Managing spasticity and spasms

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What are spasticity and spasms?

 

Spasticity is muscle stiffness that makes it difficult to move. It results from abnormal messages in the brain which cause a muscle to contract for prolonged periods. 

When spasticity is present you may experience spasms – these are sudden and uncontrolled movements of your arm or leg into either a bent position or a straight position. 

As a result of spasticity and spasms a muscle can become shortened or painful, but this risk can be avoided or reduced by good management.

What can I do to manage my spasticity and spasms?

 

Be aware of any trigger factors, and take steps to avoid or reduce them.  Here are some common trigger factors and self-management tips:  

1. Pain and discomfort

Make sure you adopt good, comfortable, positions during the day and night.  This will help prevent pressure sores, pain, and muscle shortening.

  • When you’re in a chair or wheelchair, a ‘good’ position is one in which you are sitting straight, with your back, arms and legs well supported. You should not be slumped, tilted or twisted. 
  • When you’re in bed, you should likewise take care not to be slumped, tilted or twisted.  This means having a supportive mattress which discourages these bad postures and makes it comfortable for you to maintain good ones.    
  • Some people experience spasms in their legs at night.  If you have spasms which make your legs go straight, try sleeping on your back with your knees in a bent position (over a t-roll or wedge).  If your legs tend to spasm into a bent position, you may find it better to sleep on your side. 

2. Bladder and bowel problems

Spasticity can be made worse by changes in your bladder and bowel routine – for example, if you’re not able to empty your bladder, or if you have a urine infection, constipation or diarrhoea.  It’s important to address these issues quickly, by contacting your GP practice.

3. Skin problems and infections

Good general hygiene helps to keep your skin healthy and reduces the risk of some infections, so keep your skin in as good condition as you can and try to avoid it becoming irritated.  For example you should:

  • wear comfortable clothing and make sure that no zips or buttons are digging in. 
  • keep your nails short and clean, to prevent ingrown toenails. 

If you wear a splint, check your skin every time you remove it.  If it is irritated, contact the therapist who provided the splint, as it may need adjusting. 

4. Low mood and anxiety

Anxiety, stress, and low mood can make your spasticity worse, but there are lots of things you can do to reduce these feelings and lift your mood.  For example:

  • make time every day to engage in activities you personally find enjoyable or relaxing – these could include listening to music, spending time outside, participating in some kind of physical exercise, or spending time with friends.  
  • try relaxation or ‘mindfulness’ techniques – there are some excellent free apps which you can download onto your phone to guide you with these (e.g. Headspace, Calm, or Virtual Hope Box)

If you find it difficult to manage your feelings, speak to your GP – s/he will be able to advise on and help you access other forms of help, including counselling and/or medication.

5. Being inactive 

Regular physical activity is important to maintaining a healthy body and healthy mind, and can take the form of any movement which requires energy – e.g. walking, gardening, and housework, as well as exercises.  Try to do 20-30 minutes of moderate activity each day.

Get into the habit of doing gentle stretches, taking stiff arms and legs through a range of motion, on a daily basis. If you can’t do them on your own, a family member or carer can be taught how to help you. 

Standing programmes have been shown to be helpful for people with spasticity in their legs.  This involves standing (e.g. at your kitchen worktop) for short periods of up to about 30 mins, several times per week.  If you have more difficulty, you may need a standing aid – a physiotherapist will be able to advise you on this and give you guidance on appropriate exercises. 

What medicines can help my spasticity?

 

Your GP can prescribe a variety of medicines to help manage spasticity.  If you have more complex needs s/he may refer you to a specialist spasticity clinic. 

What to do if spasticity and spasms are becoming unmanageable?

 

Keep a diary to record when your spasticity is worse, and if and when you experience spasms. This will help health professionals understand the problem and determine who can best help you.  

Some sources of help for particular problems are summarised in the table below. 

 

Difficulty with…Who can help/advise?
PainGP, consultant, practice nurse, physiotherapist
Bladder and bowel managementPractice nurse, continence nurse
Posture and comfort during the day, including splintsPhysiotherapist or occupational therapist
Stress or anxietyGP, counsellor, psychologist, psychiatrist, 
Toenail cuttingChiropodist / podiatrist
Pressure ulcer carePractice nurse, district nurse, tissue viability nurse. 
Medication managementConsultant, GP, spasticity clinic
Exercise and standing programmesPhysiotherapist