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Hypertonicity, or hypertonia, is a condition in which the muscles are excessively tight or contracted, affecting various muscles in the body, including the pelvic floor. Hypertonia is defined as an abnormally increased resistance to externally imposed movement about a joint while the patient attempts to maintain a relaxed state. It is caused by upper motor neuron pathology in the brain or spinal cord, resulting from various conditions such as multiple sclerosis, stroke, brain tumours, toxins affecting the brain, or neurodegenerative processes. Hypertonicity can be managed through physical therapy, oral medications, intramuscular injections, and surgical procedures, depending on the patient's pathology and functionality.
| Characteristics | Values |
|---|---|
| Definition | Abnormally increased muscle tone |
| Muscle Tone | The resistance of muscles to passive stretch or elongation |
| Cause | Upper motor neuron pathology in the brain or spinal cord |
| Conditions | Multiple sclerosis, stroke, brain tumours, toxins that affect the brain, Parkinson's disease, cerebral palsy, etc. |
| Symptoms | Increased subjective stiffness, tiredness, aching pain, menstrual cramping, bladder control issues, etc. |
| Treatment | Physical therapy, oral medications, muscle relaxants, biofeedback, behavioural modifications, etc. |
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What You'll Learn
Muscular hypertonicity and rheumatological manifestations
Muscular hypertonicity (MHT) is a suspected contributor to rheumatological manifestations observed in ambulatory practice. MHT is recognised in neurological practice as occurring in various pathological conditions, such as post-stroke spasticity or rigidity in Parkinson's disease. In rheumatologic and physiatric practices, MHT may be observed in patients with pericranial and cervical muscle stiffness, tension-type headache (TTH), or other painful syndromes of the neck and shoulders.
A retrospective study of non-inflammatory rheumatic disease patients investigated whether individuals clinically identified with MHT had increased clinical manifestations compared to age- and gender-matched patients with the same disorders. MHT was identified as relatively increased passive resistance of relaxed muscle on a slow, gentle stretch. The 19 MHT cases complained of greater subjective stiffness and tiredness at initial encounters and increased aching pain. They were also prescribed more mild narcotic analgesics than the 19 comparison patients.
Among juveniles and young adults, phenotypic variations in muscular hypertonicity can affect various body regions, such as hamstring tightness. Athletic coaches and directors have expressed that overloaded muscles that are too tight or insufficiently strengthened can increase the risk of sports injuries. Different degrees of constitutional muscular tonicity may be advantageous in different sports and can influence strength and physical endurance.
Further research is needed to determine whether MHT is associated with increased rheumatological manifestations. This includes quantitative measurements of muscle stiffness and shear wave elastography of passive skeletal muscle stiffness to understand the influence of sex and age. Test-retest reliability and inter-rater reliability scales, such as the Modified Tardieu Scale and the Modified Ashworth Scale, can also be employed in hemiplegic patients with strokes.
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Hypertonicity and pelvic floor dysfunction
Hypertonicity is an abnormally increased muscle tone caused by upper motor neuron pathology in the brain or spinal cord. It is characterised by an abnormally increased resistance to externally imposed movement about a joint while the patient attempts to maintain a relaxed state. Hypertonicity is often associated with neurological conditions such as post-stroke spasticity or Parkinson's disease.
Pelvic floor dysfunction (PFD) or non-relaxing pelvic floor refers to the inability to relax the muscles of the pelvic floor, resulting in a range of symptoms that can significantly impact an individual's quality of life. This condition is more common in females, particularly those with a history of holding their bladder or bowels, as they tend to keep these muscles constantly activated without allowing them to relax. Additionally, individuals who engage in intense core-engaging workouts may also develop a hypertonic pelvic floor due to the constant activation of these muscles.
Symptoms of pelvic floor hypertonicity include pain, constipation, difficulty urinating or having bowel movements, and sexual difficulties such as dyspareunia. The pelvic floor muscles support vital organs such as the bladder, rectum, and uterus or prostate, and their normal function is essential for controlling bowel movements and urination. In females, these muscles also play a crucial role during sexual intercourse.
There is currently no cure for pelvic floor hypertonicity, but various treatment options are available to help manage symptoms. These include physical therapy techniques, manual therapies such as trigger point massage and myofascial release, and exercises to strengthen and stabilise the core and pelvic floor muscles. Identifying the underlying cause of hypertonicity is crucial, and a continence physiotherapist is typically the best professional to assess and diagnose this condition.
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Hypertonicity in juveniles and young adults
Hypertonia is abnormally increased muscle tone caused by upper motor neuron pathology in the brain or spinal cord. It is clinically assessed using the Ashworth scale and is defined as a velocity-dependent resistance to stretch. Hypertonicity is generally believed to be either an associated or secondary consequence of various pain-generating or other underlying abnormalities.
Among juveniles and young adults, phenotypic variations in muscular hypertonicity are known to affect various regions of the body. For instance, increased tonus may be related to an individual's body build, gender, or degree of flexibility training. Athletic coaches and directors have expressed beliefs that sports injuries can be increased when overloaded muscles are either too tight or insufficiently strengthened. A wide range of muscle tightness or extensibility has been documented among young sports participants, which tends to correlate with the chosen type of athletic competition. Different degrees of constitutional muscular tonicity may be advantageous in one sport or another, as is observed for strength and physical endurance.
Regional variants of hypertonicity are recognized in young athletes and in individuals with tight hamstring muscles. However, studies have yet to confirm whether such muscles are measurably tight or short. To our knowledge, a more diffuse, inherent hypertonicity has not been reported in juveniles or adults.
The most common hypertonia found in children, spasticity, reflects a lesion of the descending motor tracts from the motor cortex. Spasticity is hypertonia in which resistance to passive movement increases with increasing velocity of movement. It is often a component of upper motor neuron syndrome, along with hyperreflexia, clonus, reflex overflow, positive Babinski sign, and pyramidal distribution weakness.
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Hypertonicity and neurological conditions
Hypertonia is characterised by an abnormal increase in muscle tone, which can be caused by injury or damage to the central nervous system or spinal cord, disrupting nerve pathways that are responsible for muscle tone and posture. It is often observed in patients with cerebral palsy, stroke, or severe head or spinal cord injuries. It is also associated with neurological conditions such as Parkinson's disease, post-stroke spasticity, and tension-type headache (TTH).
Hypertonia is a condition that affects both children and adults and can cause a loss of function, decreased range of motion, deformities, and muscle stiffness. In children, the movement patterns may be affected by tension and contractures, and the condition is often characterised by spastic cerebral palsy. The severity of hypertonia can vary significantly between individuals, and it may affect one or both sides of the body.
The main clinical syndromes associated with hypertonicity are hypernatremia and hyperglycemia, which can lead to high mortality rates and severe neurological deficits. Hypernatremia results from a relative excess of body sodium over water, which can be caused by a loss of water, an increase in sodium intake, or a combination of both. On the other hand, hypertonicity in hyperglycemia involves solute gain secondary to glucose accumulation and water loss through hyperglycemic osmotic diuresis.
The treatment for hypertonia aims to reduce muscle excitability and improve motor function. Physiotherapy, including muscle stretching and range-of-motion exercises, is highly effective in managing hypertonia. Other methods such as icing, topical anesthetics, inhibitory pressure, and body heat retention techniques can also help decrease reflexive activity and improve motor function. In some cases, oral medications, intramuscular injections, and surgical procedures may be required.
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Hypertonicity treatment methods
Hypertonia is a condition that causes abnormally increased muscle tone due to upper motor neuron pathology in the brain or spinal cord. It is often characterised by resistance to passive movement and can be static or progressive. The condition can manifest in either spasticity, dystonia, rigidity, or a combination of these subtypes. Spasticity is a velocity-dependent increase in muscle tone, while dystonia is characterised by sustained or intermittent muscle contractions that cause abnormal movements or postures. Rigidity is a severe form of hypertonia, where muscle resistance occurs throughout the entire range of motion of the affected joint.
There is no single treatment for hypertonicity that is universally accepted as the gold standard. Treatment methods vary depending on the level of hypertonicity, the patient's goals, and the underlying cause of the condition. Treatment options can be categorised into medication, physical management, surgical interventions, and alternative treatments. Oral medications are a common treatment option, acting on different parts of the central nervous system. However, they often come with side effects such as sedation and potential withdrawal hazards.
Physical management of hypertonicity includes physiotherapy, which has been shown to be effective in controlling the condition through stretching exercises aimed at reducing motor neuron excitability. Static stretching and PNF stretching can help increase the range of motion and reduce muscle spasticity, respectively. Other physical techniques include inhibitory pressure, promoting body heat retention, and rhythmic rotation.
Surgical procedures are also an option for treating hypertonicity. For example, selective dorsal rhizotomy and orthopaedic surgery can be performed to address contractures or balance muscle/tendon forces around the joints.
Alternative treatments for hypertonicity include botulinum toxin injections, phenol injections, and intramuscular injections. Additionally, splinting techniques and static stretch casting can help extend the joint's range of motion lost to hypertonicity. Exercise and patient education are also important for a more permanent state of improvement.
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Frequently asked questions
Hypertonicity of muscles, or muscular hypertonicity, is when the muscles are excessively tight or contracted. This can affect various muscles in the body, including those on the pelvic floor.
Hypertonicity is caused by upper motor neuron pathology in the brain or spinal cord. It can be caused by a blow to the head, stroke, brain tumours, toxins that affect the brain, neurodegenerative processes such as multiple sclerosis, or neurodevelopmental abnormalities such as cerebral palsy.
Symptoms of hypertonicity include stiffness, tiredness, and aching pain. It can also cause bladder control issues and menstrual cramping. In severe cases, hypertonicity can cause immobility, leading to potential health issues such as increased bone fragility and infection.
Treatment for hypertonicity includes physical therapy, oral medications, intramuscular injections, and surgical procedures. Pelvic floor physical therapy involves exercises and techniques to relax and strengthen the pelvic muscles. Muscle relaxants or other medications may also be prescribed to reduce muscle tension.
Hypertonicity can affect people of all ages, including juveniles and young adults. It is also commonly seen in individuals with neurological conditions such as multiple sclerosis, Parkinson's disease, or stroke.
