Spasticity is one of the most common — and challenging — symptoms of multiple sclerosis (MS). According to the National Multiple Sclerosis Society, an estimated 80 percent of people with MS have spasticity, involuntary muscle spasms or stiffness that interfere with normal movement. Spasticity is also the top symptom reported by members of MyMSTeam.
To learn more about this common issue, MyMSTeam talked with Aaron Boster, M.D., a board-certified neurologist and president of The Boster Center for Multiple Sclerosis in Columbus, Ohio. His YouTube channel covers many aspects of treating and living with MS, including spasticity.
Symptoms of spasticity range from occasional, mild muscle tightness to severe, uncontrolled muscle spasms or cramps. They can occur anywhere in the body, but typically affect the legs. “Some people’s legs get stiff just at night,” Dr. Boster said. For others, “It’s the bane of existence and almost defines their day-to-day lives.”
“Spasticity is my worst symptom, so far,” said one member of MyMSTeam. Another member said they can’t “sit for extended periods of time, drive for any distance, or get a good night’s sleep. I’m constantly repositioning my body to find a position that doesn't add to my discomfort.”
Legs spasms make it challenging for many members to walk, climb stairs, or maintain balance. “My hips lock up and it’s harder to walk,” said one. “I’ve had five frozen knees and feeling like I've run a marathon,” said another. “Spasm on my right leg is so painful, I can drop to the ground if I’m not holding onto something,” lamented one member.
Upper-body spasms interfere with eating, writing, dressing, and other aspects of daily life. “I use my fingers to eat because I can’t grip utensils,” explained one MyMSTeam member. Another said, “I can't cut with a knife and have to hold a large glass with both hands.” Hand spasticity can create a deformity that one member calls "the claw.” Another says it causes her to “dig my nails into my palm.”
Because spasticity typically occurs at night, it disrupts sleep for many members, creating daytime fatigue. “Muscle spasms start when I go to bed and keep me up for two hours,” explained one member. “I wake up during the night because my arms and hands fall asleep, and I have to slowly move them until the feeling comes back,” said another.
Many members have trouble keeping up with household chores. “I still can take care of my home, but it takes me a week to do what I previously could manage in a day,” said one. “I get someone to clean so I can do other things to get back on track,” shared another.
Besides waking up partners with uncontrolled movements, MyMSTeam members report their spasms disrupt another area of their relationships — sex. “I get spastic every time my husband and I are intimate,” admitted one member. “My left foot and toes cramp up horribly, but the sex is still great, so we deal with it,” shared another.
Spasticity is caused by a deficiency or loss of gamma-aminobutyric acid (GABA), a neurotransmitter that calms the nervous system by inhibiting certain brain signals. When there’s not enough GABA to regulate activity, the nervous system becomes overexcited. In the case of MS, the nervous system sends the wrong signals to the muscles, causing spasms.
To diagnose spasticity, a neurologist will take a medical history and conduct a physical examination. They may order magnetic resonance imaging (MRI) to assess the severity. Early diagnosis of spasticity is critical. Untreated, spasticity can lead to painful and permanently frozen joints (contractures), pressure sores on the skin, and disabling muscle tightness that may only be relieved by surgery.
Many treatment options can reduce symptoms of MS spasticity and increase your quality of life. These include physical therapy, medication, surgery, and lifestyle changes. Talk to your doctor about which options would work best for you.
Physical therapy is the first-line treatment for MS spasticity. A trained physical therapist will measure your muscle functioning and prescribe home exercises to increase flexibility and decrease spasms. More than 13,600 members of MyMSTeam report using some form of physical therapy.
“Movement is key to minimizing spasticity,” said Dr. Boster. He prescribes five minutes of stretching three times a day: in the morning, before going to sleep, and once in the middle of the day. He advises holding each stretch for at least 30 seconds, so muscles “learn what to do.”
Engaging in daily gentle exercise has helped many MyMSTeam members loosen tight muscles. “I found a yoga video that focuses just on stretching the legs — so far I am liking it!” said one member. Others swear by The MS Gym, which offers free MS exercise videos on its Facebook page. “It's the best thing to ever come along for MS and exercise,” said one member. Another fan of The MS Gym added, “I've been able to relieve spasticity in my legs with daily workouts from there.”
Occupational therapy provides modifications to ease daily life. Therapists can show you how to get dressed or shower using the least amount of energy. They may also recommend home adaptations, such as replacing drawer handles with large knobs or lowering clothes bars in closets. Assistive devices, such as long-handled brushes to wash feet while bathing, can also reduce stress.
Your doctor may recommend a brace or splint to keep legs stable and properly aligned during a spasm. Most doctors recommend custom-made braces. Ill-fitting, over-the-counter devices can create pressure sores and other factors that aggravate spasticity.
Oral medications may be prescribed when spasticity symptoms interfere with sleep or daily functioning. Two commonly prescribed medications — Lioresal (Baclofen) and Zanaflex (Tizanidine) — are short-acting skeletal-muscle relaxants for spasticity approved by the U.S. Food and Drug Administration (FDA). Baclofen, the preferred drug for treating spasticity in MS, is essentially a synthetic form of GABA. “It's like they made a neurotransmitter [you can] swallow,” Dr. Boster explained.
More than 6,000 members of MyMSTeam take Baclofen for spasticity. Results vary for each person. “I've taken Baclofen for years. It works about 50 percent of the time,” said one member. Another added, “I've been on it for years and went from multiple daily spasms to just a few a month.” For some, the drug doesn’t work at all, or they are unable to tolerate it due to debilitating side effects.
An intrathecal Baclofen (ITB) pump can be implanted under the abdominal skin for people who require a higher dose of Baclofen, but cannot tolerate the increased side effects. “Sometimes, the oral dose you need would put you in a coma,” said Dr. Boster. “With the pump, we can [deliver] liquid Baclofen in super-small doses.”
Several MyMSTeam members reported good results. “I had a Baclofen pump implanted and now I can stand up straight, have no pain, and feel like a normal person again,” shared one member. “The pump was the best thing for me, I can't believe how much better I am!” said another.
Other oral medications prescribed off-label for MS spasticity include Valium (Diazepam), Dantrium (Dantrolene sodium), Klonopin (Clonazepam), and Neurontin (Gabapentin). MS spasticity medications can have significant side effects, including drowsiness, difficulty sleeping, muscle weakness, and dizziness.
Botulinum toxin (Botox injection) is sometimes used as a local muscle relaxant for spasticity. “My ‘frozen solid’ muscles are beginning to ‘thaw’ with it,” said one member. Another added, “I’ve been doing it for years and it helps me.”
If physical therapy and medications fail, surgery might be recommended as a last resort. One therapy used with spasticity in cerebral palsy, known as selective dorsal rhizotomy, can also help with MS. The procedure involves severing nerve roots to relax cramped muscles, but it’s not without risk.
Medical cannabis and cannabidiol (CBD), where legally available, are now commonly used to relieve MS symptoms like spasticity, according to the National Multiple Sclerosis Society. The Cannabinoids in MS (CAMS) study and others have reported significant improvements in spasticity, spasms, and sleep. “Cannabinoids, in my anecdotal experience, sometimes amazingly helped with pain, spasticity, and MS,” said Dr. Boster.
Many members of MyMSTeam report success with medical marijuana. “My doctor was amazed at the difference CBD oil made in my leg spasticity. He’s now recommending it to his other spasticity patients,” said one member.
Cannabis also brings fast relief. “All my muscles relax within minutes. Why wait an hour or more for a muscle relaxer to work when you can immediately stop the spasticity,” one member said.
Being aware of your spasticity triggers can help you manage symptoms. Exhaustion, constipation, a full bladder, or even a small wound can start or increase spasticity. Spasticity can be triggered by women’s menstrual cycles as well.
Staying hydrated can make a big difference. “Drink one glass of water with each of three meals during the day, then one glass between each meal,” Dr. Boster recommended.
By joining MyMSTeam, the social network and online support group for those living with multiple sclerosis, you gain a support group more than 150,000 members strong. Spasticity is one of the most-discussed topics.
How does spasticity affect your daily life? Has your doctor found the right medication to manage your symptoms? What helps you successfully get through each day? Share your tips and experiences in a comment below or on MyMSTeam. You'll be surprised how many other members have similar stories.
Further Reading: Dr. Boster’s Recommended Studies