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Neurologic/Geriatric>>Should I Exercise with Spasticity? - 1/6/2007

Should I Exercise With Spasticity?

Spasticity is defined as hypertonus, or too much muscle tone, which may result in decreased range of motion, overactive tonic reflex activity, and stiff, awkward movements. Basically, your muscles have a mind of their own and may contract independent of your conscious efforts. The distribution and quality of spasticity is though to be related to the site and extent of the brain or spinal cord damage.

Spasticity may exist at birth or develop in the postnatal period, as in cerebral palsy. Over time, some individuals with progressive neurological disorders, such as multiple sclerosis, may develop spasticity. Damage to the brain from a stroke or head injury may also produce spasticity following a period of hypotonia or low muscle tone.

The presence of spasticity may limit or totally restrict purposeful movement. Be careful when exercising a spastic extremity not to set off or increase abnormal muscle tone. You should have control of a movement before using resistance training to strengthen that m movement. If movements are not functional due to spasticity in that muscle group, the exercise program should focus on the movement and mu7scles opposing the spastic muscle groups. For example, if you cannot extend the elbow due to strong flexor tone (spasticity) in the biceps, the use of resistance exercise for the biceps is not appropriate. However, if you can extend the elbow in the presence of biceps flexor tone (spasticity), resistance training may be indicated to strengthen the triceps. Exercising the triceps may help decrease or normalize the abnormal tone of the biceps through a mechanism called reciprocal inhibition. Decreased spasticity in the biceps and increased strength in the triceps may give you greater control and function in your arm.

There may be some cases, however, in which strengthening spastic muscles are appropriate. A spastic muscle is not necessarily a strong muscle. If you have full isolated control of all movements in an extremity or muscle with minimal spasticity, resistance training may be indicated to strengthen the spastic extremity to increase use or function in it. However, any exercise or activity that limits function or motor control (coordination) of the extremity should be stopped.

Spasticity may temporarily increase in the involved extremity with increasing muscle effort on the noninvolved side; however, it should subside shortly after exercise. If spasms occur, they do not typically have a detrimental impact on your function or daily activities. Remember, spasticity is a dynamic condition and may differ with each individual. When in doubt, consult your physician, physical therapist, or appropriate medical professional.

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