Spasticity Part 2 - Exercise is not a luxury

In my last column I explained just what spasticity is and why it varies from person to person. This time round we will start to look at what you can do about severe spasticity that is interfering with your health and quality of life.

Just remember that mild or moderate levels of spasticity can be very useful and beneficial to you if managed correctly; but if you do have severe spasticity there are 5 broad categories of treatment that you could consider in conjunction with your doctor and your physiotherapist.

These are:

  • Physiotherapy.
  • Medication taken by mouth.
  • Injections that will block nerves and/or muscles.
  • Intrathecal drug delivery systems.
  • Surgical options.

Going through each of these options one by one, it is always important to start with the simplest, safest and least invasive form of treatment and work up to the “groot kanonne” only if nothing else has helped. So this time we will focus on physiotherapy and physical treatment and exercise - and leave the other, more complex treatments, for the next issue.

Now I trust that I’m not going to offend any of the physios by venturing onto their turf, but I (as a non-physio) do have to say something about physical treatments because it is really impossible to even start to think about treating spasticity without them.

Spasticity can be controlled or at least decreased by regular, ongoing physical therapy. Recently there have been some questions raised about just how effective these treatments are, but it seems to me that they will always form the foundation of any spasticity treatment programme. We may well see the nature of physical treatments change to some extent in the coming years, but they will always be around.

  • You should ensure (if this has not already happened) that your physio teaches you how to do a comprehensive programme of active and passive arm and leg movements and stretching exercises. This will help you to maintain range of movement around the joints involved in the spasticity and will assist in preventing contractures. You should be doing these at least three times a week.
  • A regular programme of “therapeutic standing” using a standing frame, tilt-table, callipers or back-slabs can also help to decrease spasticity and maintain range of movement in the leg joints.
  • Many people find that prone lying (lying on your stomach) for about 20 minutes per day not only decreases spasticity, but helps to stretch the hip and knee joints properly. There are many of you, especially those with quadriplegia that will find this an awkward and frightening position at first, so it is important that you ask your physio or O.T. to show you how to lie and help you to get used to lying prone.
  • Hydrotherapy can significantly reduce levels of spasticity and if you do have access to a hydrotherapy pool, or at least to a pool with a warm water that you can use regularly, this is something to discuss with your physio.
  • Finally, your physio may be able to help with “trigger point” stretching treatment or with “dry needling” in some instances.

If you do have significant levels of spasticity you should first discuss this with your physio and explore all of these options.

There are no magic wands and there are no instant results, but with persistence and patience you may find that with these physical treatments alone, you achieve adequate and acceptable control of your spasticity.

Once you have set up your physical treatment regimen, it’s worth taking time and trouble to incorporate it into your day-to-day routine and to be disciplined about keeping up.

I understand that everything does take longer, requires more effort and interrupts “normal” life, but it’s really worth trying to control spasticity with these simple measures if at all possible.

There is some evidence, especially in the year or two after a new injury, that if you vigorously engage in a physical treatment program, you can modify your spasticity in the long run and end up with it not being a lifelong problem.

The converse is also true! If you neglect your positioning and end up sitting and lying with a poor posture, if you do not exercise and if you allow spasticity to get hold of you with resulting contractures, it becomes more and more difficult to break the downward spiral.

For those of you who have a spinal cord injury and who do not have immediate or easy access to a physiotherapist, I encourage you to go and have a look at this great website which has been designed to assist physios and patients in putting together practical exercise programmes for people with spinal cord injury. The site is a great resource but, wherever possible, you should try to get the advice of a physiotherapist, even if it is just to set up your programme.

This seems to be a good place to close off for now. I once saw a poster in a gym run by an innovative bio-kineticist that said, “He who would make no time to exercise, must make plenty of time for illness”! So, today’s take-home message: if you want to control and manage your spasticity, physical treatment and exercise is not a luxury, it is essential.

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