Muscle Spasms

Original Editors - Rana Muhammad Tahir Aslam

Top Contributors - Rana Muhammad Tahir Aslam, Vidya Acharya and Khloud Shreif 

Introduction

The word "Spasm" Comes from the greek word "Spasmos" which means "convulsion, winching, violent movement". The Term muscle spasm and Muscle Cramps are used interchangeably but there is marked difference between these terms. It is important clinically to differ between these so that appropriate treatment should be given. Muscles Spasms are majorly seen in the Patients of Spastic Cerebral Palsy, Tetanus, Spinal Cord injury (SCI) also they patients of stroke also acquire muscle spasm in the later stage (if appropriate rehabilitation is not provided)

Definition

Muscle Spasm is defined as the Involuntary contraction of a muscle group that is often forceful and painful. This involuntary contraction can be due to electrolyte disorders that disturb the normal muscle physiology or due to the to neurological conditions such as SCI or due to Degenerative diseases such as Cerebral Palsy. Muscle spasm are more persistent than then the muscle cramps and show palpable resistance and tightness of muscle to movement. These can also be associated with Posture distortion. The EMG studies show that during a muscle spasm there is tonic firing of the muscle unit action potential.

Causes

The muscle spasm is the key symptom to many neurological and degenerative disorders. The conditions that lead to the muscle spasms are as follow

• Pain
• Hypokalemia
• Hypomagnesemia
• Thyroid Abnormalities
• Parathyrioid Abnormalities
• Addison's Disease
• Spinal Cord Injury (SCI)
• Ischemia leads to Chronic Muscle Spasm
• RYR1 Gene Mutation , this gene is responsible for the dihydropyridine receptor that control the calcium transport.
• Malignant Hyperthermia
• Spastic Cerebral Palsy

Pathophysiology

Muscle spasm leads to Pain. This increase activity of the muscle fibers causing the pain can be explained by following Theories:

Vicious cycle theory

According to this theory, "The increase in muscle activity cause the ischemia and leads to the accumulation of metabolites which ultimately cause the pain"It is believed that these metabolites stimulate the Group III and IV nociceptors. These nociceptors than stimulate the gamma Motor Neurons that further increase the sensitivity of the muscle spindle and cause reflex increase in the muscle spindle that further sever the ischemia.In this way the person is in the viscous cycle of Pain.

Self-perpetuating cycle of muscle spasm

Acccording to this theory, "Restricted movement due to any cause can lead to the circulatory stasis this stasis leads to the accumulation of the metabolites cause the irritability and pain which leads to the reflex increase in the muscle tone, Hence Muscle Spasm. This muscle spasm Further Inhibit the movement and the cycle continues"

From the Above two theories we can say that Ischemia and pain go hand to hand in the pathophysiology of the muscle spasm.

Assessment

The assessment of the Muscle Spasm can be performed as follows, considering that Muscle spasm are more persistent than then the muscle cramps and show palpable resistance and tightness of muscle to movement.

• Past medical history- Consider patient past medical that may increase suspicion of an electrolyte Imbalance.

• Blood test- serum or urine: hCG, fasting serum metabolic panel, thyroid-stimulating hormone (TSH), HbA1c, serum liver function tests, prothrombin time (PT) and INR, serum myoglobin and urinalysis.
• Neurological examinations: may indicate nerve involvement with muscle wasting, weakness, fasciculations or any neurodegenerative condition like cerebral palsy.
• other investigations: EMG, nerve conduction test, muscle biopsy.

For further information on the Diagnosis of the muscle spasm and spasticity watch this video:

Management

The management of the muscle spasm depend upon the the symptom that leads to it. Many conditions require Pharmacological intervention while other can be managed by Physical Therapy Techniques and Modalities.

Pharmacological Management

The drugs that are used to relive a muscle spasm are as follows

Spasmolytic Drugs:

• The Drug used to treat Acute muscle spasm is cyclobenzaprine.
• The used to treat Chronic muscle spasm are baclofen, diazepam & tizanidine.
• The Drug used to treat muscle spasm in Malignant Hyperthermia is Dantrolene.
• Botulinum Neurotoxin can also be used to treat muscle spasms in cerebral palsy.

Physical Therapy Management

The most conservative and go to technique used to treat muscle spasm and other spastic conditions is Muscle stretching.Slow and sustained Stretching & eccentric muscle energy Techniques also show excellent results for muscle spasm. Studies have shown that Thermotherapy and Cryotherapy both are useful for relieving a muscle spasm but Cryotherapy has considered superior for acute muscle spasm.