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Muscle tension
Knee does not move
My arm and leg on one side is harder to move than the other
Uncontrolled movements
My hands and feet are clumsy
Hands have fine tremors
Tingling
Not seeing your symptoms? No worries!
Spasticity is abnormal muscle tightness due to extended muscle contraction. It is typically linked to damage to the spinal cord, brain, or nerves.
Your doctor may ask these questions to check for this disease:
Treatment relies on the cause. Physical therapy, occupational therapy, and prolonged stretching can help reduce spasticity. Splinting, casting, and bracing can maintain range of motion and flexibility.
Reviewed By:
Benjamin Kummer, MD (Neurology)
Dr Kummer is Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai (ISMMS), with joint appointment in Digital and Technology Partners (DTP) at the Mount Sinai Health System (MSHS) as Director of Clinical Informatics in Neurology. As a triple-board certified practicing stroke neurologist and informaticist, he has successfully improved clinical operations at the point of care by acting as a central liaison between clinical neurology faculty and DTP teams to implement targeted EHR configuration changes and workflows, as well as providing subject matter expertise on health information technology projects across MSHS. | Dr Kummer also has several years’ experience building and implementing several informatics tools, presenting scientific posters, and generating a body of peer-reviewed work in “clinical neuro-informatics” – i.e., the intersection of clinical neurology, digital health, and informatics – much of which is centered on digital/tele-health, artificial intelligence, and machine learning. He has spearheaded the Clinical Neuro-Informatics Center in the Department of Neurology at ISMMS, a new research institute that seeks to establish the field of clinical neuro-informatics and disseminate knowledge to the neurological community on the effects and benefits of clinical informatics tools at the point of care.
Shohei Harase, MD (Neurology)
Dr. Harase spent his junior and senior high school years in Finland and the U.S. After graduating from the University of Washington (Bachelor of Science, Molecular and Cellular Biology), he worked for Apple Japan Inc. before entering the University of the Ryukyus School of Medicine. He completed his residency at Okinawa Prefectural Chubu Hospital, where he received the Best Resident Award in 2016 and 2017. In 2021, he joined the Department of Cerebrovascular Medicine at the National Cerebral and Cardiovascular Center, specializing in hyperacute stroke.
Content updated on Mar 31, 2024
Following the Medical Content Editorial Policy
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Q.
Struggling to Function? Why Occupational Therapy Works & Medical Next Steps
A.
Occupational therapy works to restore daily function and independence when tasks like dressing, cooking, working, or focusing become hard, using personalized, evidence-based strategies that address physical, cognitive, sensory, and emotional barriers across many conditions. There are several factors to consider, including red flag symptoms that need immediate medical care, how OT pairs with medications and other therapies, and practical next steps like tracking symptoms, using a spasticity screening tool, and seeking a referral; see the complete details below to choose the safest next steps.
References:
* Chen, H. C., Lee, S. T., & Chen, Y. C. (2023). Effectiveness of occupational therapy in improving social participation and quality of life in people with mental health conditions: A systematic review. *Frontiers in Psychiatry*, *14*, 1248067.
* Lin, S., Zhang, S., Liu, J., Song, Y., Zhang, Q., & Lin, C. (2022). The Effectiveness of Occupational Therapy Interventions in Improving Functional Independence in Older Adults: A Systematic Review and Meta-Analysis. *Journal of the American Medical Directors Association*, *23*(7), 1184-1191.e2.
* Grimshaw, B., & Gomersall, S. (2022). The effectiveness of occupational therapy interventions to improve occupational performance and participation in daily life for adults with mild to moderate stroke: a systematic review. *Australian Occupational Therapy Journal*, *69*(1), 16-30.
* Hansen, B. L., Andersen, S. B., Søgaard, R., & Vestergaard, J. R. (2022). Effectiveness of occupational therapy interventions for people with chronic pain: a systematic review and meta-analysis. *European Journal of Pain*, *26*(9), 1855-1875.
* Hansen, J. A., Lee, S. A., & Bricout, J. C. (2020). The Impact of Occupational Therapy on Health Care Costs and Utilization: A Systematic Review. *Medical Care Research and Review*, *77*(4), 311-324.
Q.
Constant Spasms? Why Baclofen Works & Medically Approved Steps
A.
For constant spasms from neurologic spasticity, baclofen helps by mimicking GABA to quiet overactive spinal reflexes, and in oral or intrathecal pump form it often reduces stiffness and sudden spasms while improving sleep, comfort, and mobility. Because dosing must be individualized and never stopped suddenly, the best outcomes come with medical supervision plus physical or occupational therapy, trigger management, and sometimes other medicines; there are several factors to consider, so see the complete guidance below for key risks, alternatives, and when to seek urgent care.
References:
* pubmed.ncbi.nlm.nih.gov/34187661/
* pubmed.ncbi.nlm.nih.gov/33748956/
* pubmed.ncbi.nlm.nih.gov/35303279/
* pubmed.ncbi.nlm.nih.gov/38006124/
* pubmed.ncbi.nlm.nih.gov/32375549/
Q.
Is it Cerebral Palsy? Why Muscles Stiffen & Medically Approved Next Steps
A.
Muscle stiffness or tightness can be due to cerebral palsy, a non progressive brain injury that affects movement and tone, but it also has many other causes at different ages. Accurate diagnosis uses developmental and neurologic exams and sometimes MRI, and adults with new stiffness should be evaluated promptly. There are several factors to consider, including age specific warning signs, urgent red flags, and evidence based treatments such as early intervention therapies, bracing, medications, botulinum toxin, baclofen pumps, or surgery; for medically approved next steps and when to seek urgent care, see the complete details below.
References:
* Sanger TD, Chen D, Chen L, et al. The mechanisms of spasticity in cerebral palsy. Semin Pediatr Neurol. 2021 Feb;37:100882. doi: 10.1016/j.spen.2020.100882. Epub 2020 Nov 28. PMID: 33504443.
* Novak I, Morgan C, Badawi N. Early diagnosis and early intervention in cerebral palsy: an update. Semin Fetal Neonatal Med. 2017 Aug;22(4):226-235. doi: 10.1016/j.siny.2017.03.006. Epub 2017 Mar 29. PMID: 28366710.
* Novak I, Morgan C, Adde L, et al. Clinical practice guideline for the early detection and diagnosis of cerebral palsy: an update. Dev Med Child Neurol. 2020 Dec;62(12):1354-1365. doi: 10.1111/dmcn.14661. Epub 2020 Sep 28. PMID: 32986877.
* MacLennan AH, Thompson SC, Gecz J. Cerebral palsy: causes, risk factors, and prevention. N Engl J Med. 2015 Jan 29;372(5):472-8. doi: 10.1056/NEJMra1308233. PMID: 25629744.
* Graham HK, Rosenbaum P, Paneth N, et al. Cerebral palsy. Nat Rev Dis Primers. 2016 Mar 3;2:16021. doi: 10.1038/nrdp.2016.21. PMID: 27188282.
Q.
Body Locked in a "Silent Grip"? Why Tizanidine Calms the Storm & Medically-Proven Next Steps
A.
Tizanidine calms neurologic spasticity by dampening overactive nerve signals in the brain and spinal cord, easing stiffness, spasms, and movement limits seen with MS, stroke, and spinal cord injury. There are several factors to consider, including dosing strategy, common side effects like drowsiness and low blood pressure, and the need for liver monitoring. It is not a cure and works best within a broader plan that may include physical and occupational therapy, alternative medications or Botox, and advanced options for severe cases, plus clear guidance on when to seek urgent care. See below for complete, medically proven next steps and safety details that could change which actions you take.
References:
* Zafar S, Khan M, Khan R, Mir FA, Qadeer M. Pharmacological Management of Spasticity in Adults: A Systematic Review. J Pak Med Assoc. 2021 Mar;71(3):1038-1044. doi: 10.47391/JPMA.509. PMID: 33796590.
* Bhandari S, Shrestha K, Pradhan S, Dahal M, Kharel S, Ghimire N. Pharmacology, Clinical Efficacy, and Safety of Centrally Acting Muscle Relaxants for Spasticity: A Systematic Review. Adv Pharmacol Sci. 2021 Jan 18;2021:6665790. doi: 10.1155/2021/6665790. PMID: 33504351; PMCID: PMC7833054.
* Brashear A, Zafonte R, Herman RN, Sheng S, Graham GD, Alexandrescu R. Management of spasticity in adults: a practical algorithm. PM R. 2021 Jun;13(6):634-645. doi: 10.1002/pmrj.12502. Epub 2021 Feb 21. PMID: 33621427.
* See S, Gormley A, Baker D, Kim T. Spasticity: Pathophysiology, Evaluation, and Management. Phys Med Rehabil Clin N Am. 2017 Nov;28(4):713-725. doi: 10.1016/j.pmr.2017.06.002. Epub 2017 Aug 1. PMID: 28993077.
* Shibata M, Komeya R, Akashi M, Tanuma Y, Tsuruta T, Kishioka Y. Tizanidine for spasticity: an updated review. Drugs Today (Barc). 2010 Sep;46(9):661-70. doi: 10.1358/dot.2010.46.9.1504936. PMID: 20436979.
Q.
Is Your Body "Jumping"? Why Your Reflexes Misfire & How to Find Relief
A.
Sudden body jumps are usually reflex related and often harmless from hypnic jerks, stress, caffeine, fatigue, electrolyte shifts, or medications, but persistent stiffness, exaggerated reflexes, weakness, numbness, or other neurologic changes can point to spasticity or brain and spinal cord conditions that need prompt evaluation. Relief can come from lowering caffeine, staying hydrated and correcting electrolytes, improving sleep and stress control, stretching and physical therapy, and when needed targeted medicines or procedures. There are several factors to consider, and important red flags and evaluation steps are outlined below to guide your next steps.
References:
* Nardone R, et al. Spasticity: Current Treatment and Future Perspectives. J Clin Med. 2020 Jul 15;9(7):2227. PubMed PMID: 32679808.
* Trenkwalder C, et al. Restless legs syndrome: an update on treatment and diagnosis. Lancet Neurol. 2021 Jul;20(7):582-595. PubMed PMID: 34147043.
* Taricco M, et al. Spasticity management: An update. J Clin Neurosci. 2022 Dec;106:17-23. PubMed PMID: 36384232.
* Zhou L, et al. Hyperekplexia: clinical features, diagnosis, and treatment. Front Neurol. 2023 Jun 13;14:1169680. PubMed PMID: 37397746.
* Truong DD. Myoclonus: Current Concepts and Future Directions. Mov Disord Clin Pract. 2017 Mar-Apr;4(2):170-179. PubMed PMID: 30364808.
Q.
Locked-In: Why You Hear Everything But Can't Move a Muscle
A.
There are several factors to consider. Most episodes are usually harmless sleep paralysis, a brief REM sleep to wake mismatch where awareness and hearing return before muscle control, so you can hear and breathe but cannot move, sometimes with chest pressure or vivid hallucinations. See the complete guidance below for triggers, simple ways to prevent episodes, and red flags that warrant medical care, including how to distinguish sleep paralysis from narcolepsy, spasticity, seizures, or stroke and when to see a clinician or sleep specialist.
References:
* Bruno MA, Vanhaudenhuyse A, Thibaut A, Noirhomme Q, Schnakers C, Damas F, Schiff N, Laureys S. From unresponsive wakefulness to the locked-in syndrome: a new paradigm? Ann Neurol. 2013 Aug;74(2):167-73. doi: 10.1002/ana.23897. PMID: 23640277.
* Laureys S, Schnakers C. The Locked-in Syndrome: What You Hear But Can't Move. Semin Neurol. 2012 Nov;32(5):423-9. doi: 10.1055/s-0032-1329241. Epub 2012 Nov 28. PMID: 23192661.
* Arlotti M, Di Mauro S, Giustolisi L, Ricciardi D, Peruzzi F, Del Sette M. Locked-in syndrome: a descriptive study in a rehabilitation setting. Brain Inj. 2019;33(13-14):1687-1692. doi: 10.1080/02699052.2019.1654160. Epub 2019 Aug 20. PMID: 31429402.
* Monti MM, Vanhaudenhuyse A, Coleman MR, Boly M, Pickard JD, Tshibanda L, Owen AM, Laureys S. Willful modulation of brain activity in disorders of consciousness. N Engl J Med. 2010 Feb 18;362(7):579-89. doi: 10.1056/NEJMoa0905370. PMID: 20164477.
* Leonardi M, Raggi A, Ferrari A, Schiattone S, Scaratti C, Cerniauskaite M, Sattin D, Formaglio F, Buffoli M, Laureys S. Locked-In Syndrome: A Scoping Review on Diagnosis, Prognosis, and Intervention. J Clin Med. 2023 Mar 14;12(6):2274. doi: 10.3390/jcm12062274. PMID: 36983377; PMCID: PMC10057039.
Q.
Temporary Paralysis During Strong Emotions: A Woman's Guide & Next Steps
A.
Temporary paralysis during strong emotions can be caused by cataplexy related to narcolepsy, functional neurological disorder, anxiety-related freeze responses, focal seizures, or less commonly stroke or TIA; noticing triggers, preserved awareness, and symptoms like excessive daytime sleepiness can help narrow the cause. Next steps range from calling emergency services for stroke-like red flags to scheduling a medical evaluation with neurology or sleep specialists, plus using safety strategies, sleep hygiene, and symptom tracking; there are several factors to consider, and important details that could change your next move are explained below.
References:
* Scammell, T. E. (2015). Cataplexy: mechanisms and treatment. *Sleep*, *38*(11), 1667–1678. PMID: 26237222
* Kanaan, R. A., & Stone, J. (2012). Functional (psychogenic) weakness and paralysis. *Pract Neurol*, *12*(3), 164–173. PMID: 22619056
* Parees, I., & Stone, J. (2018). Functional neurological disorder: recognition and management. *Pract Neurol*, *18*(4), 290–297. PMID: 29773663
* Seneviratne, U., & Sinha, S. (2020). Psychogenic non-epileptic seizures and related functional neurological disorders. *Clin Med (Lond)*, *20*(3), 296–302. PMID: 32371424
* Spiegel, D., & Cardeña, E. (2019). Dissociative disorders: an overview of diagnosis and treatment. *Focus (Am Psychiatr Publ)*, *17*(3), 213–222. PMID: 31558913
Q.
Tizanidine for Women: Side Effects, Safety & Your Next Steps
A.
Tizanidine for women can cause drowsiness, dizziness, dry mouth, fatigue, low blood pressure, and slow heart rate, with rare but serious risks like liver injury; interactions with hormonal birth control containing ethinyl estradiol, ciprofloxacin or fluvoxamine, alcohol, and blood pressure or sedative medicines can heighten side effects, and it is generally avoided in pregnancy and used cautiously while breastfeeding. There are several factors to consider. See below for key next steps, including reviewing all meds with your clinician, asking about liver tests, taking doses when you can rest, avoiding alcohol, and never stopping suddenly, plus when to seek urgent care and how to plan around contraception, conception, or breastfeeding.
References:
* Gan J, Li C, Wang C, Lu Y, Sun J, Zhang Y, Yu J, Li X. Tizanidine: a review of its pharmacology, clinical efficacy, and adverse effects. Expert Opin Pharmacother. 2018 Jan;19(1):97-107. doi: 10.1080/14656566.2017.1408821. Epub 2017 Dec 22. PMID: 29271638.
* Munafo A, Koup JR, Chiang ST, Funke D, Rahn S. Influence of age and sex on the pharmacokinetics of tizanidine in healthy subjects. Eur J Clin Pharmacol. 1999 Apr;55(2):141-6. doi: 10.1007/s002280050604. PMID: 10367807.
* Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Tizanidine. [Updated 2023 Jul 17]. Available from: www.ncbi.nlm.nih.gov/books/NBK501258/
* Reddy KR, Suzuki A, Cohen R, Navarro V, Lewis JH. Update on the management of tizanidine-induced liver injury. Expert Opin Drug Saf. 2018 Sep;17(9):911-923. doi: 10.1080/14740338.2018.1504179. Epub 2018 Aug 3. PMID: 30068412.
* Kamen L, Borel CO, Schiess MC, Turner A, Krantz D. Efficacy and safety of tizanidine in the treatment of spasticity in multiple sclerosis: a double-blind, placebo-controlled, dose-response study. Mult Scler. 2005 Sep;11(5):547-53. doi: 10.1191/1352458505ms1212oa. PMID: 16180590.
Q.
Age 65+: why does my leg feel like it’s vibrating or buzzing?
A.
A vibrating or buzzing feeling in the leg after age 65 is usually nerve-related paresthesia, most often from peripheral neuropathy or restless legs syndrome, but circulation problems, spinal nerve compression, and medication effects are also common causes. There are several factors to consider. Evaluation may include blood tests, nerve studies, Doppler or spine imaging, and you should seek urgent care for new weakness, severe pain, swelling, warmth or redness that could suggest a clot. See below to understand more about specific causes, red flags, and treatment options to discuss with your doctor.
References:
Devigili G, Tugnoli V, Penza P, Lombardi R, Melli G, et al. (2008). The diagnostic criteria for small fibre neuropathy: a clinico–pathological… Brain, 18753168.
Trenkwalder C, Allen RP, Högl B, Paulus W, Winkelmann J. (2016). Restless legs syndrome – pathophysiology, clinical diagnosis… J Neural Transm, 26339368.
Cholongitas E, Papatheodoridis GV, Vangeli M, Terri LV, Patch D, & Burroughs AK. (2005). Systematic review: the model for end-stage liver disease… Aliment Pharmacol Ther, 16313421.
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https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Smania N, Picelli A, Munari D, Geroin C, Ianes P, Waldner A, Gandolfi M. Rehabilitation procedures in the management of spasticity. Eur J Phys Rehabil Med. 2010 Sep;46(3):423-38. PMID: 20927008.
https://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y2010N03A0423Dietz V, Sinkjaer T. Spasticity. Handb Clin Neurol. 2012;109:197-211. doi: 10.1016/B978-0-444-52137-8.00012-7. PMID: 23098714.
https://www.sciencedirect.com/science/article/abs/pii/B9780444521378000127?via%3DihubSheean G. The pathophysiology of spasticity. Eur J Neurol. 2002 May;9 Suppl 1:3-9; dicussion 53-61. doi: 10.1046/j.1468-1331.2002.0090s1003.x. PMID: 11918643.
https://onlinelibrary.wiley.com/resolve/doi?DOI=10.1046/j.1468-1331.2002.0090s1003.xBarnes MP Johnson GR. Upper Motor Neurone Syndrome and Spasticity : Clinical Management and Neurophysiology. New York N.Y: Cambridge University Press; 2001.
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