Sunday, February 23, 2014

Spasticity - Muscle Tone, Stiffness, Tightness,


What is Spasticity?
Updated 2/23/2014

Spasticity is the feeling of tightness, usually in the legs (as my case) among Multiple Sclerosis, but it can effect any part of the body. It is considered an increase in muscle tone (muscle tightness) and there are two types of spasticity that are common among Multiple Sclerosis.

Flexor – Involves hamstrings in upper legs and the hip flexors (muscles at top of upper thigh).

Extensor – Involves Quads and adductors (muscle on front and inside of upper leg).

This can cause painful spasms, lower back pain, and joint pain. It can also effect your gate (the form of how you walk) for obvious reasons because if your legs are stiff and rigid then you probably will not be able to take a simple step they way you are supposed to be able to. When spastic, everything can feel rigid, mechanical, and some people may not be able to bend their legs at all (or what ever body part is effect by spasticity for them)! Imagine waking up and feeling like you could only move as much as a wooden sketch mannequin, that is kind of what spasticity feels like. Most people who complain about spastic legs say it feels like they are "walking on stilts" and I would have to agree.

Spasticity effects about 20-34% of MS patients in some way shape or form. It is a very common symptom.

How to Treat Spasticity:

Baclofen (Oral Pill) - the most common treatment, a muscle relaxer that targets nerves in the spinal cord.

Baclofen Pump – A pump that is surgically implanted under the skin and releases a set dose of Baclofen into the spinal cord via a tube. This is for more extreme cases of spasticity.

Tizanadine (Zanaflex) - another option, Zanaflex is a skeletal muscle relaxer which slows down action in the brain and nervous system. This works great for spasms but can cause really bad cotton mouth!

Diazepam (Valium) – This drug has a strong sedation effect, many people use it to sleep which is why it's typically prescribed to help when spasticity is interfering with sleep. Also used for anxiety and to help prevent seizures. Can be addictive.

Dantrolene (Dantrium) – Typically only used when other drugs have not worked. Can cause some tough side effects.

Botox – Also for extreme cases of spasticity, Botox injections can help relieve spasticity for around 3 months, as always, this varies from person to person. It is typically administered in a medical facility.

Exercise and stretching! Even massage, acupuncture, supplements such as Magnesium, or Cannabis are said to help. For me (and most others) stretching works best!

My Experience With Spasticity

Spasticity was never an issue for me until my major relapse at the beginning of 2012 that effected my spinal cord but now I live with a bit of it everyday. When it first hit, my right leg was fully extended and so tight that I could not even bend it, in fact, I remember a nurse leaning into my extended leg as I sat in a chair and still not being able to bend it at all. I had never been in that kind of pain in my life, it made a sciatica feel like a walk in the park. I remember them giving me a shot of Dilaudid and feeling almost no relief. I was asking for Norco as soon as it was available because my lower back was so tight from my leg being extended to the max that it was causing excruciating pain in my lower back. After a while (and much rehab) I was finally able to bend my legs on my own and after much stretching and exercise at home it is not so much of a problem anymore. When I get stressed however, I immediately feel my legs start to tighten up and cramp causing me to feel like if I don't start stretching and massaging them right away that they might (but probably not) lock up rendering me unable to walk. This is one of the many reasons I try to just avoid confrontation and other stressful events.

Luckily my spasticity is under control enough that I walk just fine without the aid of a cane and I am sure that as my balance improves I should be able to do a slight jog! I have tried several medications such as Baclofen and Tizanadine, but nothing gives me that instant feeling of relief we all want from popping a pill. I take Baclofen in the morning and at night just to see if I can get any help from it and at the least it stops my myoclonus jerks at night when I am trying to sleep.

19 comments:

  1. Hi, I stumbled across your blog a few days ago, have been reading a little, but when I read this, I'm sorry to say, but I was glad to know that someone feels like I do. My neuro told me she didn't have any other patient like me,with such severe leg pain. I have been in a wheelchair on awful days, a cane on okay days, and with nothing on good days. I started Tysabri 2 months ago, and it has helped with the pain. I still have to take pain medication to be able to walk unassisted, but I can tell its better because I can go longer between each dose. I have been to so many doctors for help, on some days I would have okay'd it for them to be amputated. Anyway, I'm glad it's helping you also, I'm keeping my fingers crossed.

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  2. Hi! Haha I understand, its weird because its a common symptom with MS.... Maybe mot so bad with everyone but lots of people deal with it in some way shape or form. Glad Tysabri is working for you. Give it a couple more months, maybe it will kick in a bit more?

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  3. Matt - have you ever had this type of pain in your arm. I am not diagnosed yet, but, it's looking that way. My arm has been on this weird path over the last 2 weeks. It started with tingles and stabbing pain. It was the prickly stuff with slight ache pain. That left for a week and came back stronger. The pain felt like I had an electric current running through my arm. The current is now faint and my arm has been sore and week for a week straight. Any of this sound familiar. If I don't MS, I will be so lonely trying to figure out what is happening to me. I am so exhausted from analyzing my symptoms and trying to figure out if this stuff is in my head. I need prayer.

    Kobe

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  4. Well, that would not be spasticity, that would be paraesthesia:

    http://www.mattsms.com/2013/04/pins-and-needles-paraesthesia-tingling.html

    Dont feel lonely though, usually I respond right away but I was out of town for the last few weeks!

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  5. So good (yet sad) to hear others with similar problems. My doctor put me on Baclofen for my thighs a few years ago, looks at me weird when I describe my paresthesias and ms hug. He sent me to a neuro but he would not discuss ms with me. I also have seizure clusters, another not very common problem. Never know when I will collapse at Walmart, or drop to my knees when feet feel stung by 10,000 bees. I wish doctors were more open minded, are they upset we look on web for info? What are we supposed to do when they 'don't understand or believe us'?? Glad to see your blogs, I was beginning to think it was 'in my head'.

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  6. Yeah, I have come to the conclusion that the doctors who get all offended when you look stuff up online are just insecure with their education and simply feel they should be THE ONLY smart person in the room because they paid for school yet they still can't accept that no one has all the answers, including THEM.... It IS sad to see others with our problems but its nice to know we are not alone....

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  7. Hi Matt.. I have spasticity to and I would like to say thank you for sharing your story with the world, really help to know how other people dialing with the same symptoms. Good luck.. ;))) Sonia

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  8. Thanks! Glad you find it useful. Hope all is well!

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  9. Hi matt, great blog =).
    I am not yet dx'd yet with MS. But my neuro said she is def' leaning toward it, so I'm a possible MS. Have lesions on brain scan in all the right places and in numerous amounts etcetc.. am doing the waiting game at the moment as many have donebefore getting their dx. I did not have spasticity in my legs, but did and have in my arms which comes and goes with short exertion, was one of the main symptoms I went to the doc for. There are pages I have researched that explain MS patients spasticity is not limited to the legs.
    I do have pain in my legs though that is around the top back of my thigh near groin area that goes around to the hip and down the back of my knee, calf and ankle. Originally it was both hips and lower back, soo much so that i could only walk to the letterbox nback before having to just stop walking altogether..and stairs..pfft forget that,was excruciating. Now its just the leg, hip and back of knee pain sometimes in both but mainly left side. I do have problems mainly on left side of my body.
    just thought Id add about the arms
    like I said,great blog mate.
    be well
    Lee

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  10. Hi, yes, I thought I mentioned but maybe not, legs are common, arms second most common and technically** you can have spacticity in ANY muscle as it's just an increase in tone. Did they give you Baclofen?

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    1. Matt, hi, no they haven't given me anything as yet, My GB gave me a script for muscle relaxants (mild ones) but because we can't get through to my neuro atm he doesn't want me to get the meds because he wants her approval first, my arms seem to be more affected expecially at work, and even just typing this out, they tense up and then get pretty painful. I am still waiting on my neuro, kind of frustrating but being it's the easter break both my GP and I think she has gone on a break for the duration of easter. We can only get into contact with her secretary who keeps saying she'll send my neuro an email. I'm beginning to feel like I'm being a pain to her because I am often ringing her office for that illusive appointment, my partner says don't be silly, you need answers, but I'm not one to hassle anyone and feel like I am hassling her maybe. It's just with work and all, I need some kind of answers so I can inform them if I need any more time off for more tests etc, and I cannot give this to them *sigh* plus I would like some relief to the tightness in my arms. I guess I should just be patient.
      I just wish if she is too busy to see me that she could pass me onto a neuro who can see me, but I can't even contact her to get my MRI results off her to bring to another neuro. Is doing my head in.
      Lee

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  11. Thx for posting. I am frustrated bc my dr claims they don't typically see this symptom in ms patients. Yet it appears common when I research. My legs were the first- super rigid, tight, heavy, hard. Then my arms about a year ago. Tried diazepam, baclofen, tizanidine but developed tolerance for all. Now doing Botox but limited by every 3 mo rule. Severely impacting work/school responsibilities. I get massages but cannot afford too often. I do water aerobics (can't do land anymore due to spasticity). Any other thoughts or suggestions? Trying to go the natural route and eat foods whose properties are known to reduce cramping???

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  12. ... ... ... Is your doctor joking? Spasticity is one of the most common symptoms of MS. Most people don't present with it but develop it somewhere down the line.... Wow... Sucks that you have built a tolerance to most those meds, but since your already doing botox I have no idea what to recomend.... They say Marijuana really helps spasticity but not everyone is for that.

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  13. Matt, Hi mate,
    no I am not taking anything at the moment, My GP has given me a script for a muscle relaxant, but doesn't wish me to get it yet untill we speak with my neuro just to be sure, problem is we still can't get into contact with her, only her staff who keep saying they'll send her an email. Is the Easter break so we figure she may be off over the duration, fingers crossed I'll hear something by next week. She may not wish me to take anything till she has all the facts I guess.
    Lee
    P.s sorry if I posted a reply twice, I keep forgetting the comment as bit and when I click publish I am not sure if it goes through. so oops if I have =)

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  14. Well, if it IS spasticity from any neurologic cause, muscle relaxers will not work, it has to be something that will work on your nerves. HOPEFULLY it is NOT MS related though haha!

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  15. My regular GP Matt, is not an MS specialist, I guess he is trying to treat the symptom and not the cause, he has told me not to collect the script unless my neuro agrees with it, but we just have not heard from her as yet.

    A Question: Do you have days that seem to be totally normal with no, or very mild symptoms? I suppose I should ask "did" you instead of do you, meaning before you were diagnosed?
    Today I am not feeling too bad, have a slight stiffness in my calf muscle and a little black dot in my vision (new) but otherwise I feel fine.
    It makes me wonder if everything is just going away.

    Lee

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  16. Oh that makes sense, and yes, that is how relapsing remitting MS is before you sustain more permnanet nerve damage which on the outside shows as symptoms that don't seem to go away, the lesion doesn't heal.

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  17. Question please. I have been having very tight legs. Started with curled toes from "Morton Neruroma" right leg but still tight now but mostly one leg. Have been on muscle relaxers for 2-3 day. Not helping does this mean neuro and MS? Thanks

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  18. Well have you been diagnosed with MS? If so it's neuro and muscle relaxers will not help, you would need something like Baclofen. If you have not been diagnosed with MS than you might just need a different or stronger medication?

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