Many people with multiple sclerosis have stiff muscles and spasms, a condition called spasticity. It happens mostly in the muscles of the legs and arms, and it may keep you from moving your limbs freely.
You might feel spasticity either as stiffness that doesn’t go away or as movements you can’t control that come and go, especially at night. It can feel like a muscle tightening, or it can be very painful. Spasticity also can make you ache or feel tight in and around your joints and low back. How you feel can vary depending on your position, posture, and how relaxed you are.
What Causes Spasticity?
Spasticity happens because of an imbalance in the electrical signals coming from the brain and spinal cord, often when multiple sclerosis has damaged the nerves there. This unevenness makes your muscles contract on their own and makes them tense.
The condition can get worse when it’s too hot or cold, when you have an infection, or if you’re wearing tight clothing.
Treatment for MS Spasticity
Physical therapy, medications, surgery, or a mix of these treatments can ease spasticity when you have MS. To decide the best way to help you, your doctors will think about your overall health, how severe your symptoms are, and:
- Does the condition keep you from doing everyday tasks?
- Are you in pain?
- Which treatments have you tried, and how well did they work?
- How much will it cost?
- What are the side effects?
- Will the benefits outweigh the risks?
Physical and Occupational Therapy for Spasticity
Most of the time, a physical therapist will start treating MS spasticity with a basic physical therapy stretching program. The goal is to lengthen your muscles to ease the condition.
An occupational therapist may recommend different tools, like splints, casts, or braces, to keep up your range of motion and flexibility.
If physical and occupational therapy don’t help, your doctor may want you to try medications.
Medications for Spasticity
Doctors can choose from among several kinds of medications to treat MS-related spasticity. They include:
Skeletal muscle relaxants. These drugs relieve the muscle tension of spasticity. Some work directly on your muscles, and others act through your nervous system. One of the most common medications for spasticity is the muscle relaxant baclofen (Ozobax). Doctors also sometimes prescribe dantrolene (Dantrium). If pills don’t work, your doctor might be able to put a pump inside your body to deliver the medication directly to your spinal fluid (such as the baclofen pump).
Benzodiazepines. These are nervous system depressants, which means they slow down messages in your nervous system. They include diazepam (Valium) and clonazepam (Klonopin). They can also help you sleep if nighttime spasms keep you awake. You might also hear them called tranquilizers. They aren’t FDA-approved for treating MS symptoms. So they’re usually prescribed along with another medication, or if other drugs haven’t worked.
Botulinum toxin. You can also get shots of botulinum toxin (such as Botox or Myobloc) to relax your muscles. It blocks the nerve messages that tell your muscles to tighten up. It’s not suitable for use in large areas, so it’s best for spasticity that’s limited to one part of your body. It’s also temporary. Each shot lasts 3-4 months.
Alpha2-adrenergic agonists.Tizanidine (Zanaflex) works through your central nervous system to ease spasticity. It relaxes your muscles by decreasing nerve stimulation. Its effects are similar to those of baclofen, and it’s sometimes prescribed along with baclofen.
Your doctor might prescribe other medicines to treat some of the effects of spasticity. For some people, spasticity can lead to symptoms like pain or restless legs syndrome.
Some studies have shown that products made from cannabis (marijuana) can ease spasticity, though we need more research into this. Smoking marijuana has not been shown to have the same effect and could be harmful to people with MS. Ask your doctor if cannabis products might help you.
When Does Surgery Help?
When other treatments don't work, there are two types of surgery that can treat spasticity.
In one type, a surgeon cuts away part of the spinal nerve. The operation is called rhizotomy. The goal is to relieve pain or ease muscle tension.
Tendon release, also called a tenotomy, is the second type. A surgeon cuts severely tight tendons away from the muscles. It may make spasticity happen less often and make it less severe, depending on how old you are. Over time, you may need to have the surgery again.
These surgeries can help, but they’re usually only for extreme cases of spasticity and are rarely performed in patients with MS..