Dominic Stone
Multiple sclerosis (MS) is an autoimmune condition that affects the brain and spinal cord. While MS does not cause muscle knots per se, it does cause muscle spasms and stiffness, known as spasticity, in 40% to 90% of patients. This occurs when damage to the nerves in the brain and spinal cord disrupts normal muscle movement, causing involuntary contractions and increased muscle tension. Spasticity can affect the legs, groin, buttocks, back, vocal cords, bladder, trunk, and upper extremities. It can cause pain and discomfort, and impact a person's quality of life, emotional health, relationships, and employment.
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What You'll Learn
MS spasticity and spasms
Spasticity and spasms are common symptoms of MS, affecting between 40% and 80% of people with the condition. However, a 2021 research survey revealed that seven out of 10 people with MS had experienced spasticity for longer than they realised. This may be due to barriers such as a lack of vocabulary to describe symptoms.
Spasticity is a tightness or stiffness of the muscles, which can make them feel heavy and difficult to move. It typically occurs in the legs, groin, and buttocks. Mild spasticity may not be painful and can sometimes offer extra support when standing. However, more severe spasticity can cause significant discomfort and limit movement. Spasticity can also affect one's quality of life and emotional health, often accompanied by anxiety, depression, and low self-esteem.
Spasms are sudden involuntary contractions or tightening of one or more muscles, which may cause a limb to jerk or kick out uncontrollably. They can range from mild to severe and may be painful. Spasms can occur in different parts of the body and may be triggered by various factors, including temperature changes, infections, tight clothing, and stress. Some people experience more spasms during MS relapses, and certain triggers, such as bladder or bowel problems, can worsen them.
Managing spasticity and spasms involves maintaining flexibility through movement, stretching, and being aware of potential triggers. Physiotherapy, occupational therapy, and medications can help treat these symptoms. Identifying triggers is crucial for managing them effectively.
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MS causes nerve damage
Multiple sclerosis (MS) is an immune-mediated disease, meaning that the body's immune system mistakenly damages healthy nerve tissue. This causes damage to the myelin sheath, the protective covering around nerves in the brain and spinal cord. This inflammation leads to demyelination, which may result in nerve damage and a range of symptoms affecting different body systems.
Demyelination, or the destruction of myelin, causes MS. Myelin is a protective sheath around nerve cells (neurons) in the brain and spinal cord. It moves messages (signals) between the brain and the rest of the body to control functions like vision, sensation, and movement. With MS, the immune system becomes overactive and attacks healthy myelin, damaging it and disrupting the transmission of signals between nerve cells. This impaired nerve signaling can lead to the development of MS symptoms.
In normal movement, some muscles relax while others contract. However, MS can disrupt this process, causing multiple muscles to contract at once yet resist being stretched. This change in the motor system creates a tug-of-war between muscles, resulting in muscle spasms and stiffness. These spasms can be mild or severe, ranging from annoying and uncomfortable to painful. They can also affect walking, balance, and performing delicate movements with the hands and fingers.
MS-related muscle spasms can occur in different parts of the body and may be triggered by various factors, including temperature changes, infections, tight clothing, and stress. Identifying and addressing these triggers can help prevent and treat these symptoms. Treatments for MS-related muscle spasms and stiffness include drugs, physiotherapy, occupational therapy, and aquatic therapy.
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MS muscle spasm triggers
Muscle spasms and stiffness are very common symptoms of MS, affecting between 40% and 80% of people with the condition at some point. Spasticity, as it is called, can cause a range of problems, from minor annoyances to issues that make daily life and activities uncomfortable, painful, and difficult.
Spasticity is a tightness or stiffness of the muscles, which typically occurs in the legs (calf or thigh), groin, and buttocks. Mild spasticity may not be painful and can sometimes offer extra support when standing. However, more severe spasticity may cause significant discomfort if left untreated. It can also affect one's quality of life and emotional health, often accompanied by anxiety, depression, and low self-esteem.
Spasticity in multiple sclerosis is a result of demyelination along the nerves of the brain and spinal cord that control movement. This unevenness makes the muscles contract on their own and makes them tense. The condition can get worse when it’s too hot or cold, when the patient has an infection, or if they’re wearing tight clothing. Other common triggers include stress, bladder or chest infections, fever, and exercise.
There are several treatment strategies to reduce the effects of spasticity. Doctors can prescribe medications such as skeletal muscle relaxants, tizanidine, baclofen, dantrolene, and benzodiazepines. Complementary and alternative medicine (CAM) therapies such as relaxation techniques, deep breathing, guided imagery, and acupuncture may also help. In addition, aquatic therapy, braces, and other devices, as well as stretching exercises, can be beneficial.
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MS spasticity treatments
Muscle spasms or stiffness can affect between 40% and 80% of people with MS. Spasticity is a common symptom in multiple sclerosis, causing tightness or stiffness of the muscles, which typically occurs in the legs, groin, and buttocks.
There are several treatments for spasticity:
Drug treatments
Muscle relaxants, such as baclofen, can reduce stiffness and spasms and may be particularly useful for treating painful night-time spasms. An anticonvulsant drug can also calm overactive messages in the central nervous system that might cause spasms. Diazepam and clonazepam are similar drugs that can help if other treatments have not worked, but they are benzodiazepines, which can be addictive with long-term use. Botulinum toxin injections, sometimes known as Botox, may also be suggested by a specialist spasticity team. Phenol can be injected directly into the fluid around the spinal cord to treat very severe spasms that do not respond to other treatments.
Exercise and stretching
Exercise and stretching can help to manage stiffness due to MS, but they are sometimes not enough on their own. Aquatic therapy or aquatic exercise can be helpful, as the buoyancy of the water enables participants to move with less effort.
Medical devices
Devices such as toe and finger spreaders, as well as braces for the foot, hand, or wrist, may be of great assistance in avoiding contractures. Functional electrical stimulation (FES) can help to combat 'foot drop', where the muscles can't smoothly control the foot's actions during walking. TENS machines may help control the pain that some people experience with muscle spasms.
Complementary and alternative medicine (CAM) therapies
CAM therapies include relaxation techniques, deep breathing, and guided imagery. Some individuals may also benefit from acupuncture. Using cooling devices or ice packs after exercise may help to reduce spasticity.
Surgery
When other treatments don't work, there are two types of surgery that can treat spasticity: a rhizotomy, where a surgeon cuts away part of the spinal nerve, and a tenotomy, where a surgeon cuts severely tight tendons away from the muscles.
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MS muscle spasm treatments
Muscle spasms or stiffness can affect between 40% and 80% of people with MS. For most people, these are occasional symptoms. However, they can range from a minor annoyance to problems that make daily life and activities uncomfortable, painful, and difficult. Muscle spasms can occur in different parts of the body and may be triggered by various factors, including temperature changes, infections, tight clothing, and stress.
If MS causes nerve damage that affects muscle movements, it can cause a range of problems. Investigating potential trigger factors that cause or worsen MS spasms, muscle twitching, or stiffness is a vital step in finding solutions. For example, something as simple as loosening tight clothing might provide relief.
Several treatments can help manage MS muscle spasms and stiffness:
- Drugs and therapies, including physical therapy and occupational therapy
- Complementary and alternative medicine (CAM) therapies, such as relaxation techniques, deep breathing, and guided imagery
- Cooling devices or ice packs after exercise may help reduce spasticity
- Aquatic therapy or aquatic exercise
- Stretching exercises and range-of-motion exercises
- Medications, including muscle relaxants, alpha2-adrenergic agonists, and benzodiazepines
- Surgery, although this is typically considered when other treatments have not been successful
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Frequently asked questions
MS muscle knots, or spasms, are involuntary contractions caused by central nervous system damage. They can cause a body part to jerk in an uncontrolled way. They can be mild or severe and can be annoying, uncomfortable, and painful.
MS muscle knots are caused by heightened stretch reflexes. They are triggered when you place your foot on a hard surface. They can also be triggered by an increase in body temperature, infections, tight clothing, and stress.
There are various treatment options for MS muscle knots, including stretching exercises, physiotherapy, medication, complementary and alternative medicine (CAM) therapies, aquatic therapy, and braces and other devices.
