Spasticity can take several forms, such as a leg that jerks at night, calves that feel stiff when standing, or a hand that does not fully relax. These experiences, including muscle tightness, involuntary movements, and cramping, are all forms of spasticity. They affect around three out of four people with MS at some point.

Spasticity can be more than a minor problem. It can interrupt sleep, affect mobility, cause pain, and over time can lead to muscle shortening that is harder to reverse. It usually responds well to a combination of daily habits, targeted physiotherapy, and, where needed, medication.

This article explains what spasticity is, what can trigger it, and practical ways to reduce it.

Key Takeaways

• What spasticity is and why MS causes it
• What commonly triggers spasms to worsen
• Daily self-management strategies that can help
• When medication or other treatments may be useful
• When to seek help from your healthcare team

What Is Spasticity?

Spasticity is when muscles become tight, stiff, or contract without you intending them to. In MS, it happens because damage to nerves in the brain or spinal cord disrupts the signals that normally keep muscles relaxed when they are not in use.

It can show up in several ways:

• A constant feeling of heaviness or stiffness, especially in the legs
• Sudden spasms where a muscle tightens or jerks on its own
• Cramping, often at night
• Resistance when trying to stretch or move a limb
• Clonus, a rhythmic bouncing movement, often in the foot

Some people have mild stiffness that is mainly a nuisance. Others have more significant spasms that affect walking, driving, sleeping, or dressing.

Common Triggers

Spasticity is strongly affected by factors around the muscle, not just the muscle itself. Common triggers include:

Infections. Urinary tract infections are one of the most common, and most overlooked, causes of worsening spasms.

Tight clothing or poorly fitted shoes. These can irritate the nervous system.

Constipation or a full bladder. Internal pressure can increase spasms.

Skin problems. Pressure sores, ingrown toenails, or cuts can trigger spasms.

Cold weather and sudden temperature changes. This can be an issue with the large temperature swings common in regional Australia.

Fatigue and poor sleep. Tired muscles tend to be more reactive.

Stress and anxiety. These can raise muscle tone throughout the body.

Recognising your personal triggers is often one of the most useful steps in managing spasticity.

Daily Self-Management

Stretch every day. Stretching is central to managing spasticity. Gentle, slow stretches held for around 30 to 60 seconds, done daily, help keep muscles long and reduce tightness. A physiotherapist can teach you a short routine for your particular pattern.

Move regularly. Long periods of sitting or lying still allow muscles to stiffen. Changing position and moving around about every hour can help where possible.

Try warmth or cold. Many people find warm showers, heat packs, or warm pools ease tight muscles. Some find cold more helpful. It can be worth trying both to see which suits you.

Check your trigger list. If spasms are suddenly worse, it can help to consider possible causes, such as a new infection, constipation, dehydration, or new footwear.

Consider your sleep position. A pillow between the knees when lying on your side, or under the knees when lying on your back, reduces overnight cramping for some people.

Stay well hydrated. Dehydration can worsen muscle cramps.

Manage bladder and bowel. Regular emptying of the bladder and bowel reduces a common trigger for leg spasms. It is worth speaking with your GP or MS nurse if this is an ongoing issue.

Physiotherapy and Occupational Therapy

A physiotherapist experienced in neurology can be a valuable source of support for spasticity. They can:

• Assess which muscles are affected and why
• Design a stretching and strengthening program for you
• Teach safe techniques for daily activities
• Recommend equipment such as splints, braces, or standing frames
• Provide hydrotherapy, which many people with MS find helpful

Occupational therapists can assess your home setup, including chairs, bed, and bathroom, to reduce physical triggers of spasms during daily life. Many of these services are available through telehealth for people in regional Australia, and some may be covered under a GP Management Plan or through the NDIS.

Medications That Can Help

When self-management and physiotherapy are not enough, several medications are commonly used. These are usually prescribed by your GP or neurologist based on your symptoms.

Oral medications such as baclofen, tizanidine, dantrolene, and gabapentin can reduce muscle tone. They work by calming the nerve signals that drive the spasms, and your GP can help find a suitable medication and dose.

Nabiximols (Sativex) is a cannabis-based oromucosal spray approved in Australia for MS spasticity that has not responded to other treatments. Research supports its effectiveness for reducing spasticity and spasm frequency in people who respond to it.

Botulinum toxin injections can be useful for specific, very tight muscles, and are administered by a specialist.

Intrathecal baclofen pumps, which are surgically placed devices that deliver medication directly to the spinal fluid, are sometimes used for severe, widespread spasticity that has not responded to other treatments.

Every medication has possible side effects, with drowsiness, weakness, and low blood pressure among the most common. A common approach is to start at a low dose, increase slowly, and review regularly with your doctor.

When to See Your Healthcare Team

It is worth speaking with your GP, MS nurse, or neurologist if:

• Spasms are regularly disrupting sleep
• Spasticity is affecting your ability to walk, dress, or transfer
• You suspect an infection, for example new burning when urinating, fever, or sudden worsening
• Pain is becoming a daily issue
• Current medication is not controlling symptoms, or is causing side effects

Addressing spasticity earlier is generally easier than waiting until it becomes severe.

Summary

Spasticity is common in MS, and it is manageable. Daily stretching, identifying and addressing triggers, working with a physiotherapist, and, where needed, the right medication can all help with comfort, sleep, and mobility. Small, consistent actions tend to add up over time.

If spasms or stiffness are affecting your daily life, your healthcare team has a range of options to consider. Raising it early can help you find the approach that works best for you.

FAQs

Is spasticity the same as a muscle cramp? Not quite. Cramps are short-term muscle contractions, often from dehydration or overuse. Spasticity is ongoing increased muscle tone and involuntary contractions caused by nerve signal changes in MS.

Will my spasticity get worse over time? Not necessarily. With good management, many people keep spasticity stable for years. Active treatment can help prevent the muscle shortening that makes it harder to manage later.

Does exercise help or make it worse? Regular, appropriate exercise, especially stretching and strength training, generally helps. A physiotherapist can tailor a plan that avoids triggering spasms.

Why do spasms get worse at night? Nights involve prolonged stillness, cooler temperatures, and sometimes a full bladder, which are all common triggers. Stretching before bed, good positioning, and bladder care can all help.

Is medical cannabis (Sativex) available in Australia? Yes. Nabiximols is approved in Australia for MS spasticity that has not responded to first-line treatments. Your neurologist can advise whether it is suitable for you.

References

1. Otero-Romero, S., Sastre-Garriga, J., Comi, G., et al. (2016). Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper. Multiple Sclerosis Journal, 22(11), 1386–1396.
2. Hugos, C. L., & Cameron, M. H. (2019). Assessment and measurement of spasticity in MS: State of the evidence. Current Neurology and Neuroscience Reports, 19(10), 79.
3. Etoom, M., Khraiwesh, Y., Lena, F., et al. (2018). Effectiveness of physiotherapy interventions on spasticity in people with multiple sclerosis: A systematic review and meta-analysis. American Journal of Physical Medicine & Rehabilitation, 97(11), 793–807.
4. Nicholas, J. A., Electricwala, B., Lee, L. K., & Johnson, K. M. (2023). Efficacy of nabiximols oromucosal spray on spasticity in people with multiple sclerosis. Multiple Sclerosis and Related Disorders, 75, 104745.
5. Rice, J., & Cameron, M. (2018). Cannabinoids for treatment of MS symptoms: State of the evidence. Current Neurology and Neuroscience Reports, 18(8), 50.
6. Haselkorn, J. K., Balsdon Richer, C., Fry Welch, D., et al. (2005). Overview of spasticity management in multiple sclerosis: Evidence-based management strategies for spasticity treatment in multiple sclerosis. Journal of Spinal Cord Medicine, 28(2), 167–199.