I currently work with two clients that have MS and two clients that are stroke victims. Although each case is unique, I continue to see some similarities in them with regards to spastic and toned muscles. Outside of prescribed medication from their doctors, I am wondering if there is anything I can do to help them manage this problem more effectively. I currently use some sort of myofascial release with them and static stretching. Any tips would be greatly appreciated.
We appreciate your question and client concern. As you stated, each client is unique and therefore the below advice should be “tweaked” to each individual! Ultimately, and to answer your question, your goal with each individual case is to enhance their current level of function. This will be proved by assessing and re-assessing on a minute-to-minute basis as there are no black and white answers. Below I have listed a few definitions for clarification and points to assist you in your programming.
- Always know your intended outcome with each client. Example: What are you trying to achieve with your techniques? Is it better life function? If so, what is their function today (walking, climbing stairs, squatting to get in and out of a chair, etc.)? What are the short-term goals? What techniques will assist you in achieving the goal?
- A spasm (involuntary contraction of a muscle) is different than spasticity, and the difference between a spasm and a cramp is somewhat arbitrary; cramps are strong, painful and usually short-lived, acute contractions whereas spasms are considered low-grade long lasting contractions. Ask questions to delineate b/w the definitions.
- Spasticity is a state of increased muscle tone with exaggerated muscle tendon reflexes. As the muscles supplied by the damaged motor axons begin to tighten, your client will lose range of motion. Some spasticity may become a permanent feature of the disease-injury. It is important to note that chronically tight muscle fibers eventually atrophy, to be replaced by thick, tough layers of connective tissue. This is called a contracture. If any sensory of motor function is left in the limb, temporary episodes of spasticity may also be a problem.
Our approach, although complex in nature, is simple:
- Review entire health history.
- Follow advice from medical professional (although realize most often they don’t specialize in movement science).
- Look up medications and contraindications to movement.
- Assess the client's ability to perform current life activities (their movement vocabulary) – find their current threshold.
- Build a plan consisting of soft tissue therapy, corrective and performance movement conditioning to enhance their current levels of function (expand threshold).
Re-assess every session to “tweak” the plan of attack. With the client, you will figure out what works and what doesn’t. For example, releasing the scar tissue formed may improve proprioception to the scarred region and therefore enhance overall balance. Yet on the next client, it may create naive range of motion and create a more intense spasm. Finding this is not your fault. It’s a fact we are dynamic structures with many complexities. The key is to have a check and balance system of programming, which includes the many recommendations that exist regarding stroke and MS clients.