Life with muscle spasticity
Our spinal cord is the key component to sending signals from the brain to the very corners of the body. So what happens when those signals are disrupted? Depending on how the spinal cord is injured it can leave the signals either completely or partially cut off from the brain. The result is a Quadripelgia (Tetraplegia) or Paraplegia. When a catastrophic injury like an SCI occurs, people often experience an array of side effects due to lack of motor use and movement. One of the most common and most varied is muscle spasms.
So what are muscle spasms?
Muscle spasticity is an uncontrollable tightening or relaxing of muscles. About 65%-78% of the SCI population suffers from some form of spasticity, occurring mostly in the cervical (neck), than thoracic (chest) and lumbar (lower back) injuries. It’s usually sudden, resulting in an involuntary flexing or bending of a limb.
SCI patients have limbs that are typically stiff or tight at rest, causing difficulty relaxing or stretching and a lack of control of movement. The most common type of reflex muscle contraction seen in SCI patients are extensor spasms. These are a ridged straightening of knees and pointing of toes. Flexor spasms, which cause bending or drawing up of a limb, are the second most common followed by clonus, which is a fast rapid collection of movements.
Muscle spasms are a struggle for some injured patients because the pain can vary from mild to severe and can last seconds to longer than several minutes. These episodes can also cause sleep disruption, difficulty with breathing, difficulty with movement, pressure sores, digestive issues, and intimacy problems.
What causes spasticity?
Many of our movements are controlled by the spinal cord and directed by our brain. When one sustains a catastrophic injury to the spine, the brain can no longer regulate motion and reflexes may become exaggerated over time. With a complex system of circuits that controls our body movement, the missing link between the brain and the spinal cord leaves the body with no idea how to react. The body can no longer have quick, automatic reactions, such as jerking away from a hot object.
Here are some common triggers that cause muscle spasms:
- Limb movement
- Skin irritation
- Pressure sores
- Full bladder or UTI
- Bone fracture or tendon injury
- Tight clothes
How can I stop muscle spasms?
The simplest road to minimizing spasticity is maintaining a healthy lifestyle and practicing self-care. It is important to maintain flexibility and range of motion to encourage movement and work toward weight bearing while standing. The next step is to wear splints and braces to promote muscle stretching and help maintain a position that does not trigger a spasm.
Oral Medication – A doctor may prescribe muscle relaxants like Benzodiazepines, Diazepam, Clonazepam, Dantrolene or Tizanidine. Some patients may be hesitant to use medication because of the side effects and success rate.
Motion blockers – If a specific body part is spasming, these injections into the muscle provide temporary relief with minimal side effects.
Surgery – Though not recommend initially, some patients opt for Intrathecal medication therapy. The battery powered pump injects a muscle relaxant drug directly into the area around the spinal cord. Commonly referred to as a pump or baclofen pump, it needs to be replaced every 5-7 years. Be sure to discuss the surgical risks with your doctor when weighing out your options.
Functional Electrical Stimulation – This treatment option applies small electrical pulses to paralyzed muscles to restore or improve their function. FES is commonly used for exercise, developing muscle mass, and assistance with breathing, grasping, transferring, standing and walking. Additionally, FES can help some to improve bladder function, bowel function, and reduces pressure sores.
Are there any benefits to muscle spasms?
Health professionals actually believe that a certain amount of muscle spasticity can be a good thing. Movement, even when it is uncontrolled, helps maintain muscle mass and tone. It can also help aid functional activities such as standing or transferring or getting dressed. Below are some additional benefits of muscle spasms:
- Help indicated medical complications
- Assist in bladder and bowel problems
- Increase blood flow
- Decrease the chances of blood clots
- Help maintain bone density
With all these therapy options, be sure to communicate with your health care professional about your choices and which ones are covered by insurance. Get advice from fellow SCI patients who have experienced this and can help you make a sound decision. Muscle spasms may not be ideal, but it is good to know that there are options to help you manage the condition.
Spasticity by S. Brown
Spasticity and Spinal Cord Injury by the Department of Rehabilitation Medicine
Electrical stimulation for therapy and mobility after spinal cord injury by Centre for Neuroscience
Analysis of Spasm and Periodic Leg Movement in Spinal Cord Injury by G. Suresh