Managing Spasticity After Brain Injury

Spasticity is a common complication of stroke, traumatic brain injury, and other neurological conditions. It involves increased muscle tone — muscles become stiff, tight, and resistant to stretch. In severe cases, involuntary spasms can be painful and disabling. Understanding and managing spasticity is essential for maintaining function and comfort.

Spasticity occurs because damage to the brain or spinal cord removes the normal inhibitory control over muscle tone. Without this control, muscles become overactive. The pattern varies depending on the location of the brain injury — after stroke, spasticity typically affects the arm flexors (bending the elbow) and leg extensors (straightening the knee).

Management requires a multi-faceted approach. Regular stretching is the foundation — daily, sustained stretching of affected muscles maintains range of motion and prevents contractures (permanent shortening of muscles and tendons). Positioning is important — proper limb positioning during rest and sleep reduces spasticity.

Exercise programmes should include both stretching and strengthening of antagonist muscles (the muscles opposing the spastic ones). Active movement helps maintain joint mobility and prevents the weakness that often accompanies spasticity.

Medical interventions may be needed for moderate to severe spasticity. Botulinum toxin injections temporarily weaken overactive muscles, allowing stretching and exercise to be more effective. Oral medications, splinting, and — in severe cases — surgery may also be considered.

Untreated spasticity leads to contractures, pain, and loss of function. Early, consistent management produces the best outcomes.

Our stroke rehabilitation and neurological physiotherapy services provide comprehensive spasticity management at home, including stretching programmes, positioning advice, exercise prescription, and coordination with medical teams for botulinum toxin treatment and follow-up rehabilitation.