Spasticity is a common feature of neurological conditions such as stroke, brain injury and multiple sclerosis. Spasticity is defined as “a velocity dependent increased resistance to passive limb movement in people with upper motor neurone syndrome.” In other words spasticity may be described as the overactivity of muscles that results in abnormal positioning and tightness, which makes it difficult to stretch the muscle through range or at speed. Physiotherapists use a variety of methods to treat and manage spasticity. One treatment becoming more common across the world is intra-muscular injection. Injections are not just used by celebrities to give them ageless faces, but can be used in neurological conditions to relax overactive muscles and improve function, hygiene and maintain range of motion.
In Australia, injections for spasticity are only given by Doctors. They will usually either do so in private rooms or as part of a hospital spasticity clinic. Prior to injection there should be a comprehensive assessment of the level of spasticity and what the goals of injection would be. An example of some goals may include weakening a muscle such as the calf to enable the opposite muscle an opportunity to strengthen, such as the dorsiflexors; weakening inappropriate muscle contractions to prevent contracture and tissue shortening, often seen at the biceps or weakening a muscle to prevent damage to skin integrity and maintain hygiene, often seen in the tight fists. Goal planning is often best done in consultation with your physiotherapist. Once you have had the injection it takes around 4-7 daysto take effect. You can then expect it to last around 3-4 months. Due to this, the minimum time you can have between injections is 3 months.
When your injection has started to take effect you should visit your physiotherapist to start on a program achieve your goals. Physiotherapists and Occupational Therapists will work with you to get the most out of your injection by formulating a comprehensive treatment plan including a home exercise program. It is important to remember that this home program is a crucial part of your therapy, as the limited visits with your therapist can never make up for the hours you can spend practicing and exercising at home.
The following are some different forms of therapy that may be used following injection:
- Splinting – used to provide a prolonged stretch to a muscle by wearing the splint for a designated period of time each day.
- Orthotics – may be used to assist your walking by correcting foot position.
- Stretching – a manual stretching program may be given if splinting is not appropriate.
- Strengthening – now that a particular muscle group is more relaxed, it may be possible to strengthen another group of muscles that you previously couldn’t
- Electrical Stimulation – may be used in conjunction with a strengthening program to stimulate a particular muscle group.
- Functional Task Training – this can help you steer your therapy in the direction of your functional goals.
The important thing to remember is that the therapy after the injection is as important as the injection itself if you want to make any lasting meaningful change. The injection will relax the muscles, but the therapy associated with this will help you achieve your goals and improve your function. If you are thinking about having, or your doctor has mentioned, a botox injection, then talk to your therapist now to enable you to get the most out of it.