Best Exercises To Reduce Spasticity – Health Essentials from Cleveland Clinic

Best Exercises To Reduce Spasticity – Health Essentials from Cleveland Clinic

Spasticity is a common side effect of certain neurological conditions. And while the word might make you think of muscle spasms, it’s much different from what you might think. “Oftentimes, you may hear the word ‘muscle spasm, ’ ‘stiffness’ or even ‘rigidity, ’” says physical therapist and clinical rehab specialist Randy Karim, PT, DPT, NCS, CBIS. “However, spasticity has special nuances that make it different than those terms. ”

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What is spasticity?

To understand spasticity, it helps first to understand muscle tone. “Muscle tone gives our body structure, ” says Dr . Karim. “In everyday terms, if we had zero muscle tone, we would resemble a wet noodle, or a pile of muscles and bones on the ground. But if we had too much tone, we might be as stiff as a board and find it extremely difficult to move. ”

If you don’t have enough tone, you have what’s known as hypotonicity. Having too much tone is called hypertonicity. Spasticity falls under the category of hypertonicity, and is “velocity-dependent, ” says Dr . Karim. In other words, how quickly you move matters.

“The faster that you move a muscle — or the faster that you stretch a muscle — the more that the tone reacts. In other words, the stronger the resistance, the more spastic a muscle becomes. ”

Spasticity and nerves

But spasticity doesn’t necessarily just refer to your muscle mass fibers and muscle tone. It’s also related to the particular nerves that are connected to your muscles, says Dr . Karim. “Spasticity is essentially more of a nervous system issue rather than a muscle issue. ”

Imagine that your nervous system and your muscles are playing a game of tug-of-war. When the signals between your brain and muscles can go back and forth unimpeded, there’s an equal amount of push and pull — the same amount of force coming from each side. “Each side is equally strong, so you have good tension in your muscles, ” Dr . Karim explains.

But an injury to your nervous system causes an imbalance, disrupting the signals from your brain to your muscles — which leads to a lopsided game of tug-of-war. “Suddenly one side is pulling more, ” Doctor Karim says, “and the other side can’t push back enough. ”

“The signals are inhibited from relaxing the muscle tissue, ” he adds. “You have more signals being pushed into the muscle, causing pressure. The other side is pulling and pulling unchecked. This overactivity leads to stiffness, tightness plus spasticity. ”

Who has spasticity?

Your muscle tone can be affected by neurological conditions that cause damage to your central nervous system — your brain, your spinal cord and everything in between that connect them. “Spasticity is caused by any condition that damages the motor neurons coming from your brain and spinal cord that will connects to the muscle, ” says Dr . Karim.

Your central nervous system includes your brainstem , which regulates essential functions such as breathing, or your cerebrum . This area of your brain has many jobs, including directing muscle movement.

Common conditions that can have spasticity as a symptom include:

What parts of the body are affected by spasticity?

The parts of your body affected by spasticity depend on where the damage occurs in your nervous system. In turn, this can affect what condition you develop. For example , traumatic brain injuries are typically associated with damage to the front or back of your skull.

However , Dr . Karim says there are common muscle groups generally impacted by spasticity, located in three general areas of your body:

Upper limbs

In your upper limbs, these are muscles that cause flexion movement. Examples of this kind of motion include bending your arm at the elbow or clenching a fist. Muscle groups affected by spasticity include:

  • Shoulder adductors.
  • Elbow flexors.
  • Forearm supinators (the muscles wrapped around your forearm).
  • Wrist and finger flexors.

Lower braches

In your lower limbs plus extremities, the muscles affected are involved with extension movement. This can involve things such as toe pointing or stretching your knee. Muscle groups affected by spasticity consist of:

  • Hip adductors (inner thigh muscles).
  • Knee extensors.
  • Knee flexors.
  • Plantar flexors (these help you point your toes down).
  • Ankle inverters (these help you point your own toes inward).
  • Toe flexors (muscles that cause your toes to flex).

Head, neck and trunk

The muscles impacted here have “side bending and rotation movement, ” says Dr . Karim. Think about the muscles you use rolling your head around to stretch, or even bending your upper torso to one side. Muscles affected by spasticity here include:

  • Sternocleidomastoid (a major neck muscle).
  • Upper trapezius (a muscle covering the base of your neck over the tops of your shoulders).
  • Scalenes (muscles found on the side of your neck).

Dr . Karim says there are exceptions to the above muscle groups. “However, when I evaluate people who have had a stroke, or are living with a spinal cord injury, multiple sclerosis or cerebral palsy, they are the patterns that are more common. ”

Does exercise help with spasticity?

Exercise can temporarily reduce spasticity. “This reduction can last anywhere from minutes to a few days, depending on the amount of spasticity present and the type of intervention performed, ” says Doctor Karim. “Whether it’s an exercise or treatment that a physical therapist does, it can have a very real, calming effect on the particular spasticity. ”

However , this reduction is transient, meaning it’s not permanent. “Stretching and strengthening the spastic muscle tissue can’t cure or heal spasticity, or may not bring it back down to a normal strengthen, ” notes Dr . Karim. “Unfortunately, therapists cannot cure your spasticity. It’s not like a muscle injury that’s going to heal and go back to normal. ”

That being said, exercise can help you manage the long-term impact of spasticity, such as muscles pain, stiffness or contracture. “Contracture occurs when the muscle becomes so stiff, and it doesn’t move for a long time that will there’s actually a physiological change in the joints and in the muscle, ” explains Dr . Karim. “The tissue actually changes and cannot move anymore. ”

Best exercises to reduce spasticity

When determining a good exercise routine, the first thing to keep in mind is that whatever physical activity you do, it shouldn’t be painful. “You may have heard the saying ‘no pain, no gain, ’” says Dr . Karim. “But that’s a very inaccurate and dangerous phrase, especially when spasticity is present. ”

Soreness or a slight muscle ache is common and may even be expected. “But a pain that feels sharp, or a shooting pain that stops you in your tracks, that’s a warning sign, ” Dr . Karim adds. “You should never push through that type of pain. Stop immediately plus consult with your doctor or therapists. Feeling acute pain when performing a movement or exercise is a signal to your body that something’s wrong. ”

When it comes to exercises with spasticity, combining stretching with strength training, or resistance training, can help. Strength training has more benefits when you’re in a weight-bearing position, adds Dr . Karim.

“You might hear this technical term: closed kinetic chain. Basically, that means you don’t have your hands or legs out in the air, maybe moving weights, ” he describes. “Instead, you’re actually closing your movement chain by putting your hands or your feet down on the ground or on a solid surface. ”

Calf stretches on an incline board

One exercise Dr . Karim recommends is stretching your calves on what’s called an incline board or perhaps a slant board. These are shaped like wedges and can be adjustable. “You hold on to a stable surface and step onto this incline board, ” he says. “This is something that’s at an angle — roughly a 15- to 25-degree incline — and you stretch by stepping onto it. ”

For the best impact, “both of your heels should be on the table or one should be on the floor, ” Dr . Karim provides. “To target your calves, your knees have to stay straight, and you lean your hips forward. ” A good comparison to this stretch is thinking about how your calves feel when you’re walking up a hill or a steep incline.

You can buy these incline boards online or even make your own at home, using wood, grip tape and nonslip material. However , the angle of the incline board is crucial. “If you have something less than 15 to 25 degrees, you won’t feel much of a stretch, ” says Doctor Karim “If you have some thing a little bit higher of an position, it may be uncomfortable. ”

Dr . Karim recommends keeping this particular incline board in a room you visit a lot, like your bathroom. “Every time that you’re at your bathroom sink, as long as it’s safe, you can lean on the sink as you’re washing your hands, ” he says. “You can sneak in a stretch throughout the day, rather than just having a specific dedicated time in your day to extend. ”

Arm exercises using a wall pushup

To stretch out your wrist muscles, Doctor Karim recommends what he calls a wall pushup. “Place your arms on the surface, ” he says. “If you’re able to, I recommend putting your hands on the wall. ”

Dr . Karim stresses not to skimp on balance or safety when doing this. “You shouldn’t feel any discomfort either, ” he notes. “You’re mostly stretching your wrist muscles by leaning into the wall and leaning your body forward. ”

Aquatic exercises

Studies have shown that aquatic workouts such as swimming are very beneficial for children living with cerebral palsy. “These showed that when researchers measured the muscle itself, swimming had an elastic effect, ” says Dr . Karim, “meaning it made the muscle a little bit more flexible after being in the water. ”

Cycling or treadmill

There is some research showing that cycling and treadmill training can also help with spasticity. “To become clear, these also have a temporary effect on the spastic muscle mass, ” Dr . Karim states.

Best practices for exercising and spasticity

Anyone exercising needs to be mindful of following best practices and listening to their body. For people living with spasticity, Dr . Karim says there are some specific considerations when exercising.

Work with a bodily or occupational therapist

First and foremost, before starting an exercise routine for spasticity, Dr . Karim says in order to consult with a physical or even occupational therapist. “A therapist can evaluate you and tailor a specialized program to meet your needs. This is by far my primary recommendation for anyone before starting with specific exercises. ”

Be mindful of things that trigger spasticity

Different things can trigger spasticity. In studies, people have self-reported spasticity increases due to having a full bladder, having their period, being pregnant, a change in sleeping habits, colder weather or increased stress.

Exercise at a time of day that is good for you

Different times associated with day might be better for exercising. “Some people may experience more spasticity in the morning, ” says Dr . Karim. “This is likely due to laying in bed asleep in the same position for a long time. That can create your muscles feel very stiff each morning. ”

Be aware of medication timing

Medication timing can also make a difference in your spasticity. “If you take medication that helps muscle tissue relax, you want to be mindful of that, ” says Dr . Karim. “Therefore, it is wise to time your medication along with your exercise routine, so you’re able to have more of an impact. ”

Don’t move too fast

Because spasticity is velocity-dependent, slow plus steady wins the race when exercising. “The faster you move, the more that you can trigger spasticity, ” he says. “During an exercise routine, if you’re shifting too fast, you may actually trigger a higher degree of spasticity versus moving in a slow and controlled fashion. ”

Does stretching reduce spasticity?

Much like exercise, stretching can help you manage spasticity, not eliminate it completely or cure it. Dr . Karim says, “In the long term, stretching may not change objective measures for spasticity, but it’s also not harmful. Stretching is a preventative treatment that may prevent issues in the future. ” Prolonged stretching is helping you maintain your range of motion and prevent contracture.

If you live with spasticity, Dr . Karim says it’s vital that you think of stretching like a healthy habit like brushing your teeth. “Brushing your teeth will be something that’s been accepted as a part of our culture. From a young age, it is something that everyone understands you have to do for good long-term health.

“Stretching is the same kind of daily health maintenance that everyone has to do, ” he continues. “However, it’s especially helpful for someone living with a condition where there is a high likelihood that your muscles can become stiff later on. ”

Combining stretching with calming, deep breathing exercises can be very effective for people with spasticity. “An example of an effective breathing pattern is one where your exhale lasts longer than your inhale, ” Dr . Karim clarifies. “This pattern has a calming effect on your central nervous system. And it will help you to have a better stretch, especially if you have spasticity. ”

Therapeutic equipment and spasticity

If you have more severe spasticity, the neurologist or a physiatrist will help you decide whether techniques or movements could work in tandem with exercise to decrease spasticity. Additionally , physical and occupational therapists have equipment, therapeutic techniques and treatments available to help. “Consulting with a healthcare professional to determine the best plan can always help, ” advises Dr . Karim.

Tilt table or standing frame

This kind of assistive technology can help you “achieve and maintain proper positioning of the joints and trunk” while standing, says Dr . Karim. “If you are able to safely stand with the appropriate equipment, this is very important to prevent contracture. ”

If you use a wheelchair, it’s also important to have a wheelchair plus seating assessment by a therapy professional so you’re positioned correctly. Improper seating positions may lead to an increase in spasticity.

Splinting or orthotics

“Splinting your wrist and hand, or wearing orthotics, may both help manage spasticity, ” Dr . Karim says. “This provides a prolonged extend throughout the day that can also help prevent contractures from occurring. ”


There are several medications to manage spasticity. In addition to an oral medication, which has a general effect on your body, some options are more localized. “If you only have one or two areas in your body that are spastic, it may make more sense to put that will medication directly in those areas, ” suggests Doctor Karim. “Doctors can take medication and inject it right into the muscle that’s being affected. ”

Spasticity is different for everybody

Spasticity looks and feels different for everybody. Figuring out an approach to managing it also looks different for everyone — although taking into account multiple techniques plus considerations can have a compounding impact on reducing spasticity.

“There’s the particular timing of your exercise, making sure that you’re combining it along with medical management, ” states Dr . Karim. “For example, maybe you’ve taking dental medications or managing it with a focal injection to calm the muscle down. And then there’s also deep breathing. ”

Dr . Karim furthermore says some people can even use spasticity to their advantage and maintain their quality of life. This happens with some conditions that affect muscle tissue strength, as well as tone. “You may have weakness in your legs, but you might have a lot of spasticity as well, ” he notes. “Even though you have weakness, the spasticity may allow you to stand or assist with transferring to different surfaces. Sometimes, your own spasticity kicks in and can help perform functional tasks. ”

In a case like this, consulting with a therapy professional can help. “Healthcare providers can assist you determine, ‘Is it a good thing to decrease your spasticity? Or should we keep your spasticity in place so that you’re able to function better? ’”

At the end of the day, you and your healthcare team can decide on the best way to approach managing your spasticity. Even though we may not be able to heal your spasticity, we do have treatment options to help improve your activities of daily living, mobility and quality of life, ” reassures Dr . Karim.

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