Understanding spasms after spinal cord injury
Normal reflex activity before injury
Before spinal cord injury, reflex activity is a normal function of the spinal cord. Protective reflexes help to keep you from hurting yourself.
For example, if a painful pressure is placed on the skin or muscle, the pressure causes signals to be sent out from the nerves in the area. These signals travel to the spinal cord and then to the brain. As the signal reaches the spinal cord, it makes a loop. A signal is sent back to the muscle telling it to move or jerk away from the discomfort. The brain also plays a role in controlling your protective reflexes. Control centers in the brain send signals down the spinal cord to the muscles. These signals limit the reflex action to a single, controlled movement.
How spasms occur after SCI
After a spinal cord injury, reflex activity depends on the injury’s location. If your spinal cord injury is located at T12 or above, reflex centers in the spinal cord are still present. If the injury is between T12 and L2, the person may or may not have spasms, which occur when signals from the control center in the brain cannot get past the injury level in the spinal cord to limit and control the movement.
How spasms develop
For example, when pressure is placed on the injured person’s skin or muscle, it is usually something that causes pain or discomfort. A light touch can also cause a spasm to begin. These signals travel to the spinal cord. The signal cannot be sent past the injured part of the spinal cord to get to the brain. The signal makes a loop through the spinal cord. Then a message is sent back down to the muscle, telling it to move or jerk away from the pressure. Since the signal from the control center in the brain cannot get the block in the spinal cord, it cannot limit or control the jerking movement. The spasm stops when the muscle gets tired or when the signals get weak.
Treatment
A certain amount of spasms can be helpful with body movement. Spasms also help maintain muscle tone and improve blood flow to the muscles below the level of injury. Severe spasms can lead to joint stiffness or pressure sores. An increase in spasms may be telling you that something is wrong and should be reported to your doctor.
If you have spasms:
- If your doctor advises it, take prescribed medication to reduce spasms.
- Keep body temperature at a normal level.
- Perform passive range of motion exercises every day.
- Prevent skin sores, bladder infections, and other infections. Sores and infections increase spasms.
Therapy options
- Stretching and strengthening exercises
- Bracing or casting
- Limb positioning
- Electrical stimulation
- Biofeedback
Medication options
- Commonly prescribed medications include Baclofen (Lioresal), Dantrolene sodium (Dantrium), Benzodiazepines (Valium, Klonopin), and Tizanidine (Zanaflex).
- Intrathecal therapy implants a pump into the abdomen and a tube that delivers medication from the pump directly to the fluid that surrounds the spinal cord.
Neurosurgery options
These procedures involve surgically cutting nerves or nerve roots to relieve spasticity. Neurosurgeries are permanent procedures and should not be considered when a chance is present for recovery of function.