Physiotherapy plays a crucial role in managing spasticity, aiming to reduce muscle tone, improve range of motion, enhance functional independence, and prevent secondary complications.
- Stretching and Range of Motion (ROM) Exercises:
- Sustained Stretching: Holding stretches for extended periods (e.g., 30-60 seconds) to temporarily reduce muscle tone and maintain joint flexibility.
- Passive ROM: A therapist moves the limb through its full range to prevent contractures and improve flexibility.
- Active ROM: Encouraging the patient to actively move their limbs to promote muscle control and strength.
- 24-hour postural management strategies: Using positioning techniques in lying, sitting, and standing to reduce spasticity and prevent deformities, especially in children. This might involve advising on proper seating or specialized beds.
- Proprioceptive Neuromuscular Facilitation (PNF): Techniques that use specific patterns of movement and manual resistance to strengthen muscles, improve coordination, and reduce spasticity by stimulating proprioceptors. This often involves rhythmic initiation, slow reversals, and rhythmic stabilization.
- Modalities
- Functional Electrical Stimulation (FES): Applying electrical currents to affected muscle groups to strengthen muscles, reduce spasticity, and potentially improve function.
- Therapeutic Heat/Cold:
- Heat therapy (hot packs, warm baths, paraffin treatments): Can temporarily reduce muscle tone and increase tissue extensibility, making it an excellent preparation for stretching.
- Cryotherapy (cold application): Can also be used to reduce muscle excitability and spasticity.
- Standing Frames/Tilt Tables: Used for controlled weight-bearing, which can provide proprioceptive input and temporarily reduce lower limb spasticity.
- Strength Training:
- Despite concerns, evidence suggests that progressive resistance strength training does not increase spasticity in patients with stroke and can significantly reduce musculoskeletal impairments. It should be goal-directed and progressive.
Manual Therapy for Spasticity
Manual therapy is a fundamental component of physiotherapy for spasticity, involving hands-on techniques performed by a skilled therapist. The goal is to mobilize joints and soft tissues, reduce muscle tightness, and facilitate more normal movement patterns.
- Soft Tissue Mobilization: Techniques like massage, myofascial release, and trigger point release to address muscle tightness, spasms, and adhesions within the soft tissues.
- Joint Mobilization: Gentle, rhythmic movements applied to joints to improve range of motion, reduce stiffness, and minimize joint restrictions that often accompany spasticity. Therapists focus on “low-reflex working methods” to avoid exacerbating spasticity.
- Passive Range of Motion (PROM): The therapist manually moves the patient’s limbs through their available range of motion to prevent contractures and maintain joint integrity.
- Stretching: Manual stretching by the therapist provides sustained elongation to spastic muscles, helping to reduce hypertonia and increase flexibility. This is done slowly and gently to avoid triggering the stretch reflex.
- Neuro-facilitation Techniques: Specific manual cues and resistance applied by the therapist to facilitate desired muscle contractions and inhibit spasticity, often integrated with PNF.
- Positioning and Handling: Therapists educate patients and caregivers on proper positioning techniques in various postures (lying, sitting, standing) to manage tone, prevent pressure sores, and optimize function.
- Tactile and Proprioceptive Input: Applying various types of touch and pressure to the skin and joints can help modulate muscle tone and improve sensory awareness in affected limbs. This can include light tapping, brushing, or deep pressure.
