Spasticity isn’t the normal muscle stiffness you might experience as you age. Spasticity is a medical condition that’s caused by damage or disruption to the areas of the brain and spinal cord that control your muscle and stretch reflexes, AANS says. People who have experienced a brain injury or spinal cord injury or who have cerebral palsy (CP) or MS may have varying degrees of spasticity, and it can impact their ability to walk, talk, and move around their home or workplace safely. Muscle relaxant medications can relieve some of the effects of spasticity — but stretching, if done correctly, can also help, notes the American Stroke Association. Stretching loosens muscles that are already stiff or tightened due to spasticity, and it can also help prevent them from becoming stiff in the first place. However, because there are varying types and causes of spasticity, there are also various ways to stretch to help alleviate the condition, says Nancy R. Kirsch, PhD, a physical therapist and vice chair of rehabilitation and movement sciences at Rutgers University in Newark, New Jersey. Also, stretching may not be indicated for the type of spasticity you have, she adds. That’s why, before starting a stretching regimen, you should talk to your doctor, AANS advises. In addition, you’ll likely work with a physical therapist who will craft a stretching regimen, or a series of stretching exercises, designed around the type of spasticity you have. They will recommend stretches that are safe for you and take into consideration any other movement- or balance-related symptoms you may have. “Both physical therapists and occupational therapists are well trained to teach you how to stretch correctly,” Dr. Kirsch says. To start, a physical therapist will assess the severity of your symptoms, likely by using the Ashworth scale, which is a commonly used measurement of muscle tightness, Kirsch explains. Then, the physical therapist will create a stretching program based on the following: The Cause of Your Spasticity People who have spasticity following a stroke, for example, will have different needs and different muscle groups affected than those whose spasticity is due to MS. Thus, they will likely have different stretching programs as well. The Muscle Groups Affected Obviously, an effective stretching program will target the muscles most affected by the condition. However, your care team may emphasize some muscle groups more than others, depending on your individual needs and where spasticity most impacts your day-to-day life. Other Medical Conditions You May Have Many people with MS or CP have balance issues, which may mean that a sitting (chair-based) stretching program will be safer for them than a standing routine. Your care team will take that into consideration when designing a regimen.
What a Stretching Program Looks Like
In general, “a stretching program should be designed for each individual, depending on their own daily needs and the conditions that either increase or decrease their spasticity,” Kirsch notes. Experts typically advise short, daily stretching sessions of 10 to 20 minutes, usually first thing in the morning. However, that may vary based on your symptoms and overall health, among other factors. In addition, most stretching programs are designed around simple exercises that you can do your own, anywhere, without special — or expensive — equipment. Still, your physical therapist may recommend using a chair for seated stretches, or a yoga mat for stretches that require you to get down on the floor, according to Kirsch. In some cases, fitness bands, which are large rubber bands used for exercising and stretching, may help with certain stretches — and, if needed, they may provide some moderate resistance for muscle strengthening, she adds. The need for any assistive equipment will be determined by the physical therapist or occupational therapist designing your program, Kirsch notes. Finally, if you rely on a caregiver to help you manage your day-to-day activities, that person can and should be trained by your physical therapist with regard to how you should stretch, the stretches you need to do, and “how to recognize the signs of normal versus abnormal responses to stretching,” she adds. Stretching should not cause pain or worsen spasticity symptoms. If it does, you and your caregiver should check in with your care team. Your team should also advise your caregiver about when to reach out to a healthcare provider to modify stretching activities, since “spasticity can change in character,” Kirsch explains.
Common Stretching Mistakes to Avoid
In addition to not consulting a doctor and a physical therapist or occupational therapist before beginning a stretching routine, here are some other practices to avoid when following a stretching program: Don’t overstretch or stretch too much or for too long. It can cause muscle or joint damage, Kirsch warns. Don’t stretch too quickly. It can increase muscle tone, rather than decrease it, and actually worsen spasticity, she says. Don’t understretch, either by not doing it every day or by not doing it for enough time. It can make the program less effective, Kirsch says. Do the stretching program exactly as it was designed by your team. Don’t perform stretches incorrectly. If you don’t follow your physical therapist or occupational therapist’s instructions correctly, you could damage your muscles. If you have any questions, or if you notice any unusual pain, stop what you’re doing and ask for help. Don’t ignore changes to your spasticity symptoms. The symptoms of spasticity can change over time — either in their severity or the muscle groups affected — depending on the condition that’s causing it. Those changes may mean program modifications are needed, according to Kirsch.
