Wednesday, October 2, 2013

Stretching reduces spasticity. Yeah, no.

OK class, here's your quiz:

1. Stretching decreases spasticity T/F
2. Stretching increases the length of spastic muscles T/F
3. Stretching reduces the chance of contracture (muscle stuck at a shortened length) T/F
4. Stretch helps make joints more mobile T/F

First of all, why stretching is good: 

Stretch is good for joints. Every time we move, joints are "lubricated." That is, joints require movement in order for the fluid in the joint (synovial fluid) to be properly distributed. Stroke survivors, because they are typically weak on one side, don't get the joints on the "bad" side to move enough. How much is enough? Look at it this way, on the "good" side your joints, all of them, will be moved through their entire arc of movement (called range of motion) dozens if not hundreds of times per day. How many times are your "bad" side joints moved? Because they have trouble moving, it is wise to move them either with the "good" side doing the work, or a caregiver doing the work. This is called passive ranging.

But while stretching may be good for joints, the affect of stretch on muscles and other soft tissue (ligaments, blood vessels, fat, etc.) is, so far as the science says, negligible. So the answer to your quiz is F, F, F, and F.

I know this is hard to believe. And it is counter to what some therapists think (this statement: Prolonged stretching can lengthen muscles to help decrease spasticity)

But it is confusing. There is an immediate effect of stretch on spasticity, everyone knows that. But this is one of the many reasons stroke is so devious; what is true now may not be true 5 minutes from now.

This is a frustration for many clinicians. You observe something is true (i.e. spasticity wanes with stretch) only to find that with the next big movement by the survivor, spasticity comes right back.

Further reading from this blog on spasticity here and here
                                                     ©Stronger After Stroke Blog


Elizabeth, John and Jack said...

I HAVE had some spaticity, mostly in my affected leg...well pregnancy has not been my friend in terms of muscle spasms. I am in soo much pain only in my left leg. My doctor told me to take magnesium....but it doesn't help and I think I'm I have a rash and leg cramping. do I make it stop spasming? Stretching doesn't seem to be helping.

Peter G Levine said...

Although spasms and spasticity may be related, they may not. Many folks without spasticity get painful spasms. If they are spasmotic, I would talk to a PT in orthopedics. Note exactly where the pain is. The PT can give you specific stretches that can be done at the "moment of impact." During the non-spasmotic periods stretch the muscles that are in spasm during the night. The trick is find ind the specific muscles to be stretched. If you can take a vid of the actual spasm (ie, the toes curl up, or the ankle postures inward) that'd help the PT know whats up.

Kadima said...

Does spasticity increase witrh time? My wife can't walk as far as before due to painful shaking spasticity. She only developed this 2 years post-stroke. I think she also has developed painful extensor tendonitis in her foot due to tightness of the ankle and calf muscle. Stretching doesn't seem to help

Peter G Levine said...

In stroke, spasticity does not increase, but because of the way the survivor typically postures, over time there is shortening of the soft tissue which makes it SEEM as if the spasticity has increased.

Tamara said...

Finally I read about painful spasms! That's my main problem, in my left leg. I feel it's strongly related to emotions. Whenever I'm angry or scared, my toes start curling and my knee hurts. Is there a relation between depression and painful spasms? In my case a foot massage relaxes my foot even better than Botox.

Linda said...

My leg and side, and frankly face, started to cramp up pretty badly while sitting, trying to focus on writing an exam for over an hour yesterday. The instructor looked at me and told me to take a break and get moving. I didn't think getting up was an option. lol Prof specializes in Kinesiology and Gerontology so he figured out the exam was not my big issue at the moment.

Tamara said...

I think that my painful spasms are caused by trying too hard and resentment. After recovering for 4,5 years I'm sick of it and just want to feel and look good again. I constantly remember the words of Eckhart Tolle: Be here NOW! Because usually I'm thinking about the future and how wonderful I will look and feel than.

Tamara said...

I think my painful spasms are caused by trying too hard and resentment. I'm working hard to recover for 4,5 years now and I'm sick of everything taking so much time. I just want look and feel good again and get rid of those ugly shoes and walker I'm using to improve my gait.

Barb Polan said...

Peter, doesn't stretching prevent soft tissue from shortening? I have stretched my hand extensively and on a recent return to my OT, she was shocked at the passive range of motion 4 years post-stroke, when I have spasticity there.

Peter G Levine said...

Barb... According to at least a couple of large studies, stretching does not increase soft tissue length in folks who are spastic. In normal tissue it may very well, but where the muscles are spastic, the rules change...for the worse.

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