Managing Multiple Sclerosis Spasticity


Christopher Iliades, MD

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woman holding her lower back

If you have multiple sclerosis (MS), one common symptom you may experience is stiffness. In fact, 80% of people with MS develop some stiffness, or what doctors call spasticity. This MS-related spasticity can range from mild to very severe. It can come and go, and fatigue may trigger it. However, there are various strategies to help you cope with and manage spasticity.

Symptoms of MS Spasticity

Spasticity symptoms can range from a mild feeling of tightness to uncontrollable and painful muscle spasms. MS spasticity occurs most often in the muscles you use to walk and maintain your posture. As a result, you're most likely to notice these symptoms in your legs or back.

Your symptoms may include:

  • Difficulty moving muscles

  • Difficulty relaxing muscles

  • Difficulty straightening or bending your legs

  • Involuntary and sudden muscle movements

  • Reduced range of motion

  • Sensations of tightness or pain

Coping With MS Spasticity

MS spasticity can cause a wide range of symptoms that can vary greatly from person to person. Your MS doctor will check you for signs of spasticity by checking your muscle strength, your range of motion, and your reflexes.

It's important that your doctor checks for spasticity and treats it. Left untreated, spasticity can cause your muscles and joints to freeze. This condition is called contracture. Your options for managing MS spasticity include physical therapy, medications, and avoiding spasticity triggers.

Common triggers include:

  • Extreme temperatures

  • Fatigue

  • High humidity

  • Infections

  • Sudden movements

  • Tight clothing

Physical Therapy for Spasticity

Physical therapy is often the first choice for treating spasticity. This includes both stretching and range-of-motion exercises. Your doctor may recommend some exercises for you, or you may work with a physical or occupational therapist.

Your regimen may include:

  • Daily stretching exercises done on your own

  • Exercise in a comfortably warm pool

  • Passive stretching and range-of-motion exercises done for you by a therapist

  • Use of mechanical devices to give support and prevent contracture

Medications for Spasticity

The National Multiple Sclerosis Society recommends starting treatment with one of the MS disease-modifying drugs at diagnosis. Work with your doctor to find the best disease-modifying treatment for you. This is the best way to reduce attacks of all your MS symptoms.

There are also some medications that are specific for treating spasticity. These drugs don't cure spasticity, but they help with the symptoms.

Common spasticity drugs include:

  • Baclofen (Lioresal). This is a muscle-relaxing drug. It is the most common drug for MS spasticity. Usually, you'll take this in pill form. In severe cases, doctors might inject it into the spinal cord. It's important never to alter your Baclofen dosage or discontinue the drug without first consulting with the prescribing doctor.

  • Tizanidine (Zanaflex). This drug relieves muscle spasms. Your doctor may tell you to take it at night because it can cause sleepiness.

  • Diazepam (Valium). This drug is a benzodiazepine, so it can be habit-forming. It also causes sleepiness, which is why it's best to take it at bedtime.

  • Dantrolene (Dantrium). This is a powerful muscle relaxant. It can cause liver damage and blood problems, so it's not a first-choice drug for spasticity.

  • Botulinum toxin (Botox). This drug is an injection and may relieve muscle spasms in specific areas for up to three months.

Medical marijuana is another option you might consider for MS spasticity. A 2012 study in the  Canadian Medical Association Journal found that smoking marijuana was better at relieving MS spasticity than a placebo cigarette (one without marijuana). The study was small, involving just 37 people with MS spasticity. But it found that marijuana cigarettes significantly reduced pain and spasticity scores compared with the placebo.

It's legal to smoke marijuana for medical purposes in some states. It's not in others.  But a pill form has been legal with a doctor’s prescription since 1985. This drug is dronabinol (Marinol).

There are lots of options for managing MS spasticity. Your best bet is to let your doctor know about any spasticity symptoms. Then, work closely with your MS treatment team to prevent progression of MS and MS spasticity.

Key Takeaways

  • Spasticity is a common MS symptom.

  • Spasticity can range from mild discomfort to serious disability.

  • Symptoms of spasticity occur most often in the legs and back.

  • Your doctor should diagnose and treat spasticity to prevent severe stiffening, or contracture.

  • Managing spasticity includes physical therapy, medication, and avoiding your spasticity triggers.

Man Sleeping on His Side

Tips for Better Sleep With MS

MS symptoms like pain and muscle spasms are some obvious challenges to shut-eye.
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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Jan 19, 2018

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View Sources

Medical References

  1. Corey-Bloom J, et al. Smoked cannabis for spasticity in multiple sclerosis: a randomized. Placebo-controlled trial. CMAJ. 2012; 184(10).
  2. Spasticity. National Multiple Sclerosis Society.
  3. MS the Disease. National Multiple Sclerosis Society.
  4. Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008; 4(1): 245–259.
  5. Multiple Sclerosis and Spasticity. United States Department of Veterans Affairs.

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