Stretching spastic muscles is critical after a stroke. Spasticity is a movement disorder that causes an involuntary muscle contraction in response to lengthening. This occurs if there has been damage to the brain or spinal cord. This can make movement retraining and gait training difficult. One way to decrease the severity of the involuntary contractions is to maintain as much length in the muscle as possible. One of the best ways to do this is with a daily stretching routine.
Why is stretching spastic muscles important?
Yes, I said daily. Not once a week or “three times per week” (a therapist’s favorite exercise prescription). At a minimum, daily, and up to three times daily if possible. Before you tell me I have fallen off my rocker (to suggest such a thing), hear me out.
1. A bandaid alone does not heal the wound
Although there are several very effective treatments to “manage” spasticity, there is no cure for spasticity. Meaning, that those involuntary contractions? They are with you for the long haul. Now, before you think I am being negative, there is a “method to my madness”. More often than not, people rely on their next botox injection or worse, they are talked into tendon lengthening surgery. At the end of the day, those are just bandaids. If you don’t address the actual “wound” (by stretching the muscle), your spasticity will get worse.
Let me jump off my soapbox and get back into it. ?
2. Muscles adapt over time
So, without a cure, muscles (presenting with spasticity) will have a tendency to contract (shorten) multiple times a day. At best, when you are resting it will relax. However, in many cases, it just stays shortened….. all. day. long. The thing about muscles is they adapt. So, what happens when a muscle stays shortened for prolonged periods? The muscle adapts and adjusts to the new shortened position. No bueno. As the muscle adaptively shortens, a stretch reflex is “triggered” more easily. Meaning, more involuntary muscle contractions. This, of course, leads to more shortening……and so on.
Now, to add fuel to the fire, once a muscle has adaptively shortened, the “stretch reflex” is triggered more easily (I know, I am making this post more positive by the minute. – insert sarcasm ??♀️). Stay with me, I promise I have a point. So basically now it takes less “lengthening” to trigger an involuntary contraction. Meaning the muscle stays contracted even more throughout the day. Ugh. And guess what……more adaptive shortening.
How do you prevent spasticity from getting worse?
So, how do you prevent adaptive shortening in spastic muscles? Stretch. Not once, not twice, but multiple times a day. You want the muscle to maintain that elastic component because this decreases the severity and the frequency of those “involuntary muscle contractions”.
But, hopefully, by now you get my point. So, what is the best method for stretching a spastic muscle? I thought you would never ask……
The Proper Method to Stretch a Muscle With Spasticity
1. Be “Gentle”
Spasticity is what we call “velocity dependent”. What this means is that the faster a muscle is lengthened (speed at which you move the arm or leg to stretch the muscle), the stronger and faster the muscles will contract. I like to view this as kind of “awakening a sleeping giant”. The more you “startle” him, the “angrier” and more aggressive he will react. Same with the muscle.
2. Apply Pressure
Applying deep pressure a the muscle belly is sometimes an effective method to “quiet down” get the muscle to relax. In my clinic, I like to use a Urias air splint on the arm when I am stretching the shoulder. This helps to prevent the bicep from “getting angry” and keeps the arm straight. As well as it provides a nice even pressure on the arm muscles.
3. Get comfortable
The less “stressed,” the entire body is, the more the muscles can relax and might not be so “reactive” to the movement. That being said, if you can have the arm support on a table, for example, while stretching the wrist, you might be able to prevent the bicep from “getting angry”. Bedside tables work great for this can they are height adjustable and they are on wheels so that you can get it in the perform position for stretching
4. Find a quiet place
Believe it or not, noise can “trigger” spasms. Therefore, try and find a quiet place to perform your stretching routine
5. Stretch during “happy hour”
I know some of you just got really excited. 🙂 I am not speaking of “happy hour” in the literal sense. Pick a time of day when you are the most content. Yes, strong emotions can also make it harder to get “spastic muscles” to relax. So find a time when you are less likely to be stressed or angry.
How long should you hold a stretch when stretching a spastic muscle?
To achieve true muscle lengthening, you should hold a stretch a minimum of one minute. But, I would say, you can hold these stretches as long as you can tolerate. The longer the better. Remember, if you have moderate to severe spasticity, the muscle is staying “shortened” several hours out of the day. So, the more you stretch, the less time that muscle will stay shortened and the less chance of experiencing that “adaptive shortening”.
When it comes to the ankle, I recommend a night splint so that you can get a prolonged stretch overnight.