Muscle Spasms and Stiffness

image of soar muscles

    Many people with MS experience muscle spasms and stiffness, mostly in the arms, legs, and lower back. This can cause involuntary movements and discomfort, as well as restrict movement, either directly or indirectly through pain 1,2. The cause is thought to be nerve damage from MS that disrupts electrical signals from the brain and spinal cord, making muscles contract and tense up involuntarily 3. The condition can get worse in extreme temperatures, during illness, or with specific movements or tight clothing. Spasticity in MS is often poorly controlled by conventional medications 1 that have unwanted side effects 4, but alternative options have been associated with improvements.

  • Physical and occupational therapies can be used to help manage MS spasticity and impaired mobility 5, of which stiffness is often a cause 6. These may include a stretching program along with use of equipment such as like splints, casts, or braces, to maintain or enhance flexibility and range of motion.

  • Similar to physical therapy, targeted exercises can provide relief from – and perhaps even prevent – spasticity and impaired mobility due to MS 5. An illustrated guide is offered by the National MS Society here.

  • Massage, including reflexology, has been observed in some research to significantly relieve spasticity and pain in MS when compared with other interventions, such as physical therapy, exercise and a “sham” (non-therapeutic) massage 7. However, findings are inconsistent 2,8.

  • Acupuncture has been associated with anecdotal reports of improvements in the spasticity and stiffness associated with MS 4. In a small controlled study, ambulatory MS patients (but not those in a wheelchair) showed improvement with acupuncture 9. A case study of dry needling (similar to acupuncture, but with needle placement based on Western medicine) showed decreased spasticity and improved mobility after a single session10.

  • Cannabis has long been proposed as an antispasmodic and muscle relaxant. Smoked cannabis (once daily for three days) was observed to be superior to placebo in symptom and pain reduction in MS patients with treatment-resistant spasticity in randomized, controlled trial 11. Smokeless oral cannabis products – particularly a highly standardized tetrahydrocannabinol (THC) + cannabidiol (CBD) oromucosal spray yielding 2.7 mg of THC and 2.5 mg of CBD (Sativex®) – have been shown to ease spasticity, either alone 12 or as an add-on to conventional medications 13,14.

  • A popular homeopathy remedy for the muscle cramps sometimes accompanying spasms in MS is cuprum metallicum, often taken as a 30C single dose nightly. This appears to prevent the great discomfort that some people experience in the early hours of the morning. Some patients, particularly very chilly, anxious individuals woken in the middle of the night, may respond better to cuprum arsenicosum taken in a similar regime. These cuprum salts m help may also be supportive in dealing with the spasms themselves. Other relevant remedies include Nux vomica and ignatia, the sources of which contain the chemical strychnine, which causes spasms in poisonous doses and thus in homeopathic amounts is thought to have the opposite effect. The pure chemical itself is available as the remedy strychninum, 30C of which is recommended when indicated 15.

References

1. Bethoux F, Marrie RA. A Cross-Sectional Study of the Impact of Spasticity on Daily Activities in Multiple Sclerosis. Patient. Dec 2016;9(6):537-546. doi:10.1007/s40271-016-0173-0

2. Schroeder B, Doig J, Premkumar K. The effects of massage therapy on multiple sclerosis patients’ quality of life and leg function. Evid Based Complement Alternat Med. 2014;2014:640916. doi:10.1155/2014/640916

3. Yamaguchi T, Hvass Petersen T, Kirk H, et al. Spasticity in adults with cerebral palsy and multiple sclerosis measured by objective clinically applicable technique. Clin Neurophysiol. Sep 2018;129(9):2010-2021. doi:10.1016/j.clinph.2018.07.004

4. Karpatkin HI, Napolione D, Siminovich-Blok B. Acupuncture and multiple sclerosis: a review of the evidence. Evid Based Complement Alternat Med. 2014;2014:972935. doi:10.1155/2014/972935

5. Campbell E, Coulter EH, Mattison PG, Miller L, McFadyen A, Paul L. Physiotherapy Rehabilitation for People With Progressive Multiple Sclerosis: A Systematic Review. Arch Phys Med Rehabil. Jan 2016;97(1):141-51 e3. doi:10.1016/j.apmr.2015.07.022

6. Flachenecker P, Henze T, Zettl UK. Spasticity in patients with multiple sclerosis–clinical characteristics, treatment and quality of life. Acta Neurol Scand. Mar 2014;129(3):154-62. doi:10.1111/ane.12202

7. Tochaiwat K, Predeekanit, K., Udom, T., Srisubat, A., Thaiyakul, A. Massage Therapy for Spastic Neurological Patients: A Systematic Review. J Dept Med Ser. 2019;44(1):42-46.

8. Backus D, Manella C, Bender A, Sweatman M. Impact of Massage Therapy on Fatigue, Pain, and Spasticity in People with Multiple Sclerosis: a Pilot Study. Int J Ther Massage Bodywork. Dec 2016;9(4):4-13. doi:10.3822/ijtmb.v9i4.327

9. Miller RE. An investigation into the management of the spasticity experienced by some patients with multiple sclerosis using acupuncture based on traditional Chinese medicine. Complement Ther Med. 1996;4(1):58-62.

10. Khalilian B, Madadi S, Fattahi N, Abouhamzeh B. Coenzyme Q10 enhances remyelination and regulate inflammation effects of cuprizone in corpus callosum of chronic model of multiple sclerosis. J Mol Histol. Feb 2021;52(1):125-134. doi:10.1007/s10735-020-09929-x

11. Corey-Bloom J, Wolfson T, Gamst A, et al. Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. CMAJ. Jul 10 2012;184(10):1143-50. doi:10.1503/cmaj.110837

12. Collin C, Davies P, Mutiboko IK, Ratcliffe S, Sativex Spasticity in MSSG. Randomized controlled trial of cannabis-based medicine in spasticity caused by multiple sclerosis. Eur J Neurol. Mar 2007;14(3):290-6. doi:10.1111/j.1468-1331.2006.01639.x

13. Markova J, Essner U, Akmaz B, et al. Sativex((R)) as add-on therapy vs. further optimized first-line ANTispastics (SAVANT) in resistant multiple sclerosis spasticity: a double-blind, placebo-controlled randomised clinical trial. Int J Neurosci. Feb 2019;129(2):119-128. doi:10.1080/00207454.2018.1481066

14. Novotna A, Mares J, Ratcliffe S, et al. A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex((R)) ), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis. Eur J Neurol. Sep 2011;18(9):1122-31. doi:10.1111/j.1468-1331.2010.03328.x

15. Whitmarsh TE. Homeopathy in multiple sclerosis. Complement Ther Nurs Midwifery. Feb 2003;9(1):5-9. doi:10.1016/S1353-6117(02)00105-1

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