Extreme muscle tightness, stiffness, and rigidity are all hallmarks of spasticity, a common symptom of multiple sclerosis. In mild cases it can be annoying, but as MS progresses, it can be debilitating. While medications like baclofen can help treat spasticity—taken orally or by a pump implant if oral medication if not sufficient—the most important preventative measure is stretching. ActiveMSers contributor Dr. Ken Seaman, PT, MA, DPT, explains why.
Based on decades of experience working with people with multiple sclerosis, in my professional opinion stretching is the most important part of an MSer’s exercise regime. Why?
You can lose muscle mass for long periods of time, yet still regain strength years later. You can lose aerobic capacity for long periods of time, yet regain heart fitness within months. However, should you truly lose range of motion in your joints for an extended period of time—a condition that can be caused by spasticity, poor positioning, ill-fitted equipment, etc.—it may be impossible to regain full movement without some form of drastic intervention, which often times means surgery for either tendon release or to sever the nerve-muscle pathway.
What exactly is spasticity? As defined by the National Institute of Neurological Disorders and Stroke (part of the National Institutes of Health), spasticity is a condition in which certain muscles are more easily contractible than normal. This contraction causes stiffness or tightness of the muscles and may interfere with movement, speech, and manner of walking. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement and often occurs in association with multiple sclerosis.
Symptoms may include hypertonicity (increased muscle tone), clonus (a series of rapid muscle contractions, usually in the ankle or wrist), exaggerated deep tendon reflexes, muscle spasms, scissoring (involuntary crossing of the legs), and fixed joints. The degree of spasticity varies from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms. Spasticity can interfere with rehabilitation in patients with certain disorders, and often interferes with daily activities. Treatment may include such medications as baclofen, Zanaflex, diazepam, tizanidine or clonazepam.
But from my vantage point, a solid physical therapy regimen should be your first line of defense.
Recommendation: Stretch Three Times a Day
Flexibility exercises—muscle stretching and range of motion exercises (ROM)—can help prevent shrinkage or shortening of muscles and can help reduce the severity of spasticity symptoms.
Stretching should be performed daily on parts of the body that are most effected by spasticity. Typically those muscles most at risk for tightness include the hamstring, lower back, hip flexor (muscles on the front of the thigh closest to the trunk) and muscles on the inside of the thigh. If nothing else is done throughout the day, it is good practice to lengthen these muscles by stretching them at least two or three times per day.
You don’t need to stretch for long periods of time—usually one to three repetitions of 15-30 seconds on each of the aforementioned muscle groups, ideally three times per day, is sufficient.
Proper form is essential. For instance, in stretching the hamstring muscles it is very important to keep the knee of the leg you are stretching straight and attempt to bring the chin toward the toes rather than the forehead to the knee. One item that cannot be emphasized enough: never bounce! This may actually cause your muscles to tighten even more.
A book I highly recommend for stretching is Bob Anderson’s Stretching. A pocket book edition is also available—the main portion of the book is identical to the original—only it is more portable for gym goers. Additionally, a laminated poster (with grommets for hanging) featuring illustrations of recommended stretches to jog the memory is available.
Veteran physical therapist Karen Bexfield, the sister of ActiveMSers’ founder, recommends a stretching strap like the OPTP Stretch Out Strap for assistance. These straps help MSers perform unassisted stretches with greater control.
Dr. Ken Seaman began working with individuals diagnosed with multiple sclerosis in 1983 and has since become one of the country’s groundbreaking physical therapists in MS, earning an induction into the National MS Society’s Volunteer Hall of Fame in 2003. Click here to read his full bio.