Muscle spasticity - what is it?
Muscle spasticity is a syndrome that develops when areas of the upper motor neurons are affected, and there is an increase in tonic reflexes as a result of stretching, combined with an increase in reflexes in the tendon area. The concept of muscle tone means a certain level of tension muscle groups and resistance that occurs during extension or flexion movements of a limb segment. The normal state is considered to be a feeling of some slight elasticity when palpating the muscles, as well as some muscle tension during leisurely movements. A certain increase in the tone of muscle groups is accompanied by strong resistance during passive movements.
Increase muscle tone can greatly influence the process of regeneration of previously impaired functions. High level muscle spasticity does not allow the implementation of intact functions, as well as the full recovery of impaired ones. At the same time, an increase in muscle tone is a compensating factor for the development of paralysis. This determines the urgent need, immediately after the start of treatment, to clearly determine how necessary and useful it is to reduce the muscle tone of a cramped arm or leg.
Symptoms of spasticity
The main symptom of spasticity is involuntary muscle contraction. This process is accompanied by a headache and a general feeling of weakness throughout the body. Not always painful sensations can be classified as symptoms of spasticity. Very often, the cause of this condition is too sudden movements, which cause spasmodic contractions of the muscles of the arms or legs. In addition, pain can occur as a result of a change in the position of the patient's body, in particular at the moment when attempts are made to sit him down.
As a result of spastic contractions, the arms or legs cease to obey, become too weak, or acquire additional rigidity. In this case, a sick person with spastic muscle contractions may feel both weakness and some resistance from the cramped muscles. These factors are a consequence of the conduction of muscles and nerves. When taking medications, there is some relief from tense muscles, but the feeling of weakness remains.
Other symptoms of spasticity include involuntary contractions of individual muscle groups, as well as a feeling of general fatigue and loss of dexterity in the muscles. Numerous testimonies from patients characterize spasticity as excessive tension in the muscles, weakness in the legs, and resistance when moving the legs and arms.
Spasticity after stroke
Stroke is an extremely important medical and social problem, since it is one of the causes of many cases of disability, usually related to disorders of human motor activity. In the vast majority of all cases acute period stroke is characterized by the detection of hemiparesis; in approximately two thirds of all cases, the presence of residual effects after a stroke is noted. In the majority of cases, stroke occurs in people of retirement age, and women are 20% less susceptible to it than men.
Immediately after the onset of a stroke, there is a decrease in muscle tone in the limbs, but after three days it recovers, eventually returning to average values. Depending on the severity of the stroke, the duration of the painful condition and the degree of muscle spasticity may vary. The basis of spasticity after a stroke is a disruption of the activity of the parts of the human cerebral cortex responsible for motor activity limbs.
Spasticity with cerebral palsy
Spastic form of a child cerebral palsy is a very common phenomenon. At the same time, individual muscles of the child’s body remain in increased tone, which occurs due to failures in the full functioning of the muscles of the arms and legs. A state of extreme tension is very typical for muscles with cerebral palsy and this is the cause of a strong slowdown in their growth. At the same time, there is significantly more rapid growth bones rather than muscles, which causes a significant difference in the length of muscles compared to bones and tendons. In this case, there is a decrease in the size of the affected limb and the joints of this limb become less mobile.
To prevent all this from happening, immediately after the child is diagnosed with cerebral palsy, classes should be conducted with him. You can start with regular classes using exercises physical therapy, the results of which will determine methods of combating spasticity. Such an approach will help achieve the necessary results.
Spasticity in multiple sclerosis
Spasticity is a symptom that is most related to multiple sclerosis. direct relation. However, when describing the symptoms of their condition, patients do not always interpret it correctly. Often, by spasm they mean a sharp wave of surging pain, while a spasm is an involuntary contraction of muscle groups. To avoid confusion, the meaning of these terms should be understood.
Spasticity in people suffering from multiple sclerosis often manifests itself in the form of unexpected contractions of certain muscles. These contractions may occur spontaneously or may be a reaction of the body to external stimuli. The degree of manifestation of such symptoms is very diverse, from a mild form to severe spasms that last a long time. In this case, the patient will need to move around wheelchair. In multiple sclerosis, spasticity may change over time. In this case, the muscles of the arms and legs are mainly involved, and much less frequently the muscles of the back or other parts of the body.
There are some cases in which spasmodic muscle contractions may even be beneficial. This refers to conditions in which the sick person is too weak in the legs and the spasm helps him take stable position. In this case, when spasticity is removed, the person’s legs give way and he will not be able to stand on his own.
Spasticity treatment
Treatment methods for spasticity can be different, some of them can be distinguished:
- Physiotherapy is used to stretch muscle groups and maintain joint mobility, while reducing the risk of injury. When muscle mobility is low, physiotherapy can be used as a means of gradually and smoothly stretching them. In some cases, it may be advisable to undergo minor surgery to increase the length of the ligament by making an incision in the leg;
- Drug therapy is used in cases where it is necessary to take medications to relieve increased tension in the leg muscles. The mechanism of action may be different; some drugs affect the spinal cord, others affect brain receptors;
- botulinum toxin is a remedy that provides the proper effect when used when it is necessary to relax a spastic muscle on short time. Its alternative can be considered ethanol or phenol, despite the fact that these drugs are suitable for short-term innervation of large and strong muscles, and pain may occur in certain nerves.
Exercise for spasticity
Spasticity manifests itself as a violation of motor activity, manifested in partial or complete immobility, increased muscle tone, as well as involuntary movements. There are certain exercises that can reduce spasticity, restore motor activity and eliminate synkinesis in paralyzed limbs.
Performing exercises requires a certain synchronicity, and both affected limbs participate in them, moving in the same direction at different or the same speed. You can do the exercises yourself, or you can use someone else’s help. Execution involves an average and slow pace, the number of repetitions is limited to four. You can rest by placing your arm or leg in a position that relaxes the muscles most effectively.
Massage for spasticity
For spasticity, the following massage methods can be used. The arms are joined on the chest, the legs are pulled towards the abdominal area, the body bends slightly and in this position you can perform free light rocking, which ensures a decrease in muscle tone after a certain time. The time during which a decrease in muscle tone occurs should be used to provide high-quality stimulation for the restoration of certain motor functions that were impaired as a result muscle spasm. When muscle tone increases, it is recommended to repeat the described massage method. This technique is most effective when applied to children aged from one month to seven years.
You can use a form of massage that normalizes muscle tone using a ball. To do this, you need to lie on the ball with your chest and stomach, then make a series of movements in different planes, then change the position of your body and lie on your back on the ball, subsequently repeating the entire listed set of movements. Depending on the muscle tone at the time of the exercise, the duration of the exercise should be determined. On average, this type of massage takes no more than fifteen minutes a day.
Folk remedies
For spasticity of the lower extremities, the following remedy is recommended for use: traditional medicine. According to the shape of the legs and torso area up to lumbar region the spine requires sewing bags, which are subsequently filled with birch leaves torn from the tree. Immediately before going to bed, the patient should be placed with his feet in these bags and kept in them for some time, while ensuring that the leaves fit the person’s body as tightly as possible on all sides. This is necessary to create the necessary temperature environment in the bags so that the person sweats well. At the same time, your feet sweat just as profusely as they would when using a steam bath. It is recommended to stay in this position all night. In some cases, it may be advisable to replace the leaves around midnight if they become very wet. After undergoing several similar sessions, spastic manifestations in lower limbs will stop bothering you.
Spasticity in children
Spasticity in children is the most acceptable variant of hypertonicity, which disappears after several stroking movements; in any case, a sharp decrease may be noted. You should not waste time if you notice a similar symptom in a child; you should actively move the abducted limb as quickly as possible or perform a series of passive movements. Spasticity in children can be a consequence of various injuries or diseases. Most often, spastic muscle contractions plague disabled children suffering from cerebral palsy; its manifestations are also possible in multiple sclerosis, traumatic brain injuries and traumatic injuries to various parts of the spine. In all these cases, eliminating spasticity is much more difficult.
Spasticity in children is essentially an involuntary contraction of individual muscle groups. Symptoms can appear completely involuntarily, since in this situation there is no control over the energy consumed by the leg muscles. The commands given by the brain are perceived by the muscles completely incorrectly, which causes their spontaneous contractions.
2556. Ilya | 30.11.2013, 18:40:34
Listen, please, everyone!
I myself am an instructor in restoring movements using wave techniques, and the author of the insult5.ru project.
2557. Ilya | 30.11.2013, 18:40:50
In addition, the muscles on the affected side are weak, atrophied, and it is basically impossible to strengthen them with pills, injections, or massagers.
We have a technique, a training video, and results for a 68-year-old man, after a terrible hemorrhagic stroke and paralysis, after 5 months. classes, the abs pump, and he walks with light support.
Our other student (54 years old, with craniotomy, movement coordination disorder, barely able to move, with severe spasticity of the arm and paralysis of the leg) after 3 weeks of classes began to stand up on his own without support and stand upright (classes continue)
Another client (72 years old, ischemic stroke 3 years ago, lack of any rehabilitation, contracture + paralysis of the left arm) during the 2nd lesson was able to move it to a bend, 10 cm, and lift it by 5 cm.
So, dear forum users! From my own experience, I want to say (I can no longer remain silent, reading some comments) MOVEMENT DISORDER IS TREATED MAINLY BY CORRECTLY ORGANIZED, GENTLE MOVEMENT, A COMBINATION OF DYNAMIC AND WAVE LOAD. (And the fact that they grumble and sometimes make you nervous with their behavior - they are like children, they don’t need pity, and not punishment in the form of: “Oh, you’re so! I won’t come!” THEY ONLY NEED HELP IN RESTORING MOTOR SKILLS, THE REST THEY WILL DO IT THEMSELVES: go to the toilet, shave, eat, etc.
I don't want to be unfounded. And I suggest that those who really need help here, and not “just complain,” take a course to restore movements at home. Go here: insult5.ru. I myself will guide you, advise you, send you away necessary exercises. And you will post here on the forum about the results. This will help you and give hope to many other people. I can help those in Moscow personally.
Articles
Exercises to restore movement in the hand
There are many literary sources and publications that describe exercises aimed at restoring hand function. However, the bulk of the recommendations are suitable for people whose motor functions have not been completely lost.
We will try to describe recovery process. starting with a complete lack of movement in the affected arm.
Hand exercises need to start right away after paralysis. At the first stage, the main tasks of rehabilitation of the upper limb are:
1. Prevention of joint stiffness in the affected limb by performing passive movements in all joints of the paralyzed arm. Passive movements should be performed repeatedly throughout the day.
2. Slowing down the process of muscle atrophy: if there are no contraindications, then massage and electrical myostimulation are performed.
3. Prevention of injuries and sprains of the joint capsule shoulder joint: when the patient takes a vertical position, the sore arm should be placed in a shoulder gusset and fixed to the body.
1. Flexion - extension of the arm at the elbow.
2. The arm is bent at the elbow, straightening the arm upward.
3. The arm is bent at the elbow, the shoulder is moved to the side, the arm is straightened upward.
6. Flexion - extension in the wrist joint.
7. Squeezing - unclenching fingers.
8. Adduction - abduction and opposition of the thumb.
All exercises are performed passively (with outside help). The number of repetitions in each exercise is at least 50 times.
As active movements appear in the paralyzed arm, they begin to add to the set of exercises active-passive exercises. which are performed with outside help or with the help of a healthy limb.
When active movements occur in the affected limb, special attention should be paid correctness of the restored movements.
As a rule, people, not knowing the intricacies of the recovery process, are happy about any movements that appear and begin to actively develop them - this is main mistake. because in most cases, the first movements that appear are incorrect. Consolidation of incorrect movements leads to the appearance of spasticity and the formation of spastic contractures and stiffness of the joints.
Examples of active-passive exercises in a supine position:
1. Bend your arms at the elbows.
2. Arms bent at the elbows in front of the chest, straightening the arms upward.
3. Raising straight arms up.
Exercises can be performed with the fingers in a locking position or by immobilizing the affected limb ( elastic bandage) to the gymnastic stick.
As the patient recovers, exercises begin to be performed from a sitting and standing position, which allows for more amplitude movements.
Restoring hand and finger movements
The most labor-intensive process is recovery fine motor skills .
Many patients who have suffered a stroke, traumatic brain injury, or brain surgery develop spastic flexion contractures of the hand and fingers. Before you begin to restore movement, you must remove pathological tone and develop contractures. Spasticity is relieved with the help of muscle relaxants, massage and physiotherapeutic procedures.
Development of contractures- the process is painful and traumatic: not every person is ready to endure significant pain. When the patient experiences pain, the tone in the affected arm increases, which is why pain occurs when the joints develop.
This vicious circle allows you to overcome correctly calculated scheme of rehabilitation measures. which includes:
- massage;
— deep warming of spastic muscle groups and developed joints;
— electromyostimulation of antagonist muscles;
— passive development of movements in the joints;
— staged fixation of the limb in extreme positions using individual splints.
Let's take a closer look at these procedures.
1. Massage can be performed with the addition of warming ointments. The main purpose of massage is to stimulate blood flow to the massaged area, to warm up and give elasticity to the ligaments that are planned to be developed.
2. Deep heating carried out using physiotherapeutic paraffin and ozokerite applications. Prolonged exposure to heat reduces spasticity and promotes muscle relaxation. Working out the joint after warming up is less painful.
3. Electromyostimulation of antagonist muscles- this is the stimulation of muscle groups opposite to the muscles in spasticity. Thus, a balance is gradually formed between these muscle groups.
4. Passive development of the joint- gradual stretching of the spasmed muscle, as well as contracted ligaments. With the help of repeatedly repeated passive movements, with a gradually increasing amplitude, the range of movements in the joint increases, the muscles and ligaments become more elastic.
5. After the development of the joint is completed, the hand and fingers must fix in extension position. to the maximum angle. Fixation can be achieved using orthoses for the wrist joint. as well as splints made from plaster or polymer bandages.
As the range of motion of the limb being developed increases, the splints must be changed.
This scheme for the development of spastic contractures allows quickly achieve stable results. while causing minimal pain to the patient.
Restoring hand and finger movements begins with active-passive exercises. After movements of all fingers and movements in the wrist joint have been restored, proceed to restoration of fine motor skills and individual finger movements: for example, learning to pick up and carry objects. The smaller the object, the more difficult it is to grasp and hold.
An approximate set of exercises aimed at restoration of basic movements in the elbow, hand and fingers(exercises are performed while sitting at a table):
1. Flexion - extension of the arm at the elbow along the table surface.
2. Bend the arm at the elbow towards the shoulder, without lifting the elbow from the table.
3. Sliding your hand back and forth across the table.
4. Circular movements hand on the table surface.
5. Turn the hand palm up.
6. The brush hangs from the table, lifting the brush.
7. Squeezing - unclenching the fingers, palm on the table surface.
8. Clenching and unclenching your fingers, palm up.
Previously this word was unfamiliar to me. Spasticity resembles stiffness in very, very cold hands, when you want to move your fingers, but you can’t. Plus, it also brings them together and distorts them.
When my recovery from the stroke began, this condition was virtually throughout my entire body. Especially strong on the left side. I was almost completely paralyzed, but I still could not make much movement. They turned out as if they were in condensed milk. Tight, clumsy and very slow. There was constant tension in my hands and fingers. It did not go away for a minute, even in a calm state, and did not allow normal movements. The hands involuntarily took an unnatural position. The left one was retracted away from the body. The right one bent at the elbow and pulled up to the chest. I was very tired physically and mentally because I couldn’t relax. Only in a lying position it was easier. But as soon as I sat down, the muscles of the body and limbs tensed like crazy. From excessive tension I quickly got tired again. It was possible to sit for one or two minutes and the strength ran out.
Spasticity made it impossible to do thin and precise movements. For example, if they handed me a cup of water, I couldn’t take it. If he didn’t “hit” it, he missed. When they put the cup in my hand, I could not hold it and wrap my fingers around it. They didn't shrink. At the same time, the tension in my hand was unreal. All this rigmarole was wildly exhausting. Relieving spasticity in all limbs at once is not a realistic task. It's too big. And we, as always, broke the difficult task into simple fragments that became feasible. We decided to divide the treatment of spasticity into pieces:
HAND SPASTICITY.
LEG SPASTICITY.
It has become easier. During the training, I noticed that the decrease in spasticity in my left hand was accompanied by little relief in my right hand and legs. The connection is not significant, but noticeable. We did exercises and massages evenly for both left and right limbs. Although the spasticity was much stronger on the left side of the body. Over time, everything became equal. This approach turned out to be correct.
It was possible to relieve spasticity with a combination of gymnastics and massages.
EXTREMELY IMPORTANT!
Start with minimal movements.
Do not exert heavy loads during exercise.
Do the minimum number of repetitions.
Do not do active and strong massage. Light touches only.
Do not add or increase muscle tone.
Learn to relax your muscles and relieve tension in them.
Do not do gymnastics to relieve spasticity when you are tired.
Exercise only in the morning.
While recovering from a stroke, I got used to the fact that there are no simple tasks. But removing spasticity turned out to be extremely difficult work. The point is the contradiction of the tasks being performed. After the stroke, I needed to restore muscle strength throughout my body. That is, to work hard and hard. But at the same time, spasticity must be treated. And for this, loads and endurance training are a hindrance. It turns out that the first excludes the second. We solved this puzzle by alternating classes. One day: massage + gymnastics to relieve spasticity + exercises to restore balance and coordination. This does not require much strength, the load is not great. The next day: strength + endurance exercises. And so on in turn.
IN at the moment The spasticity was removed. There are some leftovers, but they don't interfere. Freedom and lightness returned to my movements. The tension is gone. Muscle pain and fatigue are gone. I began to spend less energy on movements. This allowed us to gradually increase the load on morning exercises.
What would recovery after a stroke do? good results, you have to follow this regime. Gradually I am gaining strength and increasing my endurance. Now I can conduct classes in one day. I do exercises in the morning with strength exercises. In the afternoon, gymnastics and massages to relieve spasticity + exercises for balance and coordination. Half a day between classes is enough for rest.
Exercises to relieve spasticity in:
HAND SPASTICITY.
I am very often asked to talk about spasticity after a stroke and how to deal with it. There is still no 100% universal answer to this question. Today I will try to answer the questions: how spasticity occurs after a stroke and how to treat it with medication.
What is spasticity after a stroke?
Spasticity after stroke (muscle spasticity) is hyperexcitation of the stretch reflex resulting from upper motor neuron syndrome.
Where does spasticity come from after a stroke?
The muscles of a person who does not suffer from spasticity after a stroke, during any action (movement, maintaining a posture) work in concert - some stretch (agonists), others contract (antagonists). Moreover, most of the movements are carried out unconsciously. A person does not need to think about how to change muscle tone in order to take a step. These processes occur automatically at the level of the spinal cord. One of the reflexes that allows you to unconsciously carry out movements is the stretch reflex.
To make it clear, remember your appointment with a neurologist.
The doctor knocks on the arms and legs with a hammer; during the impact, the arms and legs move spontaneously. This process is usually especially popular with patients. But what's going on? The doctor knocks on the muscle tendon; when the hammer is applied, it stretches.
Hyperstretching of the tendon gives a signal that antagonist muscles need to be activated in order to return the stretched muscle to its previous state. This is an instant reaction that is expressed in the movement of the arms and legs in response to the impact of the hammer. This reflex arc closes at the level of the spinal cord and does not involve the brain. But in everyday life During movement, the brain always controls this reflex.
If a person does not suffer from spasticity after a stroke, during movement (especially during sharp, fast actions), the muscles are constantly stretched, but the reaction, as when exposed to a hammer, does not occur. The brain sends special inhibitory impulses that prevent the reflex from becoming hyperexcited. During a vascular accident, the cells that send these impulses die and the reflex gets out of control. Spasticity occurs after a stroke.
Mechanism of spasticity after stroke
The reflex is constantly excited, any stretching causes an increase in muscle tone and spasticity after a stroke. Muscles prone to flaccidity are stretched (arm extensors, leg flexors), muscles prone to tension are tense (arm flexors, leg extensors). This tension and increased muscle tone is spasticity after a stroke. I just can’t relax my muscles, because... they are constantly affected by the stretch reflex.
How to deal with spasticity after a stroke?
Spasticity after a stroke must be treated with medication.
Drug treatment of spasticity after stroke.
The selection of drugs that affect spasticity after a stroke requires patience. You need to gradually increase the dose and see how it affects muscle tone. If it doesn’t work, change it, increase the dose again and see.
There are 2 groups of drugs that can affect spasticity after a stroke:
Centrally acting drugs– provide inhibition of the reflex through the central nervous system.
- non-benzodiazepine tranquilizers (Diazepam, Clonazepam),
- anticonvulsants (Finlepsin, Gabapentin, Pregabalin),
- alpha adrenergic agonists (Clonidine).
These drugs have one drawback - taking them can cause sedation, decreased memory, attention, intelligence, and dizziness. This may have a negative impact on rehabilitation. Increasing your dose gradually will help reduce the likelihood of these side effects.
Peripheral drugs– “extinguish” the stretch reflex at the level of the spinal cord. These include well-known muscle relaxants (Mydocalm, Sirdalud, Baclofen). The downside of the drugs is a general decrease in muscle tone. Those. they reduce tone in both spasmodic and strained muscles. Therefore, their use must be combined with gymnastics.
Treatment of spasticity with botulinum toxin injections.
The next stages of influencing spasticity after a stroke is the use of botulinum toxin injections (Botox, Dysport, Xeomin). This is indicated when the tone is very high and other methods do not help. Botulinum toxin acts at the muscle level, blocking the impulses of the stretch reflex.
Very important point– after botulinum toxin injection, you need to actively do gymnastics for 3 months, otherwise the effect will not be lasting.
Muscle spasticity after a stroke is an increase in muscle tone, which significantly reduces the quality of life.
Muscle contraction as a tensile impulse occurs against the background of mono- or hemiparesis (unilateral and bilateral paralysis, respectively).
The cause of such processes is damage to the cells of the motor pathways of the brain. The following areas are susceptible to post-stroke spasticity:
- hands;
- legs;
- shoulders;
- hip.
During a long stay in supine position symptoms gradually increase.
A positive trend is observed in the restoration of motor functions, which is achieved by various methods.
Spasticity after stroke: treatment medicines
The success of therapy directly depends on the time that has passed since the disease.
The earlier treatment is started, the better the prognosis for recovery. Best result can be achieved when recovery begins in the first months after the impact, but no later than a year later.
To immobilize a muscle group by blocking neural transmission, botulinum toxins (Dysport, Xeomin, Botox) are administered. The effect lasts for an average of six months, after which repeated administration of botulinum toxic drugs may be required.
- Baclofen.
- Mydocal;
- Sirdalud.
Baclofen for stroke from spasticity
The baclofen pump is used intrarectally. Acts at the spinal level by reducing the production of a number of amino acids (aspartate, glutamate).
In addition to relieving spasticity, a centrally acting muscle relaxant helps achieve significant success in reducing dystonic disorders, as well as minimizing pain.
Side effects:
- bowel disorders (diarrhea, constipation);
- drowsiness;
- decrease in blood pressure.
The dosage regimen involves a systematic increase in dosage from 15 to 60 mg per day.
Spasticity after a stroke: treatment with folk remedies
Popular methods:
- Applying heat to the spasmodic area (applying warm compresses, bags of salt or cereals).
- Bandaging the upper and/or lower extremities.
- Light massage (in the form of stroking and rubbing).
- Taking warm baths (not hot!).
- Kinesio taping.
- Taking herbs.
Teas and tinctures are made from the following components:
- calendula;
- horse chestnut flowers or fruits;
- raspberries;
- rowan bark;
- Melissa;
- oats;
- blackthorn.
Hand spasticity after a stroke is eliminated by creating a bathhouse effect.
The limb is placed in a bag with birch leaves, which is fixed and left overnight. They work similarly with spasticity in the legs, provided that the dimensions of the container correspond to the length of the limb to the lower back.
Treatment of spasticity after stroke with acupuncture
Acupuncture is a popular treatment method in post-Soviet countries, but clinical studies conducted abroad do not confirm the effectiveness of this technique.
Exercises for spasticity after a stroke
This is the most effective way to combat such an unpleasant consequence. The loads should not be too exhausting, since excessive intensity only worsens the patient’s condition (the tone increases).
Examples of exercises:
- Exercises with an expander (compression/release of a special rubber ring).
- Patients are taught to stand and walk again - for this they use stilts and other auxiliary objects.
- Classes on orthopedic devices.
- Physical activity (done independently, with an assistant).
Types of gymnastics:
- alternate bending of the legs while lying on the bed, when the ankles are pulled up to the buttocks (performed 10 times) - outside help may be required;
- gradual stretching of atrophied areas with vibration movements.
