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.

Botox ... Boom!

Every three months for the past year, I have received Botox injections – not for wrinkles – but as a treatment to relax my spastic muscles. I receive about 11 injections per session including my shoulder, bicep, forearm, calf, and the arch of my foot.

The treatment takes about 90 minutes starting with careful preparation of the poisonous and expensive substance. Botox is produced from the same bacteria that causes botulism poisoning. It's also a powerful neurotoxin (inhibits neuron communication across synapses). Essentially it blocks messages from brain to muscle, paralyzing the muscle to allow temporary relaxation.

My physical medicine doctor, "Dr. M," sticks electrodes to my skin around the targeted muscle. These sensors feed back to a computer that provides an audio representation of the erroneous signals being sent by the damaged area of my brain. Dr. M. inserts a needle into the belly of the muscle then wiggles it around until he finds the spot of highest interference – represented by a loud crackling static. Then he injects the Botox.

Yes, it hurts. My mom sat with me through one of my sessions and was distressed by my stifled cries. But about a week later the treated muscles relax enough to allow me to exercise and build the opposing weak muscles. In this way, Botox doesn't offer just temporary relief. It provides a respite during which my other treatments, such as exercise and electrical stimulation, can do their jobs more effectively to bring about long-term recovery.

Such a Spaz

When I was a kid, one of my favorite expressions was "Don't have a spaz," which I would say to someone who had lost emotional control. I didn't know it then, but spaz is a derivative of "spasticity," which is a common result of stroke. It describes a state of continuous, uncontrollable muscle contractions.

Absent the proper signals from my brain, my fingers clench into a fist. My arm curls toward my chest. My foot turns inward, pulled by tight muscles along my inner leg. My chest constricts like a steel band around my lung. Sometimes it's hard to breathe.

I am on two types of medication to counteract this problem – daily oral baclofen and quarterly Botox injections.They both ease but do not eliminate the symptoms.

My therapists tell me that I can learn to control the spasticity. For each movement, I concentrate on extending one set of muscles then contracting the opposing muscles. To straighten my arm, I focus on relaxing my bicep then recruiting my tricep. It's exhausting mental and physical work. I sometimes break a sweat just moving a can of tomato paste.

My no-longer neurologist told me that I'd be fighting spasticity the rest of my life. I'm not sure how that statement is supposed to help me. As someone who cultivated flexibility during 10 years of yoga, the idea of spending the next 30-plus years with half my body contracted totally makes me have a spaz.