Spasticity and spasms

Professor Jon Marsden, MS Clinical Nurse Louise Jarrett and Clinical Specialist Physiotherapist Rhian O’Halloran unpick spasticity and spasms

Muscle spasms and spasticity are common symptoms of MS. They can have a big impact on quality of life and daily activities for many people with MS. Treatment options include medication, physiotherapy and other therapies which can help you to maintain mobility and a pain-free life.

Spasticity makes your muscles feel stiff, heavy and difficult to move. A spasm is a sudden stiffening of a muscle which may cause a limb to kick out or jerk towards your body.

Spasticity can sometimes be helpful.  For instance, if your leg muscles are weak, a degree of stiffness in your legs may help you walk or transfer from a bed to a chair.  The health professionals who can help you in managing spasticity in MS will consider this as part of their assessment of the effects of muscle spasticity and any trigger factors that might be making it worse.  

Physiotherapists can help with stretching exercises and positioning. Occupational therapists can advise on good posture and on seating and on ways to make your day to day tasks easier. There are a number of drugs that can help manage spasticity in MS. Your MS nurse, GP or neurologist can discuss this with you.

What is the difference between spasticity and spasms?

People with spasticity describe their muscles as feeling stiff, heavy and difficult to move. When spasticity is severe it can be very difficult to bend a limb at all.

A spasm is a sudden involuntary tightening or contraction of a muscle. Any muscle can be affected but spasms and spasticity affecting the arms, legs or back are most common.

Spasticity and spasms can range from mild to severe and can vary over time, even throughout the day. The symptoms can be annoying, uncomfortable and unpredictable. Some people find that they can be painful, affect walking, sleep, and cause falls.

Different types of spasm

  • A spasm that causes a limb to bend, such as causing the leg to move upwards towards the body, is called a flexor spasm

    Flexor spasm

  • A spasm that causes a limb to extend, such as causing the leg to straighten away from the body, is called an extensor spasm

    Extensor spasm

  • A spasm that causes a limb to be pulled in towards the body, such as making it difficult to separate the thighs, is called an adductor spasm

    Adductor spasm

  • Spasms affecting the trunk - the back or trunk can arch off a bed or away from the back of a chair

    Spasms affecting the trunk

What causes spasticity and spasms?

Spasticity and spasms are caused by an increase in muscle tone in parts of your body. Muscle tone is the level of tension in a muscle. It is what enables you to move your limbs or hold a position.

Normally, your brain and muscles work together to coordinate smooth movement, tightening and relaxing different muscles in order.

If the nerve signals between a muscle and the brain are interrupted by MS damage, the muscle can remain tight and resistant. It does not relax at the right time, making the affected part of your body feel stiff or difficult to move. 

Spasticity can affect any muscle in the body because MS can affect any of the nerve pathways between your muscles and your brain. Disrupted nerve pathways can also mean your muscles get too many nerve messages, causing them to twitch or spasm. Sometimes, spasticity can be persistent, and if a limb becomes fixed in one position it is known as a contracture. 

Symptoms that often occur with MS spasms and spasticity include pain, weakness and clonus.

  • Pain
    Spasticity and spasms are not always painful. If there is pain it may feel like a pulling or tugging of the muscles, particularly around joints, or a long lasting episode of cramp.  Sometimes spasticity and spasms can lead you to alter how you sit or lie and this can also lead to pain.  Movement and stretching exercise can help manage this.
  • Weakness
    The damaged nerve pathways can make muscles stiff or weak. This can lead to some muscles being stiff and others weak in the same limb. Sometimes removing spasticity entirely is not helpful as it leaves just weakness and may make it harder for you to walk or move from bed to a chair. An assessment of your spasticity, perhaps by a physiotherapist, will identify if the stiffness in a limb is helping you function.
  • Clonus
    Clonus is a repetitive, up and down movement, often seen as a constant tapping of the foot. You can reduce the effects of clonus by moving your leg or putting more weight through your leg by standing or perhaps leaning forward.

How many people get spasticity and spasms?

Research suggests that between six out of ten to nine out of ten of people with MS will be affected by spasticity at some point. Most people will only experience occasional symptoms. About one in five people reported that spasticity and spasms frequently affected their activities and one in eight described their symptoms as severe.

What can I do if I have spasticity and spasms?

It is important to keep your muscles, ligaments and joints as flexible as possible. This can be done through stretching, active movement (where you move your own limbs) or passive movement (where your limbs are moved by a carer, physiotherapist or automated exercise machine). A physiotherapist can advise on how best to maintain flexibility, teach specific stretches that you can incorporate into your daily routine and ways of moving and positioning your body to prevent contractures.

Read more about exercises for people with MS

Maintaining good posture is also important, whether standing, sitting or lying down. An occupational therapist can help you find adapted seating, cushions or aids to improve your sleep positions and seating posture, and advise on safe use of wheelchairs or walking aids.

Read more about posture

Spasticity trigger factors

Trigger factors are the events or situations that can make spasticity and spasms worse. Types of trigger include:

  • other MS symptoms - such as bowel or bladder problems or pain
  • other health conditions - such as an infection or an ingrown toenail
  • external triggers - such as tight fitting clothes or being too hot or too cold

Managing your trigger factors can help reduce the effects of spasticity or spasm without needing any medication. If you are taking medication, it will not be fully effective unless any trigger factors for spasticity are also being addressed.

Read more about spasticity triggers

How are spasticity and spasms treated?

Using drugs to treat spasticity and spasms effectively is a balance between reducing stiffness and not reducing strength in a muscle. If you remove all of the spasticity from a limb, the muscles may be too weak to work properly. For instance, if you have spasticity in your leg, the stiffness may help to keep it rigid enough to help you walk. If all of the stiffness is removed, the muscles might be too weak to hold you up.

There are a number of medications for spasticity. NICE's clinical guideline on the management of multiple sclerosis says that the first line of treatment should be with baclofen or gabapentin. If either of these isn't helping, a combination of the two drugs may help. If not, tizanidine or dantrolene are other possible treatments to try. Pregabalin, diazepam and clonazepam are also sometimes used to treat spasticity and spasms.

Treatment usually starts with a low dose and gradually increases until a level is reached that helps you best. 

It is important that you consider when you take them during the day to maximise their effect. For instance if you struggle to get up, washed and dressed, taking your medication 10-20 minutes before you get out of bed may ease the effort of your morning routine. If you need some stiffness in your legs to help you get out of bed safely, you may prefer to take your treatment after you have got up.


Sativex is a cannabis-based mouth spray that is licensed for the treatment of MS spasticity. Sativex is not widely available on the NHS, other than in Wales where the drug regulator has approved treatment. It can be prescribed by a specialist doctor. If no improvement is seen within 4 weeks, treatment will be stopped, as only around half of people respond to Sativex.

If other approaches aren't helping your spasticity, the following treatments may be considered:

Botulinum toxin (Botox)

If the spasticity affects only part of your body botulinum toxin may be helpful. Botulinum toxin (botox) is injected into muscles and temporarily weakens them for about three months. During this period a physiotherapist can advise you on moving and stretching exercises that you can do to reduce the effects of spasticity in the longer-term. 

Intrathecal baclofen

Intrathecal baclofen therapy involves having surgery to place a small pump in your abdomen. The pump delivers baclofen through a fine tube (called a catheter) into the fluid space around your spinal cord (called the intrathecal space). The pump uses much smaller doses of baclofen than when you it take it as tablets and so causes fewer side effects.


Treatment with phenol is usually only used if you have severe spasticity that hasn't responded to other treatments. Phenol is injected into the space around the spinal cord. Intrathecal phenol is an irreversible, destructive treatment that permanently stops nerve messages. This can greatly reduce spasticity in the legs but may also reduce skin sensation, affect sexual function and alter how your bladder and bowel work. If your doctor is considering treatment with phenol, you will already be aware of these symptoms and may have a urethral or suprapubic catheter, a skin management programme to avoid pressure ulcers or be using suppositories regularly.


Surgery is rarely performed to reduce spasticity. Very rarely, an operation called Selective Dorsal Root Rhizotomy (SDR) is done, although this is more commonly performed in children with cerebral palsy. If you have contractures, your neurologist may recommend surgery once the spasticity has been effectively treated with oral medication or intrathecal baclofen.

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