How to Manage MS Spasticity with Dr. Barry Singer

Living with Multiple Sclerosis (MS) can present unique challenges, especially when it comes to managing spasticity. Spasticity, characterized by tight or stiff muscles, can significantly impact your daily life. However, with the right approach, you can manage and even improve this condition. 

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We were lucky enough to have Dr. Barry Singer on a recent episode of The MSing Link. Dr. Singer has been a pivotal figure in the field of multiple sclerosis, contributing as an investigator in over 35 MS trials. His role on the board of directors of the Multiple Sclerosis Association of America and the creation of the award-winning MSLivingWell.org in 2007 emphasize his commitment to patient education. With a podcast named MS Living Well and active engagement on social media, Dr. Singer ensures that his expertise reaches far and wide.

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Dr. Singer and I explore the intricacies of managing spasticity, discussing its various types and the symptoms that come with it. He generously shares recommendations for therapies and medications, making this episode a must-listen for anyone navigating the challenges of multiple sclerosis.

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Hi, I'm Dr. Gretchen, a physical therapist and MS-certified specialist. I've dedicated my career to understanding Multiple Sclerosis and helping individuals overcome its symptoms. Through my work, I provide MS-specific exercises, easy-to-understand educational videos, and a supportive community to enhance the quality of life for those with MS. Thousands of people have improved their everyday lives using these research-backed strategies, finding renewed hope and confidence in their ability to continue progressing and living life to its fullest.

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What is Spasticity?

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Spasticity is a condition characterized by tight or stiff muscles that can be difficult to control. It occurs when there is an abnormal increase in muscle tone or stiffness, which can interfere with movement and speech. For people with MS, spasticity can vary from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms.

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How Does Spasticity Affect MS?

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Spasticity is a frequent symptom of MS, affecting many individuals with the condition. It can significantly impact daily life by making movements such as walking, sitting, and even sleeping uncomfortable or challenging. The increased muscle tone can lead to a reduced range of motion, muscle fatigue, and joint stiffness, further limiting mobility and independence.

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What Does Spasticity Feel Like?

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For those with spasticity, muscles often feel stiff, heavy, and hard to move. The sensation can range from mild discomfort to severe pain and rigidity, where the muscles remain locked in place. 

Unlike regular muscle tightness, spasticity-related stiffness can be persistent and may not easily subside with simple stretching.

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Spasticity vs. Muscle Tightness - What Is The Difference?

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One thing that people with MS often struggle with is telling the difference between spasticity and regular muscle tightness. Spasticity makes your muscles stay locked in place, whereas regular tightness is just muscles that have shortened and can be stretched out.

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• Spasticity: Muscles stay locked in position, often causing severe stiffness and difficulty moving.
• Regular Muscle Tightness: Muscles are shortened but can be loosened up with stretching and movement.

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Knowing the difference is key to managing it effectively.

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“Dr. Gretchen, I’m experiencing spasticity, but my MRI results don’t show significant lesions”

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This is a common concern among MS patients – when your physical symptoms don’t match up with what the MRI shows. Dr. Singer explained that as MS progresses to the secondary progressive phase, it doesn’t always result in new lesions on routine MRI scans. Instead, spinal cord disease often contributes to increasing weakness and balance problems. Understanding this can be helpful for anyone feeling frustrated when their symptoms seem more severe than what the MRI indicates.

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Can I Improve Spasticity?

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Yes, spasticity can be managed and improved with the right approach - and that’s exactly what I help thousands of MS warriors face. 

While physical therapy is just one component of an effective MS treatment plan, it plays a crucial role. Managing spasticity often requires a combination of treatments, including physical therapy, medications, and sometimes more advanced interventions. Additionally, identifying and managing triggers such as stress, heat, or fatigue can significantly help reduce spasticity.

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How Does PT Improve Spasticity?

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Physical therapy (PT) can be highly effective in managing spasticity, but it must be the RIGHT PT with a therapist who understands MS. A specialized physical therapist can provide targeted exercises to improve flexibility, strength, and overall mobility. 

These exercises often focus on stretching, strengthening, and functional training to help manage spasticity and enhance quality of life.

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Understanding Lesions and MRI Results

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Dr. Singer explained that there can be a discrepancy between physical symptoms and MRI results in MS patients. He mentioned that when MS progresses to the secondary progressive phase, new lesions might not appear on MRI scans. Instead, spinal cord disease often causes worsening weakness and balance issues. This is important for patients who are frustrated because their physical symptoms seem worse than their MRI results suggest.

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Dr. Barry Singer’s Tips For Managing Spasticity:

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Dr. Singer shared some really valuable insights on managing spasticity, stressing the need for a well-rounded approach. Here are some key points he highlighted:

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• Stretching and Exercise: These should be the initial interventions to help manage spasticity.

• Medications:
  • Baclofen: Useful for reducing muscle tone and stiffness.
  • Tizanidine: Another option with its own benefits and potential side effects.

• Advanced Interventions:
  • Botox Injections: Can be effective for severe cases of spasticity.‍
  • Baclofen Pumps: An option for those who need more intensive treatment.

• Newer Approaches:
  • Ketamine: Has potential uses but requires more research.‍
  • Cannabinoid Sprays: Promising results in Europe, though further studies are needed.

Step-by-Step Process to Manage Spasticity

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Step 1: Identify Triggers

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Identifying triggers that exacerbate spasticity is crucial. Common MS triggers include

• Heat
• Stress
• Fatigue
• Tight-fitting clothing.

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While relieving your spasticity symptoms is the goal, avoiding your triggers can be a huge help in finding relief quickly. Identifying and managing what sets off your spasticity—like stress, heat, or fatigue—can make a big difference in how you feel.

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Step 2: Stretching and Exercise

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Stretching and exercise are key to managing spasticity. Stretching helps loosen tight muscles, improves flexibility, and prevents them from getting stiff and hard. Exercise strengthens your muscles, boosts coordination, and improves blood flow, which helps reduce stiffness. By combining both, you can keep moving more easily and feel better overall.

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Here are a few examples:

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Seated Hamstring Stretch

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How to do it: Sit at the edge of a chair with one leg extended forward and the other bent. Sit up tall and hinge forward at the hips without rounding your back.

Hold: For 20-30 seconds or use a dynamic approach by holding for 2-3 seconds and repeating 20-30 times.

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Figure Four Stretch

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How to do it: Sit at the end of a chair and cross one ankle over the opposite knee. Sit up tall and, if needed, hinge forward slightly to feel a stretch in the outer thigh.

Hold: For 20-30 seconds or use a dynamic approach by holding for 2-3 seconds and repeating 20-30 times.

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Step 3: Foam Rolling and Massage

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Foam Rolling

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How to do it: Place a foam roller under the affected muscle and use your body weight to roll back and forth gently.

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Duration: Spend about 1-2 minutes on each muscle group, adjusting pressure as needed.

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Massage

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How to do it: Use the heel of your palm to apply pressure and massage the tight muscle. You can also use a massage device if you have hand weakness.

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Duration: Massage each area for 1-2 minutes, focusing on spots that feel particularly tight

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Step 4: Medication

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Consult your healthcare provider about medications like Baclofen, Tizanidine, or other prescribed treatments. These medications can help manage spasticity by reducing muscle tone and stiffness.‍

Dr. Singer emphasizes, "Medications can be very effective for managing spasticity, but it's important to find the right dosage and type that works for you."

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‍Step 5: Advanced Interventions

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For severe spasticity, advanced treatments such as Botox injections, Baclofen pumps, or even surgery may be considered. These options should be discussed with your healthcare provider to determine the best approach for your condition.

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Step 6: Collaborate with a Specialist PT

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Work with a physical therapist who specializes in MS. They can design a personalized exercise program that addresses your specific needs and helps manage spasticity effectively.

Example: Managing IT Band Tightness

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Figure Four Stretch

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How to do it: Sit at the end of a chair and cross one ankle over the opposite knee. Sit up tall and hinge forward slightly.

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Hold: For 20-30 seconds or use a dynamic approach by holding for 2-3 seconds and repeating 20-30 times.

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Foam Rolling

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How to do it: Place the foam roller under the IT band and roll back and forth gently.

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Duration: 1-2 minutes, adjusting pressure as needed.

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Massage

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How to do it: Use the heel of your palm to massage the IT band. You can also use a massage device.

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Duration: 1-2 minutes, focusing on particularly tight spots.

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Spasticity in MS can be challenging, but with the right approach, it can be managed effectively. By identifying triggers, incorporating regular stretching and exercise, using medications when needed, and working with a specialized physical therapist, you can significantly improve your quality of life. 

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To further boost your ability to manage spasticity, I invite you to join my FREE MS-Specific Walking Webinar. This incredible resource will teach you about neuroplasticity and how to exercise correctly with MS. Many participants have seen amazing improvements in their walking form, stamina, balance, and more. I hope you’ll join us, and I can't wait to see how this webinar helps YOU. 

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Remember, managing spasticity is a journey that requires a holistic approach and consistent effort. Start implementing these strategies today and see the positive impact they can have on your mobility and overall well-being.