As with most conditions involving the human brain, spasticity is a complex disorder. The condition causes many muscles to contract at once, leading to tightness and uncontrollable contractions, according to the Cleveland Clinic.
Spasticity is a common complication following a stroke, but the exact prevalence is hard to pinpoint. According to a 2018 review published in the International Journal of Gerontology,1 roughly 30 to 80% of people experience spasticity after a stroke, which is a pretty wide range. “The actual numbers are controversial—it really depends on how the study is done,” Gerard E. Francisco, MD, a professor of physical medicine and rehabilitation at the University of Texas Health Science Center at Houston McGovern Medical School and the chief medical officer at TIRR Memorial Hermann, tells SELF.
What happens to the brain during a stroke?
A stroke occurs when the brain doesn’t receive enough blood or oxygen, and this can happen for two reasons. In one of them, blood vessels in the brain can become blocked by fat deposits or a blood clot, according to the Centers for Disease Control and Prevention (CDC). And in the second a blood vessel can burst or leak, putting pressure on the brain. In both cases, brain cells become damaged or die almost immediately, so getting emergency care is vital in order to preserve brain tissue.
What causes spasticity after a stroke?
To better understand why a stroke doesn’t always cause spasticity, it helps to know how the nervous system works. In order to do things like high five a friend or reach down to tie your shoes, your brain needs to communicate with the rest of your body, according to the National Institute of Child Health and Human Development. Your brain communicates using nerve cells, which are called neurons, that travel along nerve pathways located in the brain and spinal cord.
Spasticity happens when there is a disruption of communication between the brain, your muscles, and the nerves on top of the muscles that are responsible for controlling movements. As a result, your muscles may contract when they should be relaxed. Generally, spasticity happens when the cerebral cortex (a region of the brain that helps control movement) or the brainstem (which helps connect the brain to the spinal cord) are damaged after a stroke. Spasticity can occur after other causes of brain damage too, including certain neurological conditions like multiple sclerosis and cerebral palsy.
Experts can anticipate who may develop spasticity after a stroke using magnetic resonance imaging (MRI), which creates three-dimensional images of the brain. If MRI shows that lesions are located in areas of the brain that are associated with the disorder, neurologists can then monitor for symptoms of spasticity,2 Dr. Francisco says. This way, people can get diagnosed and treated quickly.
Researchers are still learning about why spasticity happens after a stroke in some people and not others. Some research shows that age may be one predictor since spasticity risk increases when a person is younger at the time of their stroke.3 Smoking may also increase a person’s chances of developing spasticity following a stroke.
What does spasticity after a stroke feel like?
The short answer? It varies. Spasticity can manifest in different ways so it’s impossible to give a definitive answer. However, there are a few telltale signs of spasticity that may occur after a stroke, according to the Cleveland Clinic:
- Your muscles are stiff, tight, and difficult to move, which can make it hard to do daily tasks such as cooking.
- Your muscles contract involuntarily, causing muscle spasms. These contractions can also occur very rapidly, which is called clonus.
- Your muscles may feel harder than usual during a spasm.
- Over time, your joints may freeze up, which can be incredibly painful and limit your range of motion.
- Standing upright and walking can be challenging due to balance problems.
Some people with mild spasticity may have stiff muscles, while individuals with more severe cases can experience numerous symptoms.
“One of the things that’s particularly striking about spasticity is the harder you fight it, the worse it is,” Dr. Worrall says. “So if you have spasticity in your elbow and you take a very gentle, slow approach you may be able to bend your elbow, but the faster and harder you push, you may get a reflexive contraction that stops the movement.” So if you have spasticity affecting your elbow, it may be easier to slowly bring a spoon to your mouth than it is to quickly shovel candy into your mouth, Dr. Worral explains.
It’s important to know that people whose native language is different from their clinician’s may experience spasticity but never get properly diagnosed, according to Dr. Francisco. “The nuance of language comes into the picture. I just saw a Filipino patient who described spasticity as his muscles feeling either ‘hard’ or ‘soft.’” So physicians may not always detect spasticity in people whose native language is different from their own, he says. If you think you may have spasticity and don’t know how to communicate that, it can help to look up information about the disorder and show it to your doctor.
Can spasticity be treated?
Spasticity can’t be cured, but a combination of physical and occupational therapy, along with medications, can help reduce symptoms. After a stroke, your doctor may recommend physical therapy to help improve muscle movement and reduce pain associated with spasticity, Joel Stein, MD, a professor of rehabilitation and regenerative medicine at Columbia University Vagelos College of Physicians and Surgeons, tells SELF. Occupational therapy, which focuses on helping you perform everyday activities, is typically recommended too. Treatment plans are individualized and may include exercises, medical aids like walkers, and modified ways of performing tasks.
Sometimes, medications such as botulinum toxin injections are included in a spasticity treatment plan to help relax muscles, according to the Cleveland Clinic. The injections typically provide relief for about three months and are more effective when treating just a couple of spastic areas.
A stroke is a severely life-changing event, and developing spasticity can make recovery even more challenging. But the right treatment can make a huge difference in your quality of life, according to Dr. Francisco. “We know that people can recover many years—even decades—after a stroke. The message is: It can be helped. We have so many options right now,” he says.
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