho, H. Y., In, T. S., Cho, K. H., & Song, C. H. (2013). A single trial of transcutaneous electrical nerve stimulation (TENS) improves spasticity and balance in patients with chronic stroke. The Tohoku journal of experimental medicine, 229(3), 187-193.

Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.