Table of ContentsView AllTable of ContentsSymptomsTypes of SpasmsCausesEffectsTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Types of Spasms
Causes
Effects
Treatment
At some point in the course of their disease, the majority of people with multiple sclerosis (MS) experience spasticity, a term that describes anincrease in your muscle tone. While that may sound like a good thing if you’re looking to tone up, what it really means is that your muscles don’t relax as much or as easily as they should, resulting in involuntary muscle spasms.
Because of this, spasticity affects your movement, making it a motor symptom rather than a sensory symptom like pain or numbness.
Verywell / Cindy Chung
Though it can occur in any muscle in your body, spasticity tends to most often affect the legs. You may also experience it in your arms, the muscles in yourbackand trunk, and near or in your joints. Spasticity also tends to be asymmetrical, meaning you may notice that it’s worse or happens more often on one side of your body than the other.
The symptoms you may experience when your muscles are spasming include:
Your spasms may be worse when you wake up in the morning or during the night when you’re trying to sleep.
Like everything in MS, spasticity affects everyone differently, and it can manifest in a variety of unpredictable ways in each individual—even over the course of a day.
There are several kinds of muscle spasms that can occur in MS, including:
One classic manifestation of spasticity is theMS hug, which occurs when the tiny muscles between your ribs spasm.
How Your Muscles Are Affected in MS
There are a variety of factors that can aggravate spasticity, acting as a trigger for spasms, like:
The Link Between Stress and MS
For many people, spasticity can be an annoyance or a passing problem that hinders smooth walking one day but is absent the next. It may just be that walking quickly or climbing stairs is harder than it was previously. Others may actually benefit from mild spasticity or stiffness, as it can counteract some degree of muscle weakness and make it easier to stand or walk.
That said, for some people, severe forms of spasticity or stiffness can cause a problem with mobility, as walking becomes difficult or impossible. For example, some spasms can be aggravated when moving from your bed into a wheelchair.
In addition, some extensor spasms can be so sudden and strong that you can fall out of a chair or bed. Flexor spasms can cause your limbs to be held in painful positions and lead to secondary joint pain.
When Your Muscles Won’t Relax
There are many different treatments for spasticity, depending on the type of spasms you have, the severity, and their responsiveness to medication. The goal of treatment is to reduce your muscle tone enough to improve your motor function, but not so much that your muscles become weak, potentially causing safety issues.
This is why it’s important for you to work closely with your healthcare team to find the best treatment plan for your individual needs. Use our Doctor Discussion Guide below to start a conversation with your healthcare provider about the right treatment for you.
Multiple Sclerosis Doctor Discussion GuideGet our printable guide for your next doctor’s appointment to help you ask the right questions.Download PDFEmail AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
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Medications
The first line of treatment for spasticity is oral medications, including:
The type of medication your practitioner prescribes will depend on the location, type, and severity of your spasms. You may even end up needing a combination of some of these medications.
Magnesium for Nighttime SpasmsFor nighttime spasms, your healthcare provider may first try having you take250 mg to 500 mg of magnesiumbefore bed. Don’t initiate this treatment—or any other supplementation—on your own, though; supplements can interfere with medications you’re taking or, in the case of magnesium, cause any bowel frequency or urgency that you already have to worsen.
Magnesium for Nighttime Spasms
For nighttime spasms, your healthcare provider may first try having you take250 mg to 500 mg of magnesiumbefore bed. Don’t initiate this treatment—or any other supplementation—on your own, though; supplements can interfere with medications you’re taking or, in the case of magnesium, cause any bowel frequency or urgency that you already have to worsen.
If none of these drugs are effective or your situation calls for a different treatment, other approved medication options include:
How Botox Is Used to Help With Spasticity
Non-Pharmacologic Treatments
Since they can give you additional relief, there are some non-pharmacologic treatments that you can consider trying as well, such as:
Managing your triggers, stretching, and maintaining good posture can help you minimize your spasticity symptoms enough that you may not even need medication.
Complementary and Alternative Medicine (CAM)
Many people experiencing spasticity try complementary and alternative methods to relieve it, including:
While there is limited scientific evidence to back up the use of these methods, some people find them helpful, and these therapies may have other feel-good benefits as well.
3 Mind-Body Therapies to Reduce MS Symptoms
Cannabidiol Oromucosal Spray
An oral spray derived from cannabis called Sativex (nabiximols) is another potential option to treat spasticity. A 2019 systematic review of observational studieson this particular use of this product found that the spray is effective and safe as an additional treatment for MS patients who don’t respond well to or can’t tolerate the regularly-prescribed medications for spasticity.
Nearly 42 percent to 83 percent of patients saw at least a 20 percent reduction in their spasticity symptoms within the first month of treatment (the average dose was five to six sprays per day), and this decrease continued for six to 12 months.
Adverse effects such as dizziness, drowsiness, nausea, and fatigue affected 10 percent to 17 percent of the participants, but these effects decreased over time. The researchers also found no evidence that long-term use of the spray led to abuse or tolerance development.
Sativex isn’t currently approved in the United States, but it’s available in a number of other countries. If cannabis spray is something you’re interested in trying, don’t use it on your own—talk to your healthcare provider about how you can obtain it and what dosage is right for you.
How Multiple Sclerosis Is Treated
Surgery
In the most severe cases of spasticity, there’s a surgical option in which your nerves are severed. However, this is rarely needed or used.
A Word From Verywell
When managing your spasticity, try your best to keep moving, stretching, avoiding certain triggers, and engaging in therapies like physical therapy or hydrotherapy. Be sure to treat your mind too. Let your healthcare provider know if your spasticity is affecting your quality of life so that you both can work on a plan that will help you feel your best.
Overcoming Muscle Spasticity
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Multiple Sclerosis Society.Spasticity.Family Doctor.Multiple sclerosis.Mukherjee A, Chakravarty A.Spasticity mechanisms - for the clinician.Front Neurol.2010;1:149. doi:10.3389/fneur.2010.00149American Association of Neurological Surgeons.Spasticity.Love S.Demyelinating diseases.J Clin Pathol. 2006;59(11):1151-9. doi:10.1136/jcp.2005.031195Cheung J, Rancourt A, Di poce S, et al.Patient-identified factors that influence spasticity in people with stroke and multiple sclerosis receiving botulinum toxin injection treatments.Physiother Can. 2015;67(2):157-66. doi:10.3138/ptc.2014-07Cleveland Clinic.Spasticity: management and treatment.Zakin E, Simpson D.Evidence on botulinum toxin in selected disorders.Toxicon. 2018;147:134-140. doi:10.1016/j.toxicon.2018.01.019Johns Hopkins Medicine.Types of complementary and alternative medicine.Akgün K, Essner U, Seydel C, Ziemssen T.Daily practice managing resistant multiple sclerosis spasticity with delta-9-tetrahydrocannabinol: cannabidiol oromucosal spray: A systematic review of observational studies.J Cent Nerv Syst Dis. 2019;11:1179573519831997. doi:10.1177/1179573519831997Weill Cornell Brain and Spine Center.Spasticity.Additional ReadingAkgün K, Essner U, Seydel C, Ziemssen T.Daily Practice Managing Resistant Multiple Sclerosis Spasticity With Delta-9-Tetrahydrocannabinol: Cannabidiol Oromucosal Spray: A Systematic Review of Observational Studies.Journal of Central Nervous System Disease. 2019;11:1179573519831997. doi:10.1177/1179573519831997.Crabtree-Hartman E.Advanced Symptom Management in Multiple Sclerosis.Neurologic Clinics. 2018;36(1):197–218. doi:10.1016/j.ncl.2017.08.015.Olek MJ, Narayan RN, Frohman EM, Frohman TC.Manifestations of Multiple Sclerosis in Adults. UpToDate.Olek MJ, Narayan RN, Frohman EM, Frohman TC.Symptom Management of Multiple Sclerosis in Adults. UpToDate.Zakin E, Simpson D.Evidence on Botulinum Toxin in Selected Disorders.Toxicon. 2018;147:134–140. doi:10.1016/j.toxicon.2018.01.019.
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Multiple Sclerosis Society.Spasticity.Family Doctor.Multiple sclerosis.Mukherjee A, Chakravarty A.Spasticity mechanisms - for the clinician.Front Neurol.2010;1:149. doi:10.3389/fneur.2010.00149American Association of Neurological Surgeons.Spasticity.Love S.Demyelinating diseases.J Clin Pathol. 2006;59(11):1151-9. doi:10.1136/jcp.2005.031195Cheung J, Rancourt A, Di poce S, et al.Patient-identified factors that influence spasticity in people with stroke and multiple sclerosis receiving botulinum toxin injection treatments.Physiother Can. 2015;67(2):157-66. doi:10.3138/ptc.2014-07Cleveland Clinic.Spasticity: management and treatment.Zakin E, Simpson D.Evidence on botulinum toxin in selected disorders.Toxicon. 2018;147:134-140. doi:10.1016/j.toxicon.2018.01.019Johns Hopkins Medicine.Types of complementary and alternative medicine.Akgün K, Essner U, Seydel C, Ziemssen T.Daily practice managing resistant multiple sclerosis spasticity with delta-9-tetrahydrocannabinol: cannabidiol oromucosal spray: A systematic review of observational studies.J Cent Nerv Syst Dis. 2019;11:1179573519831997. doi:10.1177/1179573519831997Weill Cornell Brain and Spine Center.Spasticity.Additional ReadingAkgün K, Essner U, Seydel C, Ziemssen T.Daily Practice Managing Resistant Multiple Sclerosis Spasticity With Delta-9-Tetrahydrocannabinol: Cannabidiol Oromucosal Spray: A Systematic Review of Observational Studies.Journal of Central Nervous System Disease. 2019;11:1179573519831997. doi:10.1177/1179573519831997.Crabtree-Hartman E.Advanced Symptom Management in Multiple Sclerosis.Neurologic Clinics. 2018;36(1):197–218. doi:10.1016/j.ncl.2017.08.015.Olek MJ, Narayan RN, Frohman EM, Frohman TC.Manifestations of Multiple Sclerosis in Adults. UpToDate.Olek MJ, Narayan RN, Frohman EM, Frohman TC.Symptom Management of Multiple Sclerosis in Adults. UpToDate.Zakin E, Simpson D.Evidence on Botulinum Toxin in Selected Disorders.Toxicon. 2018;147:134–140. doi:10.1016/j.toxicon.2018.01.019.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Multiple Sclerosis Society.Spasticity.Family Doctor.Multiple sclerosis.Mukherjee A, Chakravarty A.Spasticity mechanisms - for the clinician.Front Neurol.2010;1:149. doi:10.3389/fneur.2010.00149American Association of Neurological Surgeons.Spasticity.Love S.Demyelinating diseases.J Clin Pathol. 2006;59(11):1151-9. doi:10.1136/jcp.2005.031195Cheung J, Rancourt A, Di poce S, et al.Patient-identified factors that influence spasticity in people with stroke and multiple sclerosis receiving botulinum toxin injection treatments.Physiother Can. 2015;67(2):157-66. doi:10.3138/ptc.2014-07Cleveland Clinic.Spasticity: management and treatment.Zakin E, Simpson D.Evidence on botulinum toxin in selected disorders.Toxicon. 2018;147:134-140. doi:10.1016/j.toxicon.2018.01.019Johns Hopkins Medicine.Types of complementary and alternative medicine.Akgün K, Essner U, Seydel C, Ziemssen T.Daily practice managing resistant multiple sclerosis spasticity with delta-9-tetrahydrocannabinol: cannabidiol oromucosal spray: A systematic review of observational studies.J Cent Nerv Syst Dis. 2019;11:1179573519831997. doi:10.1177/1179573519831997Weill Cornell Brain and Spine Center.Spasticity.
National Multiple Sclerosis Society.Spasticity.
Family Doctor.Multiple sclerosis.
Mukherjee A, Chakravarty A.Spasticity mechanisms - for the clinician.Front Neurol.2010;1:149. doi:10.3389/fneur.2010.00149
American Association of Neurological Surgeons.Spasticity.
Love S.Demyelinating diseases.J Clin Pathol. 2006;59(11):1151-9. doi:10.1136/jcp.2005.031195
Cheung J, Rancourt A, Di poce S, et al.Patient-identified factors that influence spasticity in people with stroke and multiple sclerosis receiving botulinum toxin injection treatments.Physiother Can. 2015;67(2):157-66. doi:10.3138/ptc.2014-07
Cleveland Clinic.Spasticity: management and treatment.
Zakin E, Simpson D.Evidence on botulinum toxin in selected disorders.Toxicon. 2018;147:134-140. doi:10.1016/j.toxicon.2018.01.019
Johns Hopkins Medicine.Types of complementary and alternative medicine.
Akgün K, Essner U, Seydel C, Ziemssen T.Daily practice managing resistant multiple sclerosis spasticity with delta-9-tetrahydrocannabinol: cannabidiol oromucosal spray: A systematic review of observational studies.J Cent Nerv Syst Dis. 2019;11:1179573519831997. doi:10.1177/1179573519831997
Weill Cornell Brain and Spine Center.Spasticity.
Akgün K, Essner U, Seydel C, Ziemssen T.Daily Practice Managing Resistant Multiple Sclerosis Spasticity With Delta-9-Tetrahydrocannabinol: Cannabidiol Oromucosal Spray: A Systematic Review of Observational Studies.Journal of Central Nervous System Disease. 2019;11:1179573519831997. doi:10.1177/1179573519831997.Crabtree-Hartman E.Advanced Symptom Management in Multiple Sclerosis.Neurologic Clinics. 2018;36(1):197–218. doi:10.1016/j.ncl.2017.08.015.Olek MJ, Narayan RN, Frohman EM, Frohman TC.Manifestations of Multiple Sclerosis in Adults. UpToDate.Olek MJ, Narayan RN, Frohman EM, Frohman TC.Symptom Management of Multiple Sclerosis in Adults. UpToDate.Zakin E, Simpson D.Evidence on Botulinum Toxin in Selected Disorders.Toxicon. 2018;147:134–140. doi:10.1016/j.toxicon.2018.01.019.
Akgün K, Essner U, Seydel C, Ziemssen T.Daily Practice Managing Resistant Multiple Sclerosis Spasticity With Delta-9-Tetrahydrocannabinol: Cannabidiol Oromucosal Spray: A Systematic Review of Observational Studies.Journal of Central Nervous System Disease. 2019;11:1179573519831997. doi:10.1177/1179573519831997.
Crabtree-Hartman E.Advanced Symptom Management in Multiple Sclerosis.Neurologic Clinics. 2018;36(1):197–218. doi:10.1016/j.ncl.2017.08.015.
Olek MJ, Narayan RN, Frohman EM, Frohman TC.Manifestations of Multiple Sclerosis in Adults. UpToDate.
Olek MJ, Narayan RN, Frohman EM, Frohman TC.Symptom Management of Multiple Sclerosis in Adults. UpToDate.
Zakin E, Simpson D.Evidence on Botulinum Toxin in Selected Disorders.Toxicon. 2018;147:134–140. doi:10.1016/j.toxicon.2018.01.019.
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