Spasticity and spasms

Spasticity and spasms affect how you move, can interfere with daily life and may be painful. Spasticity makes muscles feel tight and stiff, while spasms cause parts of your body to suddenly arc, bend, clamp together or kick out. Tailored health care support, regular movement, stretches and learning about triggers, will help reduce the risk of complications.

Learning to identify spasticity and spasms is the first step to getting help. This is not always easy with a condition like MS. A 2021 research survey revealed that seven out of 10 people with MS had had spasticity for longer than they’d realised. When it came to discussing spasticity with their health professionals, half felt they lacked the words to describe it.

Spasticity and spasms can restrict how you move, cause uncontrolled movement and may be painful. To help you recognise them and their associated symptoms (contractures and clonus), we explain how they can feel below, alongside their medical terms: 

• Spasticity

People often say spasticity makes their muscles feel stiff, heavy and difficult to move and bend. 

Health professionals will talk about an increase in muscle tone. This is a tightness or feeling of resistance that gets worse the faster you try to move, though you can experience tight muscles when you're resting too. 

Your movements will be slower. Some liken it to wading through treacle. Others describe it as a pulling or tugging feeling. 

This tightness can affect individual muscles, a group of muscles in a particular area or across your body. It mainly affects your legs, arms and trunk, and for some their speech and swallow.  

• Spasms

A spasm is a sudden exaggerated movement that can catch you off guard, make you lose your balance and wake you at night. It happens when multiple muscles contract at the same time causing a sudden jerky movement. Examples can include your legs shooting upwards, kicking out or clamping together. It can also affect your spine making it twist or arch.  

Spasms can affect any muscle, but they are most common in your legs, arms and back. 

They can feel uncomfortable, sometimes painful like a longer episode of cramp. They can also be embarrassing, annoying and tiring. 

Your health professionals will use these terms to describe the different types of spasms:

	a flexor spasm causes your limb to bend upwards towards your body
	an extensor spasm makes your limb extend away from your body
	an adductor spasm causes a limb to be pulled in towards your body - for example making it difficult to separate your thighs
	back and trunk spasms can make you arch off a bed or away from a chair

• Contracture (limb not able to move) 

Prolonged spasticity and spasms can lead to the movement in your legs and arms being completely restricted. 

Lack of movement causes muscles to shorten, so you or someone else is unable to move your arm or leg. Without effective stretching, positioning and use of medication, a joint can fix in position permanently. This is a contracture and preventative measures are vital to avoid reaching this stage. Once a contracture develops, it is difficult to treat and change the position of the limb. It's why spasticity and spasms require an effective management plan and regular assessment. 

• Clonus 

Clonus is often associated with spasticity and spasms. You are most likely to notice your foot suddenly starts tapping, a fast, repetitive, up down movement. It's caused by heightened stretch reflexes and is often triggered when you place your foot on a hard surface like a wheelchair footplate.

You can reduce the effects of clonus by moving your leg or putting more weight through your leg by standing or leaning forward.

The central nervous system and muscles work together to coordinate our movements by passing signals back and forth along the nerve pathways. This keeps our movements smooth and fluid, ensuring opposing muscles tighten and relax in sequence. 

Our stretch reflexes – like the response when your knee's tapped and your leg kicks out – regulate how much tension is in our muscles. They control the amount our muscles tighten and relax. They do this to help us move but also to protect our muscles from injury. They help us stay upright when sitting or standing, correct our posture and balance, and keep us from falling.

MS can upset this careful balance. Its damage can interrupt the nerve signals travelling to and from the central nervous system. In the confusion your stretch reflexes become more excessive. Your muscles become hyperactive, their tension increases and causes your spasticity and spasms.

Spasticity and spasms are common in MS though the intensity can vary greatly from person to person.

Research suggests that at least two thirds of people with MS will experience some degree of spasticity, and this increases to nine out of 10 people at its highest estimate. It is an important symptom to know about, even if you only have mild symptoms as early interventions can benefit you in the long term. 

Symptoms can change day to day and hour to hour. They may evolve over time, but being easily aggravated, they can suddenly worsen. They can range from minor changes to your mobility, comfort and function, to permanent loss of movement. It is why effective symptom management is so critical.   

In the first instance speak to your MS team or GP. You are likely to need a referral for an assessment with a physiotherapist. 

Local teams managing spasticity and spasms can vary, but often include a physiotherapist, doctor and nurse. Depending on your needs, you may also be referred to other specialists such as occupational therapists and seating services. 

Your assessment may take place with more than one health professional so they can pool their knowledge. It is likely to include:    

1. discussing your symptoms, triggers, and expectations

You will be asked about the history of your symptoms, how they impact on everyday life, and whether you have any pain associated with them. They will ask about any medications you are taking, so it can help to bring along a list that includes the doses and what time you take your medication. 

An important part of your discussion will focus on trigger factors. Have you noticed anything in particular that sets off your spasticity and spasms? Do you have any unresolved MS symptoms such as problems with your bladder or bowel? These are known to worsen spasticity and spasms and will need treatment to manage them effectively.

You will be asked about what's important to you, your hopes and expectations. As long as these are achievable, they will shape your symptom management plan.

2. observation

Your health professional will want to gauge how you move. They may ask you to walk a short distance if appropriate or observe your positioning when sitting. They are looking to see if your spasticity and spasms have affected your posture. Poor posture leads to pain and pressure sores, which in turn worsens your stiffness and spasms.     

3. physical examination

It may help to wear loose clothing because your health professional will want to check:  

• whether spasticity or weakness is the main reason for your stiffness or feeling of heaviness
• the amount of muscle resistance when they move your arms and legs
• your range of movement 
• any visible signs of spasms  
• if you have any contractures.

There are things you can do now to help your symptoms while waiting for your appointment, so it's worth speaking to your GP and MS team. Self-management is one of the most important aspects of managing spasticity and spasms. Your health professionals will advise you, but movement, exercise, stretches and recognising trigger factors will need to be an essential part of your new daily routine:

• get to know your symptom triggers. Spasticity and spasms are easily aggravated by things that may seem completely unrelated at first. They include blisters, pressure sores, bad posture, urinary tract infections, bladder and bowel issues, colds, temperature extremes, menstruation and tight clothing. Some may be very individual to you, so keeping a diary of your symptoms can really help. Take a moment to read what triggers these symptoms and if any ring true, speak to your MS team or GP. Managing these triggers successfully will help reduce your spasticity and spasms. 

• stretch within your range of available movement:  to keep your muscles, joints and ligaments mobile. This is important because muscles shorten from lack of use, potentially leading to permanent loss of movement over time. Stop if you experience any pain. Regular movements can include continuing to move every part of your body each day and adjusting your position regularly from lying to sitting, and sitting to standing if possible. This can mean by yourself, with support of someone else or with the use of equipment for example a standing frame. Speak to your MS team, physiotherapist or GP if you have any concerns about doing these exercises safely. 

  You can read more about exercises for people with MS here.

Managing these challenging symptoms requires a team approach with you at the centre, actively involved. Self-management is hugely important with the support of a range of health professionals. It can take time and perseverance to find the best approach for you. 

Visit our managing spasticity and spasms page for an in-depth look at the various therapies, self-management strategies and medications.

Spasticity and spasms can have a knock-on affect on other aspects of your life such as:

• pain
• weakness
• poor posture
• pressure sores
• walking difficulties
• disturbed sleep
• sexual problems
• low mood, low self-esteem and depression

To try and address these, it is worth speaking to your MS team or GP about possible referrals that may help.