Spasticity is a muscle tone disorder characterized by excessive and involuntary contraction of muscles that develops due to damage to the central nervous system.
Due to the communication break in the nerve pathways that control the body’s movement, the muscles constantly receive the signal of “contraction”, and this causes stiffness, limitation of movement and often pain in the joints.
What is Spasticity?
Spasticity is more than a simple muscle stiffness, it is a high muscle tone that shows a speed-dependent increase; that is, the faster the muscle is stretched, the greater the resistance.
Under normal conditions, our brain tells the muscles when to contract and when to relax, but in the case of spasticity, these inhibitory signals from the brain cannot reach the muscles.
As a result, the muscles remain constantly tense, making it difficult for the patient to perform daily activities such as walking, grasping, or self-care.
According to Assoc. Prof. Dr. Erdinç Özek; “Spasticity should not be seen only as a physical stiffness. This condition is when the communication between the patient’s nervous system and muscles becomes chaotic. Our main goal in treatment is to relieve this chaos and enable the patient to regain his functional freedom.”
What Causes Spasticity? (Causes)
Spasticity is not a disease, but a clinical finding caused by primary damage affecting the central nervous system.
Damage to the movement control centers in the brain or spinal cord disrupts the flow of signals from these areas to the muscles.
- Cerebral Palsy (CP): It is the most common cause of spasticity in childhood; It is caused by damage to brain development before or after birth.
- Stroke (Paralysis): It is common in adults when the movement centers are damaged as a result of interruption of blood flow in the brain or bleeding.
- Traumatic Brain or Spinal Cord Injuries: Physical severing or crushing of nerve pathways as a result of an accident or impact.
- Multiple Sclerosis (MS): Damage to the myelin sheath that protects nerve fibers slows signals and triggers spasticity.
- Anoxia: Widespread neuronal damage caused by oxygen deprivation of the brain.
The following table compares the conditions that cause spasticity and the area of the nervous system it affects:
| Cause | Area of Damage | Clinical Presentation |
| Cerebral Palsy | Brain (Developmental) | Movement disorder that starts at an early age. |
| Spinal Cord Injury | Spinal cord (Traumatic) | Stiffness in muscles below the level of damage. |
| Stroke | Cerebral Vascular Structure | Stiffness that usually appears in one half of the body. |
| Multiple Sclerosis | Central Nervous System | Variable increase in muscle tone due to attacks. |
What are the Symptoms of Spasticity?
Spasticity is a set of symptoms that can occur in different severity and form in each patient and may vary over time.
This involuntary activity in the muscles causes not only physical stiffness but also functional losses that limit the person’s daily life.
- Muscle Stiffness (Increased Tone): It is the feeling of resistance to moving the joints and the tense muscles.
- Involuntary Contractions and Spasms: It is the sudden and uncontrolled contraction of the muscles, causing severe pain.
- Clonus: It is a series of rhythmic and repetitive contractions that occur when a muscle is stretched rapidly.
- Deformities in the Joints (Contracture): It is the shortening of the tendons and the permanent bending of the joints as a result of the muscles being constantly short and tense.
- Shear Walk: It is a typical gait disorder seen in the form of the legs hitting or crossing each other, especially due to spasticity in the legs.
- Pain and Sleep Disorders: It is the decrease in the patient’s rest quality due to severe cramps that increase at night.
Assoc. Prof. Dr. Erdinç Özek; “Spasticity symptoms are not limited to the muscles; Uncontrolled contractions can lead to permanent freezing (contractures) in the joints over time. Therefore, it is vital to intervene when symptoms are mild to prevent larger surgeries that may be needed in the future.”
How is Spasticity Diagnosed?
Diagnosis of spasticity is a process that requires a multidisciplinary approach, blending the patient’s clinical history with physical examination.
The main purpose of the diagnosis phase is not only to detect spasticity, but also to reveal the severity of this condition and how much it affects the patient’s functionality with numerical data.
- Neurological Examination: Checking reflexes begins with measuring muscle strength and assessing joint range of motion (ROM).
- Ashworth or Modified Ashworth Scale: It is the most common clinical scale used to measure the level of muscle tone; The resistance of the muscle is given a score between 0 and 4.
- Penn Spasm Frequency Scale: It is used to assess the number of spasms experienced by the patient during the day and their severity.
- Imaging Methods (MRI and CT): It is ordered to determine the location and extent of the actual brain or spinal cord damage causing spasticity.
- Gait Analysis: It is an advanced assessment method that digitally analyzes the patient’s muscle activity and joint angles during walking.
The following table compares common scoring systems used in clinical assessment:
| Assessment Tool | What is measured? | Clinical Significance |
| Ashworth Scale | Resistance of the muscle to passive movement | It determines the degree of spasticity. |
| Tardieu Scale | Velocity-dependent resistance response of the muscle | It measures the speed at which the muscle contracts. |
| GMFCS Score | General gross motor functions | It shows the patient’s capacity for independent movement. |
Clinical Experience Note (Anonymous Case):
In a patient who presented with the complaint of continuous contraction in the ankle, it was determined that the Modified Ashworth score was 3 and contracture developed at the initial level. Instead of a diagnosis based on observation alone, dynamic electromyography (EMG) analyzes were used to determine which muscle group was overactive and thus personalized the treatment protocol.
Spasticity Treatment Methods
Spasticity treatment is carried out with a step-by-step approach that aims to increase the patient’s independence and reduce pain.
Treatment plan; It is personalized based on the patient’s age, the extent of spasticity, and the underlying root cause.
Our aim is to maintain existing muscle strength and prevent permanent joint disorders while reducing excessive tone in the muscles.
Drug Treatments
Systemic drug therapy is usually the first line of choice for mild to moderate widespread spasticity.
Muscle relaxants taken by mouth work by suppressing the stimulating signals on the central nervous system.
However, since the use of these drugs in high doses can cause side effects such as dizziness, weakness and loss of concentration, dose adjustment should be done meticulously.
Physical Therapy and Rehabilitation
Physical therapy is an indispensable building block of treatment, involved in every stage of spasticity management.
Shortening of the muscles is prevented with stretching exercises, strengthening exercises and appropriate device (use of orthosis).
Modern methods such as robotic rehabilitation and in-water exercises play an important role in increasing the patient’s mobility.
Botulinum Toxin (Botox) Applications
One of the most effective methods for regional (focal) spasticity is botulinum toxin injections directly into the targeted muscle.
This process temporarily blocks the communication between the nerve and the muscle, allowing the muscle to relax.
Its effect usually lasts 3-6 months and is especially preferred to increase compliance with physical therapy or to see muscle response before surgery.
Surgical Treatment Methods
In cases where conservative methods (medication and physical therapy) are insufficient, surgical options come into play.
Modern neurosurgery offers advanced technological solutions capable of controlling spasticity at its source (at the level of the spinal cord or nerve root).
Baclofen Pump (Intrathecal Baclofen Treatment)
The baclofen pump is a surgical method that allows the drug to be delivered directly into the spinal fluid (intrathecal distance) in patients with severe and widespread spasticity.
A small pump placed in the abdomen continuously delivers medication to the target area through a thin catheter.
The biggest advantage of this method is that it provides much stronger relaxation with one thousandth of the oral dose without causing systemic side effects.
Selective Posterior Root Risotomy (SDR)
SDR is a delicate surgery performed to permanently reduce spasticity in the legs, especially in children with Cerebral Palsy.
Faulty sensory nerve roots that come out of the spinal canal and send an “excessive contraction” signal to the muscles are tested one by one with intraoperative neuromonitoring.
Only the fibers that transmit faulty signals are selectively cut off, thus permanently disabling the mechanism that causes spasticity while maintaining normal motion signals.
The table below compares the characteristics of the two primary surgical methods:
| Feature | Baclofen Pump | Selective Posterior Root Risotomy (SDR) |
| Duration of Effect | Adjustable / Reversible | Permanent / Irreversible |
| Application Area | Whole Body (Common) | Especially the lower extremities |
| Method | Drug Release Device | Cutting Nerve Fibers |
| Ideal Candidate | Severe Diffuse Spasticity | Children with CP with Walking Potential |
Assoc. Prof. Dr. Erdinç Özek; “‘Timing’ is everything in the decision of surgery. For methods such as baclofen pump or SDR, taking action before permanent freezing (contractures) occur in the joints doubles the functional success of surgery.”
Clinical Experience Note (Anonymous Case):
In an 8-year-old patient with Cerebral Palsy, his ability to walk began to decline due to intense contraction in the legs. After SDR surgery, the stiffness in the legs decreased by 60%, and the patient switched from assisted walking to independent walking at the end of 1 year with intensive physical therapy after surgery.
What happens if spasticity is not treated?
Spasticity is not a static condition when left alone; on the contrary, it tends to leave irreversible damage to muscle, joint and bone structure over time.
Untreated or improperly managed spasticity brings with it a range of complications that can render a patient bedridden.
- Contracture Development: As a result of the muscles being in a short position all the time, the tendons shorten and the joints completely lose their mobility and freeze at a certain angle.
- Bone and Joint Deformities: Especially in growing children, the muscles constantly pulling the bones in the wrong direction causes hip dislocations and spinal curvatures (scoliosis).
- Pressure Sores: The patient’s inability to change position due to contractions and constant pressure on the same point leads to skin wounds that are difficult to treat.
- Self-Care Challenges: Failure to provide hygiene and meet basic needs such as dressing and nutrition seriously reduces the patient’s quality of life.
According to Assoc. Prof. Dr. Erdinç Özek; “Untreated spasticity causes the body to lock itself in. Without early intervention, the problem simply leaves the nervous system and turns into an orthopedic wreck; this increases the surgical burden and patient suffering.”
Frequently Asked Questions
Does spasticity go away?
Although spasticity cannot be completely eliminated due to underlying nervous system damage, it can be controlled with personalized surgery and medical treatments by reducing it to a level that does not restrict the patient’s daily life.
How is spasticity diagnosed?
Characteristic symptoms such as encountering rapidly increasing resistance when trying to move a joint, involuntary muscle contractions and scissor gait indicate the presence of spasticity.
What is the difference between spasticity and rigidity?
While spasticity has a resistance that increases as the speed of movement increases; Rigidity is the continuous and constant rigidity of the joint in all directions, regardless of the speed of movement.
Source and Expert Knowledge:
The medical information in this article has been arranged with reference to Assoc. Prof. Dr. Erdinç Özek’s 2026 current clinical protocols in the field of functional neurosurgery and movement disorders surgery. Assoc. Prof. Dr. Erdinç Özek is an expert who provides services at international standards in the differential diagnosis and surgical management of complex neurological pictures.
