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The spinal cord is an integral part of the human body, controlling movement and processing sensations. Spinal cord injuries (SCI) can cause spasticity, which results in stiff or tight muscles that are difficult to relax or stretch. This can be managed through various treatments, including oral medications, injections, and physical therapy. Muscle spasms, which are involuntary contractions, can occur with or without a spinal cord injury and are often treated with muscle relaxants. Flexion relaxation phenomenon (FRP) studies have investigated the impact of load, angular velocity, and posture on lumbar stability and muscle fatigue. Spinal electrical stimulation implants are being researched to improve functional outcomes and decrease spasticity. The myotatic reflex, induced by rapid muscle stretch, also plays a role in muscle relaxation and contraction.
| Characteristics | Values |
|---|---|
| Spinal cord function | Carries information such as touch, pain, movement, or a muscle stretch up to the brain |
| Spinal cord injury | Causes stiff or tight muscles at rest, making it hard to relax or stretch |
| Treatment for spinal cord injury | Surface stimulation of nerves using a nerve stimulator or TENS unit; spinal electrical stimulation implants; selective dorsal rhizotomy; intrathecal drug pump; oral or injectable medications; acupuncture; meditation |
| Muscle spasms | Can be caused by spinal cord injury, fatigue, stress, dehydration, low potassium, low magnesium, or overuse of muscles |
| Treatment for muscle spasms | Muscle relaxants, massages, stretches, consistent exercise, ice and heat |
| Myotatic reflex | Produces a muscle contraction in the agonist muscle or muscle group with simultaneous antagonist muscle relaxation |
| Biceps brachii reflex | Involves a reflexive muscle contraction of the biceps and relaxation of the triceps |
| Brachioradialis reflex | Involves a reflexive muscle contraction of the brachioradialis and relaxation of the triceps |
| Extensor digitorum reflex | Involves a reflexive muscle contraction in the forearm |
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What You'll Learn
Muscle spasms and spinal cord injuries
Muscle spasms are a common occurrence after a spinal cord injury (SCI). While they can be uncomfortable or painful, they often indicate a positive sign of recovery, especially in individuals who initially experienced paralysis after their injury. The spinal cord is responsible for transmitting sensory information to the brain and carrying signals from the brain to the rest of the body. After an SCI, this normal flow of signals is disrupted, resulting in muscle twitching, jerking, or stiffening.
Spasticity, or involuntary muscle contractions, is a common condition following an SCI. It can cause pain and stiffness, making it challenging to relax or stretch the affected muscles. However, spasticity is not always detrimental and doesn't always require treatment. In some cases, it can be beneficial, aiding in functional tasks like standing or gripping objects. Additionally, it can help preserve muscle mass and improve body composition and metabolism.
There are various treatments available to manage spasticity and muscle spasms after an SCI. These include injecting numbing medicines, ethyl or phenol alcohol, or neurotoxins like botulinum toxin into the affected muscles. Oral medications, such as benzodiazepine muscle relaxers (e.g., diazepam or clonazepam), dantrolene, tizanidine, and anticholinergics, may also be prescribed. An intrathecal drug pump, also known as a "pain pump" or "baclofen pump," can be surgically implanted to deliver medicine directly to the spinal canal. While these treatments can improve mobility and reduce pain, they may not be permanent solutions, and side effects should be carefully considered.
It is important to consult a healthcare provider to determine the best treatment plan for managing muscle spasms after an SCI. At-home treatments such as ice, heat, muscle relaxants, massages, stretches, and consistent exercise can also provide relief. Additionally, recognizing common triggers and maintaining flexibility can help prevent and manage spasticity. While muscle spasms can be a sign of recovery, they can also indicate a more serious underlying disorder, so it is crucial to monitor other symptoms and seek medical attention when necessary.
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Spasticity treatments
Spasticity is a symptom of several neurological conditions, causing muscles to contract simultaneously, affecting movement and speech. While there is no cure, treatments aim to alleviate symptoms and improve quality of life.
Oral Medications
Oral medications are typically inexpensive and easy to use, but they may have unwanted systemic effects. These include centrally acting agents like baclofen, clonidine, and tizanidine, as well as anticonvulsants such as benzodiazepines, gabapentin, and dantrolene. Benzodiazepines are muscle relaxants that can be used to treat back spasms, which are sometimes a symptom of spasticity.
Interventional Procedures
Interventional procedures include focal injections of botulinum toxin, phenol, or alcohol. Botulinum toxin injections can be used to treat spasticity in specific muscle groups, but their effects are temporary, requiring repeated injections over time. Injections of phenol or alcohol are numbing medicines that can be used alone or in combination with oral medications.
Intrathecal Baclofen Pump
Also known as a "pain pump" or "baclofen pump," this treatment involves surgically implanting a battery-operated pump that delivers baclofen medication directly into the spinal canal through a catheter. This method provides a steady dose of medication with fewer systemic side effects and a lower risk of drowsiness compared to oral baclofen.
Selective Dorsal Rhizotomy (SDR)
SDR is a surgical treatment for severe cases of spasticity. It addresses the underlying cause by rebalancing the electrical signals sent to the spinal cord through the careful cutting of selected nerve roots.
Physical Therapy
Physical therapy focuses on lower extremity stretching and strengthening exercises, mobility training, and gait improvement. It is often used in conjunction with other treatments and is particularly beneficial for individuals with spasticity in only a few muscle groups.
Multidisciplinary Healthcare Team
The most effective way to manage spasticity is through a multidisciplinary healthcare team, which may include neurologists, rehabilitation specialists, physical therapists, occupational therapists, speech and language pathologists, neurosurgeons, and orthopedic surgeons.
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The spinal cord and brain circuit
The spinal cord is a long, thin, tubular structure made up of nervous tissue. It carries nerve signals from the brain to the rest of the body and back, forming a complex circuit with the brain that controls the movement of our bodies and processes sensations. This circuit is protected by three layers of tissue or membranes called meninges, which are surrounded by the canal. The dura mater is the outermost layer, forming a tough protective coating. The arachnoid mater, the middle protective layer, is named for its spiderweb-like appearance. The innermost protective layer is the delicate pia mater, which is tightly associated with the surface of the spinal cord.
The spinal cord starts at the bottom of the brainstem and runs through the spine, ending in the lower back in a cone shape called the conus medullaris. The spinal cord has three areas that match the three sections of the spine: cervical (neck), thoracic (upper back), and lumbar (lower back). There are 31 nerves connected to the spinal cord, with 30 of them being pairs (one on each side of the spinal cord).
The spinal cord carries information such as touch, pain, movement, or a muscle stretch up to the brain. In response, the brain interprets the signal and sends the necessary commands back down the spinal cord. These signals tell the body how to react while controlling the intensity of the response.
The spinal cord is also responsible for coordinating reflexes and contains reflex arcs that can independently control reflexes. It is the location of groups of spinal interneurons that make up the neural circuits known as central pattern generators. These circuits control motor instructions for rhythmic movements such as walking.
The spinal cord and brain together make up the central nervous system, with the brain acting as a central computer that controls the body's functions. The brainstem, made up of the pons, medulla, and midbrain, connects the brain and spinal cord, controlling and coordinating messages going in and out of the brain.
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Myotatic reflex
The myotatic reflex, also known as the stretch reflex, is a muscle contraction in response to stretching a muscle. It is a spinal reflex that results in a fast response involving an afferent signal into the spinal cord and an efferent signal out to the muscle. The reflex is induced by the sudden passive muscle belly fibre stretch, producing a muscle contraction in the agonist muscle or muscle group with simultaneous antagonist muscle (or muscle group) relaxation.
The myotatic reflex is facilitated by several structures. The first is the muscle spindle, which detects a stretch and conveys the information to the central nervous system. The muscle spindle consists of an outer connective tissue sheath containing spiral threads, intrafusal specialised muscle fibres, and nerve endings. The second structure is the afferent sensory neuron, which carries the signal from the muscle to the spinal cord. The third is the efferent motor neuron, which carries the signal from the spinal cord back to the muscle. The fourth structure is the gamma motor neuron, which regulates how sensitive the stretch reflex is by tightening or relaxing the fibres within the spindle.
The myotatic reflex is a fundamental part of neurological examination and has been studied since the late 1800s. It is a monosynaptic reflex, which means that the signal entering the spinal cord arises from a change in muscle length or velocity. The reflex is also influenced by inputs from the motor cortex, which can either facilitate or depress its strength.
The myotatic reflex is important for maintaining muscle function and posture. It helps to resist changes in muscle length, which is useful for maintaining the position of a limb or posture. The reflex is also used for body posture and movement and does not rely on cerebral input for function.
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Flexion relaxation phenomenon
The flexion relaxation phenomenon (FRP) is characterised by the reduction or cessation of paraspinal muscle activity at maximum trunk flexion. During forward bending, there is a sudden cessation of erector spinae muscle activity, which is part of the normal kinematics of the spine.
FRP is reported to be altered in more than half of nonspecific chronic low back pain (NSCLBP) patients, where there is persistence of spinal muscle activity. This altered FRP may be explained by the complete relaxation of the spinal extensors at full flexion, with the extension torque supported by the posterior ligaments of the spine.
FRP has been studied in various populations, including female yogis and non-athlete groups, to understand its occurrence and potential clinical significance. The pattern of forward bending differs in yoga practitioners, and this learned pattern may make them more susceptible to injuries.
The biomechanical and clinical importance of FRP has been reviewed in the literature, specifically regarding the lumbar erector spinae flexion-relaxation phenomenon. This phenomenon is relevant in understanding the kinematics of the multi-segmental spine in NSCLBP patients and has been proposed as a muscular activity biomarker for this patient population.
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Frequently asked questions
A spinal cord injury (SCI) can cause muscle spasms and spasticity, which is the tightening of muscles that makes it difficult to relax or stretch them. The disruption of signals between the spinal cord and brain results in the brain being unable to regulate muscle reactions, leading to involuntary muscle contractions and reduced relaxation.
The spinal cord and brain form a complex circuit that controls muscle movement and sensations. During the myotatic reflex, a rapid stretch of certain muscles sends an action potential to the spinal cord, which returns to the muscle group, causing a reflexive contraction. Simultaneously, an action potential is inhibited in the antagonist muscle group, allowing it to relax.
There are various treatment options to manage spasticity after an SCI, including oral medications, injectable medicines, and surgical procedures. Oral medications include muscle relaxers such as benzodiazepines (e.g., diazepam, clonazepam) and dantrolene. Injectable treatments involve numbing medicines, alcohols, neurotoxins, or botulinum toxin delivered directly into the affected muscles. Surgical procedures, such as tendon releases or tendon lengthening, can also help relax the pull on the muscles.
Yes, non-invasive treatments include physical therapy, cold/heat therapies, acupuncture, meditation, massages, stretches, and consistent exercise. Surface electrical stimulation using a TENS unit can also help relax muscles and interrupt spasticity.
