b'Symptom ManagementUUnnddeerrssttaannddiinnggMMSSSSppaassttiicciittyyHow daily stretching can helpBy Ted BrownSpasticity is one of the more common yetWhen spasticity worsens, the gait becomes misunderstood symptoms of multiple sclerosis.increasingly unsteady with shortened strides, Spasticity may be experienced in various ways,more sway from side-to-side, and problems including limb stiffness, muscle spasm, fatigue,such as foot dragging and scissoring of the or pain. This article will review the causes oflegs arise. spasticity, its cardinal signs, what sort of painAnother sign of spasticity is overactive symptoms it causes, and strategies used toreexes. Human reexes involve a signal loop manage it.carried from a stretched muscle tendon to T wooffaacceessooffssppaassttiicciittyy the spinal cord and then back to the muscle. TwThe word spasticity is derived from theThe result is a reex contraction of the muscle impulses from the central nervous system. In Greek word spastikos, meaning drawing in,spasticity, the regulatory signals coming from tugging, or shaking uncontrollably. At its core,higher levels of the central nervous system spasticitymeanshavingunnaturallystiffare impaired, which causes the reexes to muscles with overactive reexes. Well discussbecome exaggerated. The medical term for stiff muscles rst. Normal muscle actions suchthisishyperreexia.Thismayresultin as walking, sweeping the oor, or hammeringmuscle spasms, which may be spontaneous a nail require coordinated repetitive patterns ofor triggered by movement and can be brief or movement during which muscles alternatelyprolonged. Generally, the longer the muscle relax and contract. With spasticity, muscle bersspasm, the more painful. areinaconstantstateoftension,knownWe have described two aspects of spasticity, medically as hypertonicity. namely hypertonicity and hyperreexia. Both Spastic muscles dont relax when they arecan cause pain. In a state of hypertonicity, supposed to. This makes the limb(s) stiffen,the longer a spastic limb remains inactive, the joint range of motion declines, and thethe tighter and tighter the muscle becomes, desired movement is more effortful and lesslike a twisting rubber band. This causes an uid in execution. The simultaneous contractionachy kind of muscular discomfort.of muscles to ex and extend a limb adds toHere is how one patient, Dan, described the the workload and energy expended by thepain caused by sleeping overnight without muscles in routine activities of daily living.movement: When I wake up in the morning, Even with mild leg spasticity, the energyI am so tight and stiff that I literally groan in expended in walking goes up by one-third.pain.msfocusmagazine.org 18'