Spasticity
Stiff or jumpy muscles after SCI — what helps and when to worry.
What is it?
Spasticity is muscle stiffness or sudden jerks below your spinal cord injury. After an SCI, the signals between your muscles and your brain get scrambled. The muscle reflex circuits fire on their own.
Some spasticity is helpful. It can keep your muscles fuller, help you transfer, and warn you about a problem (like a bladder infection or pressure injury). Too much spasticity is a problem. It can hurt, mess up your sleep, cause skin breakdown from rubbing, and make moving harder.
How you might feel
- Sudden tightening in your legs or trunk
- Muscle jerks when you are touched, change position, or first wake
- Clonus — your foot or leg shakes in a fast rhythm
- Stiffness that makes catheterizing or transferring hard
- Pain or trouble sleeping when spasms hit at night
⚠️ A sudden change in spasticity is a warning sign
It often means something below your injury is wrong: bladder infection, pressure injury, ingrown toenail, kidney stone, fracture, or even appendicitis. Look for the trigger before you change your medicine.
What you can do at home
- Stretch every day. Slow, sustained stretches (30–60 seconds each) for hips, knees, ankles, and trunk. Most people aim for 30 minutes total per day.
- Stand or use a tilt table if your team has cleared you. Daily standing reduces stiffness.
- Avoid triggers. Tight clothing, full bladder, full bowel, skin breakdown, low room temperature.
- Range of motion when you cannot do it yourself. Train a caregiver to move each joint through its full range twice a day.
💊 Medicines
- Baclofen is the first-line oral medicine. Start low (5 mg three times a day), go slow. Do not stop suddenly — that can cause fever, confusion, and rebound spasticity. Always taper.
- Tizanidine 2–4 mg up to three times a day. Watch for sleepiness and low blood pressure.
- Gabapentin can help if spasticity comes with neuropathic pain.
- Diazepam at night for night spasms — but it can build a habit.
When pills are not enough
- Botulinum toxin injections for one or two muscles that cause the most trouble.
- Intrathecal baclofen pump — a pump under your skin sends baclofen straight to the spinal fluid. Much lower dose, fewer side effects, big results for severe spasticity.
📞 Call your doctor if
- Spasticity gets suddenly worse — look for an infection, pressure injury, or other trigger.
- Pills are not working.
- Your skin is breaking down from spasms.
- Your pump is alarming, leaking, or your dose runs low. Call right away — sudden withdrawal is dangerous.
At your next clinic visit
Bring a list of triggers, what helps, and how spasticity affects your day. A spasticity scale and your goals guide the plan.
Education only. Not medical advice. If you have a clinical question, talk to your rehab team. For emergencies call 911.