Spasticity triggers

Spasticity and spasms are easily aggravated, so getting to know your trigger factors is important. Being able to identify and act on them when your symptoms suddenly worsen, is a key part of managing your stiffness and spasms effectively. There are many different trigger factors and some may surprise you.

Muscle stiffness and spasms are common MS symptoms and can worsen significantly due to other influences, such as an infection or a change to your routine. They are called trigger factors (or aggravating factors). If your trigger factor is managed appropriately, then your stiffness and spasms will likely ease without any changes to spasticity medication. If not, it can lead to worsening stiffness and spasms, unnecessary medication changes or secondary problems such as muscles becoming tighter and shortened. This can be very distressing and may affect mobility, dexterity and quality of life. 

Although identifying spasticity and spasm triggers is usually straightforward, sometimes it can be difficult to pinpoint what is responsible. The list below will help you identify some potential trigger factors and explain what to do next to resolve them. It is not an exhaustive list, but you may find it a useful checklist should you notice a change in your normal function or routine. 

If you have difficulty identifying your trigger factor, it can help to keep a muscle stiffness and spasm diary.

These include:

This is one of the most common causes of worsening spasms and stiffness and may require antibiotic treatment. Its symptoms may include some of these:

• frequent urge to pee
• pain or discomfort when weeing
• smelly pee
• wee that has changed colour
• painful catheter
• blocked catheter
• difficulty starting urine flow
• needing to wee again soon after going to the toilet
• pain in the lower abdomen

Most people experience some or all of these symptoms with a UTI, while others may experience additional symptoms. Keep in mind that some people with MS may not have any of the usual symptoms yet still have a urinary tract infection, so it is worth getting tested if you notice your MS symptoms worsening. 

Suspect a UTI?

If you need to wee soon after going to the toilet or are having difficulty peeing, it can be a sign your bladder is not emptying properly. This can irritate your bladder and make you more at risk of infection.

Recurrent urinary tract infections or pain in the lower abdomen may require investigation. 

It is very important that your bowels move regularly and freely. A change in your normal bowel routine is one of the most common causes of worsening stiffness or spasms. If you are having more difficulty moving your bowels, they’re less frequent or your stools are hard and difficult to pass, you may have constipation. Sometimes people can have constipation together with diarrhoea and this can be a sign of extreme constipation and a full bowel. It is called an impacted bowel. Loose stools or irritable bowel syndrome can also affect your stiffness and spasms.

Anything rubbing on your skin can cause irritation, redness or blistering. Common causes include tight clothing, friction from new footwear, rubbing from a leg or arm splint or urinary catheter, or a side effect of medication. Left untreated, skin irritation increases the risk of developing an infection and complications from skin breakdown.

Excessive pressure on the skin affects your circulation and leads to skin damage, breakdown and pressure sores. This can occur if you have difficulty moving and changing position. It is a good idea to check your skin daily for any signs of damage. Skin damage and breakdown is a very serious problem and needs immediate medical attention.

Any burn can set off your symptoms, so it’s important it is dealt with properly to avoid infection and serious complications. Contact your GP as they can organise treatment from your district or practice nurse. 

Any infection will aggravate your stiffness and spasms until it has settled. Common examples include a urinary tract infection, chest infection, mouth or tooth infection and common illnesses such as a cold, flu or tummy bug. See your GP or dentist for appropriate treatment. 

If you have difficulty changing your position when lying or sitting, you may experience discomfort. This may mean that you have too much pressure on certain parts of your body. If this is causing your spasticity and spasms to worsen then contact your local physiotherapist or occupational therapist for further advice.

This should be checked by your GP. They can prescribe appropriate pain medication and refer you for further investigation if required. If you have nerve pain, your GP may refer you to your MS nurse or neurologist for further advice regarding appropriate pain medication.

If you have new joint or muscle pain, contact your local physiotherapy service or ask your GP to refer you. 

If your body is overtired then this can temporarily worsen your symptoms. This may be due to physical tiredness, mental exhaustion or difficulty sleeping. Your symptoms will generally ease as your energy levels improve, but you may benefit from advice from your local physiotherapist or occupational therapist to help you pace your activities and manage your fatigue.

If you are feeling stressed or anxious about something, then your symptoms may worsen. Sometimes being aware of your feelings helps, but you may also benefit from speaking to a counsellor. Your GP can refer you. 

Being too hot or cold can cause your stiffness and spasms to temporarily worsen. Try to keep your temperature as constant as you can. The spasms and stiffness will ease once you become more comfortable.

Some people can experience a worsening of symptoms after vaccinations for example for Covid-19 or flu. This is generally a short-term effect and symptoms will settle down in time. If you have concerns, you should contact your GP for further advice.