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Spasticity

Spasticity is involuntary muscle tightness caused by injury to the brain or spinal cord — after stroke, spinal cord injury, traumatic brain injury, or in conditions such as multiple sclerosis. Dr Chris Martin is a pain and rehabilitation physician who assesses and treats upper and lower limb spasticity with targeted injections, physiotherapy and goal-based rehabilitation, for patients across Western Australia.

When the brain or spinal cord is injured, the normal regulation of muscle tone can be lost. Affected muscles become persistently overactive: stiff, resistant to stretch, sometimes jerking in spasms. This is spasticity. It is common after stroke and traumatic brain injury, in spinal cord injury, and in multiple sclerosis and related conditions — and it is frequently under-treated, partly because people and even clinicians assume nothing can be done.

What problems does it cause? Beyond stiffness itself: pain, from muscles held constantly tight and joints pulled into awkward positions; difficulty walking, using a hand, or transferring; problems with washing and dressing — a hand that cannot be opened, an arm held against the body; pressure areas from fixed postures; and disturbed sleep from spasms. Over time, untreated spasticity can become contracture — fixed shortening of muscle and tendon that no injection can reverse and only surgery can address. Preventing that is one of the strongest reasons to treat early.

Does all spasticity need treatment? No — and this judgement is central to good care. Some people use their increased tone functionally: a stiff leg that bears weight for transfers, extensor tone that makes standing possible. Reducing tone indiscriminately can take away function rather than restore it. The question is never simply "is there spasticity?" but "what is this pattern of spasticity costing this person, and what would reducing it gain?"

How is it assessed? By examining the pattern — which muscles are overactive, what postures they produce, what they interfere with — and by setting explicit goals with you and those who care for you. Goals differ: easier hygiene, a better gait, less pain at night, easier care. The assessment also distinguishes spasticity from contracture that has already become fixed, because their treatments differ.

What does treatment involve? For focal spasticity — specific overactive muscles — targeted intramuscular injection reduces tone in exactly those muscles, with the effect developing over one to two weeks and lasting some months before treatment is repeated. The injection opens a window; physiotherapy, stretching and splinting within that window produce the lasting gain. For more generalised spasticity, oral medication options exist and are considered against their sedative cost. Serial casting can lengthen shortening muscles. Where deformity has become fixed, surgical opinion is arranged. These approaches are combined around your goals rather than used in isolation.

Why a pain and rehabilitation physician? Spasticity sits squarely within rehabilitation medicine — Dr Martin's Advanced Training included spasticity management, spinal cord injury and brain injury — and spasticity commonly coexists with pain problems that need parallel attention. Managing tone, pain and function together, with your physiotherapist and care team, is the model this practice works to.

Reviews and ongoing care. Spasticity changes over time, and treatment is reviewed against your goals — what improved, what did not, and whether the plan should change. Referrals from GPs, neurologists, rehabilitation services and residential care are all accepted.

Who is seen here. Adults with spasticity after stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, cerebral palsy, and other neurological conditions; people whose spasticity has been untreated for years as well as those recently injured; and patients referred from GPs, neurologists, hospital and rehabilitation services, and residential care. Rural and remote patients can be assessed and reviewed by telehealth, with injection visits scheduled in Perth.

Dr Martin's experience. He holds fellowships in both rehabilitation medicine and pain medicine, completed Advanced Training that included spasticity management, spinal cord injury and brain injury, and has performed thousands of spasticity injections. He has also trained other medical practitioners in spasticity injection technique. Read more about spasticity injections, and about spasticity after stroke, after spinal cord injury, after brain injury and in adults with cerebral palsy, and about upper limb and lower limb patterns.

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