Monday, July 9, 2012

Fighting Spasticity

In my last post Definitions for Recovery, I talked about breaking spasms and fighting spasticity – the muscle tightness that keeps me from walking and using my hand normally. These are the treatments that have made a significant difference:

Electrical Stimulation: Electrodes placed strategically on my skin emit an "alternating" electrical current mimicking my body's own electrical conductivity and stimulating my weak muscles. This has helped improve my own nerve conduction and muscle responsiveness. 3x/week.

Strength Training: Strength-building exercises are key to fighting both spasms and spasticity. Muscles go into spasm as a protective measure against further injury. For example, the spasm on the inside of my calf and foot defends against my weak ankle rolling out. By building strength in my ankle over time, I can break the spasm cycle. Already, muscle I've built in my upper back has significantly reduced spasms in my chest, improving range of motion in my shoulder. 3x/week.

Pressure Point Massage: Look for a massage therapist like mine who has extensive training in sports injury rehabilitation (mine used to travel with the L.A. Lakers), as well as knowledge of kinesiology and neurology. My masseuse works through all three layers of muscle, sometimes applying pressure so deep, her hands shake. 1x/week.

Botox: (Post 1-26-12)

Baclofen: I take a low daily dose (20 mg) of this muscle relaxant – helpful especially in the beginning when exercise increased the stiffness in my muscles. I hope to soon reduce my dosage and ultimately discontinue it.

Home Program: I continue to be active; to wear my nighttime foot and hand braces; and to stretch and exercise my hand 5-6 times/week.

Next post: how you know you're on the right track – what it feels like when spasms start to break down.

20 comments:

  1. I don't think I ever had spasms as bad as yours sound...are they painful?

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    1. Not usually. They are uncomfortable. In the beginning I did suffer rare cramping in my leg. I now have central nervous pain. My main issue with the spasms is the way they interfere with functionality.

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  2. My spasms are not painful but they are irritating and look bad. Jane

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  3. mine are painful and irritating. Just when I think I'm improving the spasms set me back. My ankle turns in and clonus. I've had nonstop spasms in my bicep from the first day of my stroke. Stretching and exercises just makes it more painful. My arm is actually very strong. The E-stem works wonders though and so does the acuptucture. With the Baclofen at least I'm not getting the spasms that run from my big to my hip anymore...what a relief.

    My neurologist says Botox is next.

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    1. I had clonus in my ankle for about the first three-five months. It's gone now.

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  4. I'm still confused. I have spasticity, but not spasms (I think). It sounded like Arbi and Mira are talking about spasticity, not spasms. Or, are spasms and spasticity part of a continuum?

    I'm glad you're bringing this up. I'm always disappointed by the lack of information for survivors (except Peter Levine) on the mechanics of physical recovery after the acute phase.

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    1. It is confusing. I'm guilty of using them somewhat interchangeably. Most of my doctors simply use "spastic/spasticity." Now that you're asking for clarity, I would say that "spasm" can be present without movement. Example: I have a spasm in my left armpit that keeps my index finger in a curled position regardless of whether I am at rest or trying to move it. Once we break that spasm, I will be able to lift my index finger. At that point, the finger may be subject to spasticity (velocity-induced tightness). As I said in "Definitions for Recovery," I get different inputs on whether spasticity can go away. I'm guessing that my degrees of spasticity may vary in future depending on my level of fatigue, etc. There are so many variables. Perhaps that's why the information is so spotty. I'd love to hear from other survivors who have dealt with this over time — especially if they've experienced significant improvement.

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    2. i'm 2.5 years post stroke, and i have bad spasticity in my left forearm. i cannot extend my wrist at all. and its hard to tell if its because the connections arent there, or because the spasticity in my flexors is just too high to overcome it. i have tried PT/OT for a long time, including electrostim and stretching. i tried botox once but that didn't really do much for me. i am debating whether i should try it again. i am very frustrated by not being able to use my hand yet. i'm not very hopeful that it will ever get better.

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  5. Irene CarpenterFriday, July 27, 2012

    I have botox injections every three months that help but don't get rid of the spasticity completely. Right now my leg and hip muscles are so tight it makes it hard to walk. I've been hesitant about trying the Baclofen that's been suggested because of my low tolerance for most muscle relaxers.But I might ask about it next month when I go in for a follow up with my neurologist.

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    1. My wife had Baclofen for post stroke spasticity. It reduced her spasticity, but she could not tolerate the associated fatigue.

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  6. I was wondering if you've ever used an elliptical trainer. I'm hoping to transition away from the hospital-based gym to a local Planet Fitness. I'm just curious as to what machines you use.

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    1. I use the cross trainer (20 mins 3x/wk), which is similar to the elliptical, but has more of a stair-climbing action. When I first tried the elliptical, I couldn't get it going fast enough to keep the power on. I've recently been thinking of trying again.
      I also finish every workout with 15 min. on the recumbent bicycle, which my trainer recommended to help improve my gait. And it works! I usually walk well for about 45 seconds after I get off the thing.

      Transitioning from the hospital gym to my local gym was one of the best decisions I made. I did it at a point where I felt the hospital PT didn't have any new ideas for me. Once back at a "real" gym, I realized how limited the equipment at the hospital was. However it's important to note that I needed and still rely on the guidance of a very knowledgeable personal trainer. See blog post "A-Team: A is for Arbi" (9-26-11) for video of us working out together.

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    2. I'll be getting PT at a more local hospital outpatient facility that doesn't have a program where you can use their gym for a fee. They'll help me in the transition process, I'm sure. I don't know if Planet Fitness has personal trainers or not :)

      My stroke was 3 years ago...my right side was paralyzed. I walk with a cane, but not very fast. I'd love to ditch the cane and increase my walking speed. I'm still working on my arm too. I get botox to help with the spasticity.I'll check out the video, too.

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  7. Botox as a treatment for spastic muscles is becoming popular in the medical community. Botox is used to helps to relax the spastic muscles to allow people to perform better at their daily tasks. Although it has been known to have side effects, most of it is relative to a number of factors, including where you were injected and the expertise of the doctor. You said in your earlier post that you had 11 injections per session? Isn’t that a lot? If so, have you experienced any side effects?

    Shavonda Duarte

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    1. The treatment can generate flu-like symptoms for a couple days after injection. This has occurred for me only once. My muscles also can be sore for a day or so because they tense so much during the procedure. As for long-term effects, we'll have to see ... but I'm living in the "now." The total amount of Botox that can be injected "safely" is, I believe, 500ml every 3 months. So this amount is spread among the 11 injections. Yes, 11 is a lot, but my spasticity is bad. I have it in all my muscles and am a 4/5 in my limbs. However, this time I've allowed 4 months to pass between injections because I'M GETTING BETTER. The idea is to let more and more time pass between injections until I don't need them anymore.

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    2. No, that is wrong. Botox does not generate flu-like symptoms. This is incorrect information.

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  9. had a stroke 2 yrs ago, some months ago had a uti first ever, pain from the neck down a previous problem I had got rid of, can move all my fingers walk round house , where before I was reall getting better, going out etc and no pain would the amount of antibiotics about 5 lots dr kept giving for uti have messed my system up ?

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