Spasticity is one of the most common MS symptoms, and often feels worse at night. This is because it can be aggravated by reduced movement, tight muscles and pain from other symptoms. If you have increased MS spasticity at night you should look carefully at your sleeping position, mattress and pillows, as well as considering temperature regulation and the timing of your medication. There are also MS spasticity exercises you can do in bed.
The main feature of spasticity is stiffness or increased resistance when attempting to move a limb or joint.
Other features that may be associated with it include spasms, pain, weakness and clonus (involuntary contractions in a rhythmic pattern in response to sudden stretch of a muscle). It can vary in intensity from person-to-person.
Spasticity can be triggered at any time through a variety of stimuli:
Spasticity can feel worse at night as:
Spasticity may also feel worse in the morning due to the time you have spent inactive in bed.
Pain and insomnia are linked in people with MS due to muscle tightness. Experiencing insomnia can increase fatigue, which can create stress and increase spasticity. Managing these symptoms is essential to improve your quality of life.
There are plenty of things you can do to improve spasticity.
Managing factors that trigger your spasticity can help ease the symptoms and spasms. Being able to identify these triggers is important in managing your symptoms.
Positioning
You may be offered medication to relax muscles or to aid sleep if spasticity is worse at night, think about the timing of your medication to make sure you get the best effect when you need it most.
Medication can come in the form of:
Feeling negative or depressed has been reported to increase spasticity. Using stress reduction techniques could help with spasticity symptoms. Try meditation, relaxation techniques, deep breathing, and guided imagery.
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Some people find that cold and hot temperatures can make spasticity worse. This could also be a result of Uhthoff’s phenomenon (the worsening of multiple sclerosis symptoms that some people experience when exposed to heat).
Make sure you maintain a comfortable temperature at night using air conditioning, a fan, bedding or heating when necessary.
Other ways to avoid spasticity symptoms related to temperature:
It is important to maintain flexibility with specific stretches, as spasticity can be aggravated by reduced movement. A physiotherapist will be able to help you with a program of suitable stretches.
Studies have reported positive effects of exercise on reducing spasticity in persons with MS. These have included cycling [Sosoff et al. 2009], a group exercise intervention [Tarakci et al. 2013] and locomotor training [Giesser et al. 2007].
Spasticity can cause muscles to shorten and joints to stiffen which can then increase muscle overactivity. Exercises to increase flexibility and increase muscle tone may be useful. Prolonged stretching can make muscles longer, helping to decrease spasticity and prevent contracture.
Aim to stretch daily to muscle’s full length. It is also important to do some ‘range of motion’ exercises, used to keep joints strong and flexible. Make sure you balance your movements – do the same number of reps on each side and combine ‘push’ and ‘pull’ exercises.
A thorough stretching program will include exercises in certain sitting or lying positions that allow gravity to aid in stretching specific muscles.
If you are having spasticity symptoms at night, try some moves in bed e.g. drawing knees up to the chest and letting one knee fall to the side, then repeat on the other side. Otherwise, get up and try some moves slowly and mindfully.
Yoga / adaptive yoga
Yoga is a flexible practise and there are lots of types which you can choose from to suit you – it is also something you can do at home. You can use props such as a chair, bolster or the wall.
Yoga and pilates can also help improve posture and positioning. Yoga has also been found to decrease fatigue. Other studies have reported improvement in anxiety, depression, fatigue, bladder function, pain, spasticity, weakness and walking.
Here is an example yoga relaxation sequence you can use. This can also help you to relax.
Pilates / MS pilates
Pilates stretching exercises can also be very helpful. Pilates is a series of exercises based on whole-body movement and are low impact, building strength and control.
This can also help with other MS symptoms such as cognitive symptoms and like all exercise, it can reduce fatigue levels, as well as improve things like strength, mobility and bowel and bladder function.
Passive range of motion exercise
Passive exercise is when something or someone is moving your joints for you.
To improve spasms, try strengthening exercise to keep your muscles strong. This could be using light weights or exercise bands. This will depend on the intensity of spasms and the individual.
To help manage spasticity at night, a combination of factors can help reduce the symptoms. A combination of medication, improving sleep positioning and gentle exercise can help manage the symptoms effectively.