Home › Conditions › Spasticity after stroke

Spasticity after stroke

Spasticity develops in a substantial proportion of people after stroke, most often as a tight, bent arm and clenched hand, or a stiff leg with a foot that points down and turns in. It can appear weeks or months after the stroke and often worsens if untreated. Targeted injections combined with physiotherapy can improve comfort, care, positioning and, for some people, function.

After a stroke, the part of the brain that regulates muscle tone on the affected side may be damaged. In the weeks and months that follow, muscles on that side can become persistently overactive — stiff, resistant to stretch, pulling the limb into a fixed posture. This is post-stroke spasticity. It affects roughly a third of stroke survivors, and it is one of the most common reasons for pain, loss of function and difficulty with care in the years after a stroke.

How it shows up. In the arm, the typical pattern is a shoulder held against the body, an elbow that will not straighten, a forearm turned palm-down, a wrist bent and fingers curled into a fist with the thumb tucked inside. In the leg, the common pattern is a foot that points down and turns inward, making the heel hard to place, the knee stiff or snapping straight, and toes that claw. Each of these has consequences: pain in the shoulder and hand, skin breakdown in a closed palm, difficulty putting on a sleeve or a shoe, a walking pattern that is slow and unsafe, and sleep broken by spasms.

Why timing matters. Spasticity that is left untreated tends to progress. Muscles held short for long enough begin to shorten permanently — contracture — and at that point no injection can restore the range; only surgery can. Early assessment, even where the decision is not to treat yet, allows the pattern to be monitored and treatment started before contracture sets in. That said, spasticity that has been present for years still responds to treatment, provided the muscle has not become fixed.

Assessment. The examination identifies which muscles are overactive and what each is costing you: pain, care, positioning, or movement. It distinguishes spasticity from established contracture, and from weakness, which is treated differently. Goals are set with you and your family or carers — a hand that can be opened for washing, an arm that can be dressed without pain, a foot flat enough for a shoe and a brace, or simply less pain and better sleep.

Treatment. For focal spasticity — tone concentrated in particular muscles — targeted injections into those muscles reduce tone for a period of months. The injection opens a window; stretching, splinting and, where movement remains, task practice within that window produce the lasting gain. Treatment is repeated as the effect wears off, and adjusted at each cycle. Where tone is more generalised, oral medication may be considered. Serial casting can lengthen a muscle that has begun to shorten. Where contracture is already fixed, surgical opinion is arranged.

Pain after stroke. Spasticity is only one source of pain after stroke. Shoulder pain from a subluxed or immobile joint, central post-stroke pain generated by the injured brain itself, and musculoskeletal pain from an altered gait each need separate attention. Because Dr Martin is trained in both pain medicine and rehabilitation medicine, these are assessed together rather than across separate services.

Working with your stroke team. Treatment is coordinated with your stroke unit, rehabilitation service, GP, physiotherapist and occupational therapist. Referrals are accepted from any of these, and from residential aged care.

Sources: Stroke Foundation — Clinical Guidelines for Stroke Management; Healthdirect Australia.