Editor’s Note: This story is Part 2 of a 2-part series on spasticity. Part 1 focuses on the basics of the condition.

Treating spasticity, in which an issue with the central nervous system causes muscles to tighten abnormally, involves a team approach. A neurologist, a physical therapist, an occupational therapist and a speech therapist may all play a role.

“Having your team behind you is really important,” said Patty Bobryk, a neurologic physical therapist with UCHealth SportsMed Clinic in Steamboat Springs. “We can look at the whole person, understand the issues and help support the best outcomes.”

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Initial assessment: When someone is referred to physical therapy for spasticity, one of the first steps is to assess muscle movements.

Understanding which muscles have tightened abnormally helps determine next steps.

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“The arm might be tight with a bent elbow and fisted hand, or the leg might be difficult to bend at the knee with a foot that’s turned in or positioned down,” Bobryk said. “It happens involuntarily and might limit you from being able to move out of that pattern of movement.”

Targeted medications: Oral medications and targeted Botox injections can help provide relief. A collaborative approach is key: a physical therapist may determine where the injection would be most useful, then a neurologist injects the drug.

“We’re the movement and muscle people, and really study anatomy and function of muscles,” Bobryk said. “If you’re trying to relax a flexed-back wrist, we can identify the muscles that flex it back and inject those. It’s very targeted.”

Three to four weeks after an injection, Bobryk will re-evaluate the patient, then may suggest changes to the dosage or location of the next injection.

“We’re able to determine if this did what we wanted it to do,” she said. “It isn’t something that’s a one-and-done. The first set of injections may not give the person their optimal results.”

Though it can take time, results can be surprisingly good.

“One patient had a stroke many years ago, and we did injections in the upper body for a bent elbow and pain in the shoulder. The patient saw decreased pain, and the arm was more relaxed, so the patient wasn’t as self-conscious,” Bobryk said. “With lower extremities, I get a lot of feedback from patients that it makes a difference in their ability to move: their toe doesn’t catch as much, their ankle is in a better position. Those are all real wins for us.”

Physical therapy regimen: Stretching, strengthening opposing muscles, and rhythmical, reciprocal movements, such as riding a bike or walking, can help normalize movement patterns.

“Exercise and stretching are key,” Bobryk said. “Just putting weight on these muscles can send a message to the brain, which responds, ‘Oh, you want me to put weight on the leg? I can decrease spasticity a bit.'”

Splinting or bracing can keep the joint or extremity in more optimal positions, reducing pain and preventing structural changes.

Electrical stimulation may decrease tightness. Cold or heat sometimes help, though Bobryk cautions that effects vary and, in some cases, cold or heat can worsen the condition.

Pain from spasticity may increase at night, making it difficult to sleep. Stretching, rhythmic or reciprocal exercises, and getting into a position that opposes the spasticity can help.

An individualized approach: Treatment is tailored to each patient.

“There’s not a one-size-fits-all treatment when it comes to spasticity,” Bobryk said.

One truth always holds: it’s easier to treat the condition sooner rather than later.

“It’s a lot easier to treat something when it’s mild rather than when it has become so significant, it’s impairing your function,” Bobryk said.

But even if symptoms have been ongoing, it’s not too late to seek help.

“Whether you have had a recent injury or an old injury that’s causing spasticity, it’s never too late to investigate what options are available to have a better outcome and manage spasticity better,” Bobryk said.

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at cunninghamsbc@gmail.com.