What spasticity is, in plain language and some challenges you might face.

After a stroke or other sudden brain or spinal injury, the messages between your brain and your muscles change. Your muscles still work, but the “dimmer switch” that normally smooths out movement gets stuck. The result is increased muscle tone: muscles feel tight or pull into certain positions, and movements can trigger exaggerated reflexes. You might notice a clenched fist, a pointed foot that drags, or a knee that kicks out when you try to stand. It is not you being difficult. It is your nervous system trying to protect and stabilise, just a bit too much.

How it feels from the inside.

• Stiffness that fights you: Trying to open your hand or lift your foot can feel like pushing against an invisible bungee cord.
• Jerks and spasms: A quick stretch, a cold breeze, pain, or even a strong emotion can set off a sudden pull or shake.
• Velocity matters: Slow movements are usually easier. Fast movements make the tightness worse.
• Good days and bad days: Fatigue, stress, infection, dehydration, or pain can turn a manageable morning into a sticky afternoon. Patterns matter.

Common patterns you might see

• Arm: Shoulder pulled in, elbow bent, forearm turned inwards, wrist and fingers curled.
• Leg: Hip stiff, knee straightening or snapping, ankle pointing down and in, toes clawing.
• Face and trunk: Less common but possible, for example tightness in the jaw or a side pull in the torso.

You may have some of these or a unique combination. No two bodies present exactly the same.

Why it happens

The brain usually balances “go” and “slow” signals to muscles. After injury, the “slow” signals are weaker. Reflexes that were once quiet become loud. The body prefers predictable postures because they feel stable. That stability can help in the short term, but without care it can lead to shorter muscles and joint problems over time. Understanding this helps you be kinder to yourself: your body is not failing, it is adapting.

Day-to-day impact

• Movement and balance: Walking, reaching, and transferring can be harder. Falls risk may rise when muscles yank at the wrong time.
• Hands and function: Buttons, zips, cutlery, and phone use can become slow or tiring.
• Comfort and sleep: Night-time cramps or a tight calf can wake you.
• Skin and hygiene: Curled fingers or a clenched fist can make washing and nail care tricky, which raises the risk of skin problems.
• Emotions: The constant effort can wear you down. Shame and anger are common, and completely valid.

What makes it worse

• Rushing movements
• Pain and discomfort
• Stress, anxiety, or being startled
• Infection or illness
• Being too cold
• Fatigue and poor sleep
• Dehydration or constipation
• Poorly fitting splints or shoes

When you notice a flare, scan this list. Often there is a fixable trigger.

What helps, practically

I split management into five layers. You rarely need all of them at once, but building a routine across layers works well.

1) Foundations: comfort, rhythm, and prevention

• Go slow: Move with steady speed and give your body a heads-up before you move. Count in, breathe out as you move.
• Warmth: Warm showers, heated mitts, or a warm pack before stretching can soften the start.
• Hydration and regular meals: Low energy worsens tightness.
• Sleep routine: A consistent wind-down, a pillow between knees, and relaxed breathing can reduce night spasms.
• Skin and hand care: Keep nails short, moisturise palms, and clean between curled fingers daily.
• Footwear: A supportive shoe, wide opening, and if needed an ankle-foot orthosis fitted by a professional.
• Position changes: Little and often. Do not “park” a limb in one posture for hours.

2) Stretching and movement that respects spasticity

• Hold, do not yank: Slow sustained stretches, 30 to 60 seconds, two or three times a day.
• Prolonged positioning: Use a soft roll in the palm, wrist in slight extension, elbow gently straighter, ankle at 90 degrees.
• Task-based practice: Combine stretches with real tasks, for example open hand, place sponge, gently squeeze to wash.
• Reciprocal movement: Move the opposite muscle group to help quiet the tight one, for example gently lifting toes to quiet the calf.
• Rhythm and breath: Exhale during the hardest part. Counting out loud helps many of us.

3) Tools and supports

• Splints and rests: Resting hand splints or wrist supports can maintain length. They must be comfortable and checked for skin marks.
• Orthoses: Ankle-foot orthoses, wedges, or shoe inserts can improve foot clearance.
• Electrical stimulation: Under guidance, stimulation can wake the weaker muscles and reduce tone in the tight ones.
• Adaptive kit: Button hooks, long-handled sponges, kettle tippers, or touch-fastening shoes reduce the “fight” moments that trigger spasms.

4) Therapy and clinics

• Physiotherapy and occupational therapy: Ask for a spasticity-informed plan. The right exercises at the right speed make a big difference.
• Spasticity clinics: In the UK, your GP, stroke team, or community neuro service can refer you. Clinics offer joined-up plans that may include botulinum toxin injections, orthotics, and therapy blocks.
• Botulinum toxin: Well targeted injections can relax specific muscles for several months, creating a window to retrain movement and protect joints.
• Oral medicines: Some people benefit from options like baclofen or tizanidine. These can cause sleepiness or weakness in some, so review regularly with your clinician.

5) Pacing, pain, and stress

• Pacing: Alternate effort with recovery. Spasticity loves fatigue.
• Pain control: Treat pain early. Unmanaged pain feeds tightness.
• Stress skills: Box-breathing, guided relaxation, or a brief body scan before tasks. Family can help by giving time and reducing noise during tricky moments.
• Community: Peer groups, local stroke clubs, or online communities reduce isolation and provide tips that clinicians may not see.

Support for family and friends

• Ask, do not assume: “Would you like a hand to slow your elbow before you reach?” gives choice and preserves dignity.
• Slow the environment: Turn down the radio, reduce clutter, allow time to move at a steady pace.
• Hands-on help: If shown by a therapist, support from behind the elbow or at the shoulder, never pull at the hand.
• Protect skin: Dry between fingers, check for pressure marks from splints or shoes.
• Celebrate small wins: Spasticity management is a marathon of tiny adjustments. Recognition matters.

Warning signs that need medical attention

• A sudden increase in tightness with fever or feeling unwell
• A red, hot, swollen calf, or sudden severe leg pain
• New or worsening pain, especially in a joint, after a fall
• Skin breakdown under a splint or shoe
• Unusual drowsiness or weakness after starting a new medicine

If any of these happen, contact your GP, NHS 111, or urgent care.

Making progress you can feel

I track three things each week: one task that felt easier, one trigger I avoided, and one stretch or habit I kept. Progress with spasticity is often quiet. You notice it when you realise you opened your hand without thinking, or your foot cleared the mat on the first try. Write those moments down. They add up.

A simple daily routine you can adapt

1. Morning warm-up: Warm shower, gentle hand and calf stretches, ankle at 90 degrees for a minute before standing.
2. Breakfast with practice: Two-hand mug hold or adaptive handle, slow reach to plate with breath.
3. Short walk or seated marching: Five minutes, focus on heel strike or lifting toes.
4. Midday reset: Hand hygiene, moisturise, check splint fit, two slow wrist and finger stretches.
5. Afternoon task: One meaningful activity, for example cooking with a stabilising board, or a short garden potter.
6. Evening unwind: Heat on tight spots, gentle long holds, legs supported, breathing practice before sleep.

Myths to ignore

• “Tight means strong.” Tightness is not strength. You can be tight and weak at the same time.
• “You must force it to make progress.” Forcing often backfires. Slow and steady wins this race.
• “Bad days mean you are going backwards.” They usually mean you are tired, stressed, unwell, or due a review. Adjust and carry on.

Working with your team

Bring a short video of tricky movements to appointments. List your top two goals, for example “open my hand for washing” or “clear my toes when I walk”. Ask how each suggestion helps those goals. If something is not practical for your home, say so. The best plan is the one you can actually do.

Bottom line: Spasticity is common after sudden disability, and it is manageable. Understanding your triggers, moving with respect, using the right tools, and building a calm routine can turn daily battles into daily wins. You are not alone in this. With patience, practice, and support, your body can learn safer, easier patterns, and your life can feel better again.