Stroke Recovery: Spasticity vs. Adaptive Shortening vs. Contracture
Muscle tightness after stroke is common and can be the greatest barrier to restoring normal arm and leg movement. But not all tightness is the same.
To treat it effectively, you need to understand the differences between spasticity, adaptive shortening, and contracture—because each has a different cause, and a different solution.
Spasticity: Brain-Driven Overactivity
Spasticity is caused by a disrupted signal from the brain—not the muscle itself. After a stroke, the nervous system loses the ability to regulate how much signal gets sent to certain muscles. This leads to involuntary over-activation and resistance to movement, especially with faster movements.
It often presents as:
- A sudden snap or “catch” during a stretch
- Increased tone with stress, fatigue, or movement
- A flexed arm or pointed foot that fights against motion
Treatment must focus on restoring signal control, not just stretching. That includes slow movement, sensory feedback, and sometimes medication.
Adaptive Shortening: Muscles Reacting to Position
Muscles and tendons respond to the positions they’re kept in. If a limb stays flexed or immobile, the muscle shortens over time. This isn’t due to brain signal issues—this is a use problem.
It looks like:
- A limb that appears spastic but has no true catch
- Reduced passive range of motion over time
- Poor joint alignment or posture
🧠 Treatment focuses on restoring full range: prolonged stretching, joint positioning, and most importantly—active movement through range.
Contracture: Structural Change
A contracture occurs when the tissue itself becomes fibrotic or fixed. This is typically the result of long-term immobility and unaddressed shortening.
It presents as:
- A joint that is physically “stuck”
- No response to stretching
- Loss of joint mechanics and tissue pliability
🧠 Prevention is key. Once a contracture forms, treatment is limited. Management may include serial casting, orthotics, or surgical options.
Why This Matters
These three conditions can overlap—and often do. But mistaking one for the other leads to the wrong plan.
Spasticity ≠ Shortening.
Shortening ≠ Contracture.
- Spasticity needs brain retraining and splinting to minimize the length of time a muscle stays in a shortened position
- To prevent shortening it prioritize consistent lengthening and use.
- Contractures need to be avoided early by early range of motion, stretching, and positioning.
A tight muscle doesn’t always need to be stretched harder. First, it needs to be understood.
Once you gain understanding, you have the ability to maintain muscle length but more importantly set yourself up for successfully restoring movement post stroke.
