How to Manage Spasticity After a Spinal Cord Injury

By Scihealthhub – December 16, 2024

Spasticity is a common complication after a spinal cord injury (SCI), affecting between 65% and 78% of individuals with the condition (1). 

It is characterized by abnormal, uncontrolled, persistent tightening of the muscles due to prolonged muscle contraction. Simply put, spasticity is an unwanted, prolonged muscle contraction. 

While spasticity can sometimes be beneficial—helping maintain muscle tone and circulation—it often leads to severe discomfort, reduced mobility, and challenges in daily life.

Managing spasticity effectively requires a combination of medical and physical therapy, tailored to individual needs.

Understand the Causes and Triggers

Spasticity arises due to disruptions in the communication between the brain and spinal cord, causing an exaggerated reflex response.

Spinal cord injuries are common causes of spasticity. 

Other disorders of the central nervous system (brain or spinal cord) that can also cause spasticity include;

• Stroke 

• Cerebral palsy 

• Brain injury 

• Multiple sclerosis 

• Amyotrophic lateral sclerosis

• Spinal cord tumor 

Triggers

Furthermore, certain factors may trigger or worsen already existing spasticity. They include:

• Infections, especially urinary tract infections. It is one of the most common triggers of spasticity. 

• Pressure sores

• Constipation, impacted stool (stuck poop) or large haemorrhoids 

• Full bladder 

• Anything that can irritate the skin including in-grown toenails or anything that is too hot or cold or that can cause pain.

• Occult (invisible) fracture below the level of spinal cord injury 

• Injury to the muscles or tendons below the level of spinal cord injury.

• Use of certain medications such as fluoroquinolones (e.g., ciprofloxacin)

Identifying and managing these triggers can help reduce the frequency and severity of spasticity.

What are the symptoms of spasticity? 

The symptoms of spasticity may differ in nature and severity from person to person. 

They include:

• Tight or stiff muscles 

• Recurrent muscle spasms: Sudden, involuntary tightening or contraction of a muscle. Unlike spasticity, spasms are usually brief. 

• Overactive muscles such that ordinary light touch can trigger muscle spasms 

• Pain or discomfort 

• Muscle fatigue 

• Clonus – uncontrollable repetitive jerky motions 

• Abnormal posture 

• Bone and joint deformities 

What are the negative impacts of spasticity? 

Spasticity can negatively impact the quality of life of individuals with spinal cord injury in the following ways:

• Spasticity can be very painful and discomforting.

• It can make it difficult to sit properly on the wheelchair, drive or transfer safely. 

• It can cause sleep disturbance. 

• It cause accidents such as falls from the wheelchair especially during transfers, showering or propelling on an uneven surface. 

• Spasticity in the chest can cause difficulty in breathing. 

• It can cause contractures (permanent contraction of the muscles and tendons) 

• It can lead to rubbing that can cause breakdown of the skin and pressure sores. 

Managing Spasticity after a Spinal Cord Injury

The approach to managing spasticity include:

• Manage Triggers 

• Medical Treatments

• Physical Therapy 

• Advanced Treatments 

Manage Triggers 

Sometimes managing the trigger factors can help reduce the effects of spasticity without needing any medication. 

Also, If trigger factors for spasticity are not addressed, any medication the individual is taking to reduce spasticity will not be fully effective.

Here are ways common triggers can be managed:

Manage urinary tract infections. Seek prompt treatment if there are symptoms of urinary tract infections such as fever, feeling unwell and cloudy urine. 

Check the buttocks and other pressure points for any signs of pressure sores. 

Evacuate compacted stools using combination of bisacodyl suppository and manual evacuation. 

Perform clean intermittent catheterization to empty a full bladder. 

Promptly treat injuries like ingrown toenails, cuts, or fractures. 

If the spasticity started or worsened after you commenced a medication, consult your provider and inquire if the medication is the culprit. Request dosage adjustment or alternative medications that are less likely to trigger spasticity.

However, spasticity that persist even after the triggers have been addressed, can be effectively managed using a combination of medical treatments and physical therapy.

Medical Treatments

Medications are often prescribed to control moderate to severe spasticity. Common options include:

Baclofen – considered the preferred first-line treatment to reduce spasticity in spinal cord injury 

Tizanidine 

Gabapentin

Pregabalin 

Benzodiazepines (diazepam, clonazepam) 

Dantrolene sodium

These medicines reduce spasticity by depressing signals from the brain and spinal cord, with the exception of dantrolene which act directly on the muscles to suppress spasticity.

The commonest side effect of these medicines is drowsiness, though a few people may also experience dizziness and weakness. However, usually these side effects reduce with time. 

Physical Therapy and Exercises

Stretching and Range-of-Motion Exercises: Regular stretching helps lengthen tight muscles and improve flexibility. Focus on slow, sustained stretches to avoid triggering spasms.

Weight-Bearing Activities: Standing frames or supported standing activities promote proper joint alignment and may reduce spasticity over time.

Cold or Hot Therapies: Cold or hot packs may temporarily relax the muscles and reduce spasticity. However, be careful to check skin tolerance frequently because this treatment may result in damage to the body if one apply packs that either too hot or too cold, especially in areas of the body with reduced or no sensation. 

Orthotic Devices: Splints, braces, and positioning devices can help manage spasticity by keeping joints in proper alignment, preventing contractures, and reducing muscle overactivity.

Advanced Treatments 

These advanced treatments may be considered in severe spasticity that has not responded to medical and physical treatments. They include:

Botulinum Toxin Injections: Involves targeted injection of botulinum toxin (commonly referred to as Botox) directly into the spastic muscle to suppress contractions and reduce spasticity for several months. 

Intrathecal Baclofen Therapy (ITB): This intervention, which is reserved for extreme cases of spasticity, involves the surgical placement of a programmable pump and catheter in the individual’s abdomen to deliver regular dose of baclofen directly into the spinal fluid, providing effective relief with fewer systemic side effects.

Final Thoughts

Spasticity is a common and often distressing condition for individuals living with spinal cord injuries. However, most cases can be effectively managed through a combination of addressing triggers, medical treatments, and physical therapy. By adopting the right approach and seeking professional guidance, individuals can enhance their quality of life and gain greater control over their symptoms.