Spasticity: A Western Perspective and Historical Context

Spasticity, characterized by increased muscle tone and stiffness, has long been recognized in Western medicine as a significant clinical challenge. It often results from conditions affecting the central nervous system, such as stroke, multiple sclerosis, and cerebral palsy. The traditional Western approach to managing spasticity includes pharmacological interventions, physical therapy, and sometimes surgical procedures to alleviate symptoms and improve functional outcomes.

Defining Spasticity and Its Challenges

Spasticity is clinically defined as resistance to both passive and active movement in skeletal muscles, arising as a debilitating symptom of various neurological conditions such as traumatic brain injury, stroke, multiple sclerosis (MS), cerebral palsy, ALS, and PTSD. Categorized as an upper motor neuron syndrome, spasticity indicates damage to motor neurons that reside above the more primitive brainstem region containing the cranial nerves. This damage leads to uncontrolled and involuntary overactivity of muscles due to disrupted signals from the brain, particularly common in individuals with neurogenic trauma like stroke, Parkinson's disease, or traumatic brain injuries (TBIs). People experiencing spasticity may feel as if their muscles have tightened and won’t relax or stretch.

Spasticity significantly impacts coordinated and smooth movements, which are controlled by the vestibular system within the central nervous system. These movements originate in the cerebral cortex and pass through the internal capsule, brainstem, and spinal cord. When primitive reflexes are not fully integrated due to early trauma or are reactivated in neurogenic disease, it contributes to the development and persistence of spasticity. Spasticity is a hidden component of many chronic orthopedic injuries such as rotator cuff syndrome (frozen shoulder), Dupuytren’s contracture, carpal tunnel, and back or neck injuries, often undiagnosed or untreated.

My integrative understanding of spasticity reflecting deep internal disharmony within the ANS developed when I began vestibular work for my own traumatic brain injury (TBI). During this period, within 1 day, I realized that 100% of my clients' exhibited patterns of spasticity, regardless of their childhood or medical history. This observation also suggests that in addition to trauma, sympathetic dominance as a physiological state refl;ecting our culture is far more prevalent than previously realized.  

Management of Spasticity in Western Medicine

Western medical treatments for spasticity vary depending on the severity and specific needs of the individual. Common interventions include the use of medications such as Baclofen, Tizanidine, Diazepam, and anticonvulsants like Gabapentin, which help manage muscle tone and reduce spasms. Botulinum toxin injections (Botox) are also frequently employed to target specific muscle groups and alleviate tightness.

For more persistent or severe cases, physical therapy plays a crucial role in improving mobility and managing symptoms. Surgical options may be considered, including selective dorsal rhizotomy (SDR), which involves cutting nerve fibers to reduce spasticity, and orthopedic surgeries to correct joint deformities and enhance functional abilities.

In cases of profound spasticity, an intrathecal Baclofen pump may be implanted. This device delivers Baclofen directly to the spinal fluid, providing continuous spasm control and significantly reducing muscle rigidity. Each treatment plan is tailored to the individual's specific condition and needs, often involving a combination of therapies and polypharmacy to achieve the best outcomes. However, it's important to note that these treatments typically offer only mild symptom relief and do not address the underlying cause of spasticity. They are part of a broader strategy aimed at managing symptoms and improving quality of life, rather than providing a cure.

As we address the limitations of conventional treatment, patients with neurogenic trauma face compounded risks due to the systemic nature of sympathetic dominance. Patients with demyelinating diseases (MS or Parkinson's), or those with more severe brain and spinal cord injuries often exhibit severe autonomic dysregulation. This dysregulation causes the autonomic nervous system to react excessively to stimuli, resulting in dangerous spikes in blood pressure, vaso-vagal motor disturbances, vestibular issues, gait problems, and nystagmus. Long-term malabsorption from the derangement in the ENS (middle jiao) contributes to the wasting frequently seen in these patients. If not properly managed, these conditions can lead to life-threatening complications or even death.

Hidden Patterns of Spasticity

Spasticity significantly impacts coordinated and smooth movements, which are controlled by the vestibular system within the central nervous system. These movements originate in the cerebral cortex and pass through the internal capsule, brainstem, and spinal cord. When primitive reflexes are not fully integrated due to early trauma or are reactivated in neurogenic disease, it contributes to the development and persistence of spasticity. Spasticity is a hidden component of many chronic orthopedic injuries such as rotator cuff syndrome (frozen shoulder), Dupuytren’s contracture, carpal tunnel, and back or neck injuries, often undiagnosed or untreated.

Hidden Spasticity:  Chronic Orthopedic Injuries

Many patients with chronic orthopedic injuries, such as recurrent shoulder injuries, tennis elbow, or repetitive strain injuries like carpal tunnel syndrome, exhibit significant levels of spasticity within the fascia near and surrounding the site of these injuries.

Chronic back injuries, particularly those unresolved over long periods, frequently result in spasticity along the length of the spine. This can lead to conditions such as kyphosis and lordosis, where there is an excessive curvature of the spine. Patients with chronic back pain often develop compensatory movement patterns that exacerbate spasticity, creating a cycle of pain and restricted movement. The fascia and muscles along the spine become increasingly tense, leading to further postural issues and mobility limitations. This chronic spasticity not only affects the back but can also influence the overall posture and gait, contributing to a shuffling gait and decreased quality of life. 

.Breast Cancer and Spasticity

Breast cancer patients show marked and significant spasticity along the center midline of the chest, along the pathway of the Ren Mai in TCM and through the intercostal muscles of the rib wall (Yin Wei, Dai Mai, and Chong Mai). They also exhibit severe webbing and stasis through the brachial plexus (including the anterior and posterior rotator cuff) and marked spasticity through the cervical plexus and cervical spine. Interestingly, in long-term clients under my care who were later diagnosed with breast cancer, the chronic orthopedic pain and spasticity patterns preceded the diagnosis by years. These patterns were then aggravated by the diagnosis itself (fight-or-flight response), chemotherapy, radiation, and reconstructive surgery. This observation points to a possible pathomechanism for cancer through chronic impingement that has not been thoroughly explored.

Understanding that the symptoms of spasticity are a sign of sympathetic dominance we can see spasticity as a physical manifestation of a chronic high arousal or fight-or-flight response. The diagnosis of breast cancer, for example, is traumatizing to all individuals who receive it, leading to heightened states of tension, fear and stress within the body. Treatment, including chemotherapy and radiation, exacerbates this condition by severely impacting the tissue in the upper GI tract and ribcage, specifically the secondary vessels in the trunk, neck, and middle jiao. Chemotherapy damages the enteric nervous system, leading to chronic malabsorption and setting the stage for later issues. Breast reconstruction is invasive and extremely painful, keeping the patient in heightened states of arousal long-term due to pain. In this way, spasticity as an indicator of the body's prolonged fight-or-flight state reflects the underlying autonomic dysregulation.

Primitive Reflex Reactivation During Pregnancy

Pregnancy is a unique physiological state that can lead to the reactivation of primitive reflexes, contributing to spasticity. The significant hormonal and physical changes during pregnancy can overwhelm the autonomic nervous system, resulting in the re-emergence of these reflexes. By understanding that primitive reflexes also represent "primitive instincts," many mothers can align with this from an emotional perspective of being protective of their children. For example, the instinct to protect one's child—expressed in thoughts like "if anybody hurts my child, I’m going to take them out"—illustrates a primitive instinct. It is a higher function to refrain from retaliation, but when triggered, these visceral, primitive emotional states emerge as protective mechanisms.

In addition, to carry a pregnancy to term, prenatally, mothers must re-engage certain reflexes to support the growing fetus. However, due to our sympathetically dominant culture, there often isn't enough rest and recovery during pregnancy and postpartum to facilitate the reintegration of these reflexes. As a result, these reflexes may remain active, contributing to increased stress patterns, postpartum depression, and related conditions. Psychological distress, such as stress, anxiety, and fatigue, can negatively impact breast milk production. These stressors can interfere with the letdown reflex and impair the release of oxytocin, a hormone essential for milk ejection. When milk isn't fully ejected during each feeding, breast milk production can decrease. Stress can also cause the body to release cortisol, a hormone that can get into breast milk and slow down its flow.

This lack of reintegration can exacerbate the mother's physiological and emotional stress, contributing to issues of bonding and poor milk production. This highlights the need for comprehensive postpartum care that addresses both physical and neurological recovery.

Parents with children who have undergone trauma often see these reactive or retained primitive reflexes resurface during periods when their children experience trauma, such as after catastrophic injury, rape, or bullying. Bullying is a common issue that can restart these pathways in parents, highlighting the strong emotional and physiological connections involved.

Additionally, for many adult survivors of childhood sexual abuse, pregnancy is often the first memory trigger for repressed trauma. While this is a complex conversation beyond the scope of this paper, it is important to acknowledge that pregnancy can trigger the fight-or-flight response in these individuals, contributing to spasticity.

Latent Spasticity Patterns and Early Trauma

Latent spasticity patterns frequently appear in patients who experienced clinical trauma during the perinatal, birth, and postnatal periods, up to the age of ten.  Trauma during the perinatal period, regardless of outcomes, often leaves patients in a state of sympathetic dominance, which interferes with the developing nervous system and contributes to spasticity patterns. Many of these cases go undiagnosed, unrecognized, and untreated.

This includes trauma from child abuse or in situations where the home is effectively dismantled, such as in divorce or immigration. Children of parents who immigrated, for example, whether by force or choice, show marked increases in high arousal, stress, and related symptoms.  My clients who have reported birth trauma, such as breech births, medical interventions requiring intubation, early surgeries, or interventions for congenital heart conditions, as well as unexpected childhood surgeries like tonsillectomies or appendectomies, may show chronic spasticity. Trauma during the perinatal period, regardless of successful outcomes, often leaves patients in a state of sympathetic dominance, which interferes with the developing nervous system and contributes to spasticity patterns. Many of these cases go undiagnosed, unrecognized, and untreated.

Management of Spasticity in Western Medicine

Western medical treatments for spasticity vary depending on the severity and specific needs of the individual. Common interventions include the use of medications such as Baclofen, Tizanidine, Diazepam, and anticonvulsants like Gabapentin, which help manage muscle tone and reduce spasms. Botulinum toxin injections (Botox) are also frequently employed to target specific muscle groups and alleviate tightness.

For more persistent or severe cases, physical therapy plays a crucial role in improving mobility and managing symptoms. Surgical options may be considered, including selective dorsal rhizotomy (SDR), which involves cutting nerve fibers to reduce spasticity, and orthopedic surgeries to correct joint deformities and enhance functional abilities. 

In cases of profound spasticity, an intrathecal Baclofen pump may be implanted. This device delivers Baclofen directly to the spinal fluid, providing continuous spasm control and significantly reducing muscle rigidity. Each treatment plan is tailored to the individual's specific condition and needs, often involving a combination of therapies and polypharmacy to achieve the best outcomes. However, it's important to note that these treatments typically offer only mild symptom relief and do not address the underlying cause of spasticity. They are part of a broader strategy aimed at managing symptoms and improving quality of life, rather than providing a cure.

As we address the limitations of conventional treatment, patients with neurogenic trauma face compounded risks due to the systemic nature of sympathetic dominance. Patients with demyelinating diseases (MS or Parkinson's), or those with more severe brain and  spinal cord injuries often exhibit severe autonomic dysregulation. This dysregulation causes the autonomic nervous system to react excessively to stimuli, resulting in dangerous spikes in blood pressure, vaso-vagal motor disturbances, vestibular issues, gait problems, and nystagmus. Long-term malabsorption from the derangement in the ENS (middle jiao) contributes to the wasting frequently seen in these patients. If not properly managed, these conditions can lead to life-threatening complications or even death.