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Approaches to spasticity

By Mary Pettigrew

Spasticity sucks!

There are so many of us with MS who deal with spasticity at one time or another. I don’t think I really started to have problems with spasticity until several years into my diagnosis with MS, but some people have different tales to tell. We are all different, right? 

For me, issues with spasticity started in my feet, then my calves, then my ribcage area. Some people call this the “MS hug,” but it’s not a hug. I wish there were another name to describe this area of pain. It’s excruciating. Restless leg syndrome is no fun either. I never thought it was an issue linked to MS, but boy, was I wrong. I don’t know if others can relate, but sometimes when I wake up in the morning, my feet and, especially, my calves will be sore as if I had just run a marathon. I’m sure that’s from the leg cramps during my sleep. My ribcage pain is another story. In fact, there have been times where I can actually see visible bruises as if I’ve injured my upper ribcage area.

I’ve explored a few treatments including stretching, over-the-counter meds, prescription meds, topical creams/patches, and other homeopathic therapies of which I’ll elaborate more in detail at the end of this article. 

My mother has been dealing with elderly onset rheumatoid arthritis (possibly). She is 82 years old, so her primary care physician and her rheumatologist have not confirmed, so she remains in the mystery phase of a definitive diagnosis. A lot of us can relate to this too, right? My mom has been on prednisone for several months and she does not do well with steroids at all. I’ve tried to be both a supportive daughter and amateur “nurse” with her. I can understand and relate to some of what she’s dealing with, yet there are other symptoms that I can only surmise out of possible reasons, concern, and curiosity. As I’ve continued to offer her some ideas, resources and suggestions based on my own experiences and research, her latest symptoms with leg cramps and spasticity struck a chord with me. In fact, my mother’s rheumatologist recently suggested something I had not heard of (tonic water), so let’s take a closer look into spasticity. 

Again, spasticity sucks. But there are a few things we can do to relieve some of these issues. I’d like to hear your tips, tricks, and remedies as well.
  • Stretching: Once a cramp starts, stretch it out. If you can stand, face a wall, flex your foot with your heel on the floor and toes on the wall, then lean your body into the wall. If you are unable to stand, try to do the same flexing movement by reaching down and pulling your toes towards your upper body. If you can’t do this by yourself, ask your partner or caregiver to step in as a stretch coach. The more often you can stretch, the better.
  • Hydration: Remember caffeine and alcohol are dehydrating, so stick with water or Pedialyte, Gatorade, and the like.
  • Tonic water: This has been promoted because of the quinine it contains. The evidence of efficacy remains unclear, but some doctors still recommend it. If you buy the typical brands such as Schweppes or Canada Dry, the tonic water contains no more than 83 mg of quinine per liter. Based on studies, quinine tablets are not recommended because of the higher concentration being related to bleeding and heart rhythm issues. Drinking a few ounces of tonic water should be fine. It’s safe, but will it help with leg cramps? Who knows? Just avoid adding vodka or gin to that tonic. 
  • Baclofen: Discuss with you doctor about usage, side effects, and recommended dosage.
  • Magnesium: Definitely discuss this and all supplements with your doctors to ensure proper dosage and no possibility of medical interactions.
  • Ice: Ice packs (the squishy gel packs) are my friend. These help with headaches too. I also like to alternate ice and heat depending on the cramping area. 
  • Heat: Heating pads, moist heat, foot/calf soaks are helpful.
  • Topicals: Theraworx, Lidocaine, Biofreeze, Aspercream, Salonpas, CBD ointments, and other topicals can be helpful. Some can be used as often as you need, but don’t “stack” one thing on top of the other. Also, don’t use a heating pad along with these topicals.
  • Massage: I wish I could afford a masseuse, but oh well. I try to use an aromatherapy-type lotion and massage into the areas which are most affected. I don’t do this nearly as often as I should.
  • Compression socks (and other similar products): I love these especially in the winter. Spasticity tends to hit me more in cold temperatures. I use Copper Joint brand, but there are others. They can be bought online or at most pharmacies such as CVS, Walgreens, etc.
  • Exercise: Enough said, right? Exercise! Yes, exercise can cause soreness and muscle cramps if we overdo it or if we don’t stay hydrated, but, still do it. We all need it.