How to Manage Muscle Spasms During the Recovery Phase of Myelitis

Understanding Spasticity in Myelitis Recovery

Whether caused by inflammation or trauma, spinal cord injury—such as that seen in myelitis—often leads to similar long-term complications. One of the most common and disruptive issues during the recovery phase is muscle spasticity. This involuntary muscle contraction can significantly affect mobility, comfort, and quality of life. For patients who retain partial walking ability, spasticity may interfere with gait patterns and functional movement, making targeted intervention essential.

Treatment Options for Managing Spasticity

Pharmacological approaches are often the first line of treatment. Oral medications like baclofen help reduce nerve activity responsible for muscle tightness. In more severe cases, intrathecal baclofen therapy—delivered directly into the spinal canal via an implanted pump—offers a more controlled and effective solution with fewer systemic side effects. This method allows for continuous delivery of medication, providing consistent relief from severe spasms.

The Role of Botulinum Toxin Injections

Among non-surgical treatments, botulinum toxin (Botox) injections have proven highly effective for localized spasticity. By temporarily blocking nerve signals to overactive muscles, Botox can improve range of motion and ease discomfort. However, due to dosage limitations, its use in myelitis patients is often restricted. A single session typically cannot exceed 600 IU per limb, which limits coverage when spasticity affects multiple muscle groups across both legs.

For bilateral involvement, clinicians usually prioritize one side during the initial treatment, followed by the opposite side after a 12-week interval. This staged approach ensures safety while still delivering meaningful improvements in muscle control and patient comfort.

Addressing Specific Gait Abnormalities: The Case of Scissoring Gait

Many individuals with myelitis develop a condition known as scissoring gait, where excessive tone in the hip adductor muscles causes the legs to cross inward during walking. This not only impairs mobility but also complicates personal hygiene and increases the risk of skin breakdown in the groin area.

Focused Treatment on Hip Adductors

In these cases, targeted injections of botulinum toxin into the inner thigh muscles—specifically the adductor group—can dramatically reduce muscle stiffness and improve leg separation. Patients often experience improved sitting balance, easier dressing, and better perineal care following treatment. While this approach effectively addresses adductor spasticity, it does not resolve generalized lower-limb spasticity affecting other muscle groups such as the hamstrings or calf muscles.

When Is Treatment Necessary?

Not all spasticity requires intervention. The decision to treat depends largely on functional goals. If a patient has preserved ambulatory capacity, managing spasticity becomes crucial to maintaining independence and preventing joint contractures. Conversely, in individuals without walking potential, mild to moderate spasticity may even aid in muscle tone maintenance and circulation, so aggressive treatment is generally avoided unless it causes pain, sleep disruption, or caregiving difficulties.

In summary, a personalized, multidisciplinary strategy—including medications, neuromodulation, and focal injections—is key to optimizing outcomes during the recovery phase of myelitis. Early assessment by neurologists and rehabilitation specialists can help tailor interventions that enhance mobility, comfort, and overall well-being.