Spasticity can cause persistent muscle stiffness, spasms, tightness, pain, abnormal posture, limited range of motion, and difficulty with movement or daily function.
Muscle stiffness, tightness, and involuntary spasms can make everyday movement difficult. Dr. Siefferman discusses the causes of spasticity and the treatments available to improve comfort, mobility, and function.
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Hi, I’m Dr. Jason Siefferman, medical director at Manhattan Pain Medicine. Spasticity occurs when there is an upper motor neuron injury. The upper motor neurons come from the brain and the spine. So, not a peripheral nerve.
This happens with multiple sclerosis, stroke, cerebral palsy, any condition which can affect the brain or spinal cord. What happens with spasticity is that the reflex response is hyperactive. So the muscle is almost constantly reflexive and as a result it becomes tight and any activity to attempt to stretch or counterbalance often results in increased tension. When we treat spasticity the hallmark treatment is usually botulinum toxin and it is FDA approved for this.
So using botulinum toxin to soften or weaken that muscle, not to completely paralyze it, but to find the optimal level of activity in that muscle for optimal function is our goal. And this is combined with physical therapy to retrain the muscle and find the best use in this situation.
Spasticity is a neurologic muscle overactivity condition that can cause abnormal stiffness, tightness, spasms, cramping, pulling, clonus, pain, or difficulty moving normally. It is often associated with conditions that affect the brain, spinal cord, or motor pathways, including stroke, spinal cord injury, brain injury, multiple sclerosis, cerebral palsy, or other neurologic disorders.
Spasticity is different from ordinary muscle tightness or temporary muscle spasm. It can affect walking, hand use, posture, sleep, hygiene, range of motion, and daily care. At Manhattan Pain Medicine (MPM), evaluation begins by identifying the muscle pattern, neurologic history, pain contributors, functional limitations, and overlap with dystonia, muscle pain, joint restriction, or musculoskeletal strain before treatment is recommended.
At MPM, spasticity care begins with a diagnosis-first evaluation of the affected muscles, movement pattern, pain location, range of motion, gait or functional impact, and prior response to therapy or medication. For patients seeking spasticity treatment in Manhattan, MPM considers whether symptoms reflect spasticity, focal dystonia, cervical dystonia, orofacial dystonia, contracture, radiculopathy, myelopathy, orthopedic tightness, muscle pain, or another neurologic or musculoskeletal condition.
Care may include coordination with neurology, rehabilitation medicine, physical therapy, occupational therapy, and pain medicine, with botulinum toxin or ultrasound-guided injections considered only when the pattern and goals support that approach.
Spasticity can create pain in several ways. Sustained muscle contraction may strain joints, tendons, ligaments, and surrounding soft tissue. Abnormal posture or movement can overload other muscle groups, restrict range of motion, contribute to stiffness, and make walking, reaching, gripping, or positioning more difficult.
For some patients, spasticity leads to compensatory pain in the neck, back, shoulders, hips, legs, hands, or feet. It may also contribute to sleep disruption, skin pressure, hygiene challenges, falls, difficulty with mobility, or loss of independence. MPM evaluates spasticity as both a neurologic muscle overactivity pattern and a musculoskeletal pain generator, so treatment can be matched to the patient’s functional goals.
Spasticity sits within MPM’s neurological conditions framework, with strong relevance to Musculoskeletal issues because abnormal muscle tone can create pain, joint stress, tendon strain, restricted movement, and compensatory muscle overload. Symptoms may also overlap with focal dystonia, cervical dystonia, orofacial dystonia, muscle pain, neck and back pain, and complex pain patterns.
MPM evaluates whether stiffness is caused by spasticity, dystonia, contracture, muscle guarding, orthopedic restriction, nerve-related symptoms, or another source. This distinction helps determine whether treatment should focus on rehabilitation, medication adjustment, botulinum toxin, ultrasound-guided targeting, pain management, or specialty coordination.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
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This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
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Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
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Dr. Siefferman is a genius. He is very informed and listens attentively.
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Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
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Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
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Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
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Spasticity is abnormal muscle tightness or overactivity related to nervous system injury or dysfunction. It can cause stiffness, spasms, cramping, pulling, clonus, pain, abnormal posture, and difficulty moving normally. Spasticity often occurs after conditions such as stroke, spinal cord injury, brain injury, multiple sclerosis, cerebral palsy, or other neurologic disorders. It should be evaluated carefully because treatment depends on the underlying neurologic condition, the muscles involved, and the patient’s functional goals.
Spasticity may feel like persistent muscle tightness, stiffness, pulling, spasms, cramping, or resistance when trying to move. Some patients experience clonus, which is repeated rhythmic muscle jerking. Spasticity may make the arm, hand, leg, foot, neck, or other body region feel difficult to control. It can also cause pain, reduced range of motion, abnormal posture, difficulty walking, difficulty using the hand, trouble sleeping, or discomfort during stretching or movement.
Spasticity is usually caused by injury or dysfunction in the brain, spinal cord, or motor pathways that control muscle tone. It may occur after stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, cerebral palsy, or other neurologic conditions. When normal communication between the nervous system and muscles is disrupted, muscles may remain overactive or resist movement. The pattern and severity vary by patient and should be evaluated in the context of the underlying neurologic condition.
Spasticity is related to nervous system injury or dysfunction and often causes persistent or recurring muscle overactivity, stiffness, abnormal posture, or resistance to stretch. A typical muscle spasm is often a temporary contraction related to strain, irritation, overuse, dehydration, or local muscle pain. The two can feel similar, but the cause and treatment may be different. MPM evaluates the full pattern to determine whether symptoms reflect spasticity, dystonia, muscle spasm, contracture, nerve-related pain, or another condition.
Yes. Spasticity can cause pain through sustained muscle contraction, abnormal positioning, joint stress, tendon strain, reduced mobility, compensatory movement, and secondary muscle overload. It may also contribute to sleep disruption, difficulty walking, hand function problems, hygiene challenges, skin pressure, or falls. Pain care should be integrated with the broader neurologic and rehabilitation plan, especially when stiffness affects function or daily care.
Yes. Botulinum toxin may be used to reduce overactive muscle contraction in selected muscles. In spasticity care, botulinum toxin is a medical chemodenervation treatment, not cosmetic Botox. It is used only when the diagnosis, muscle pattern, and functional goals support treatment. Effects are temporary and may require repeat treatment when appropriate. Proper muscle selection, dosing, technique, and follow-up are essential.
Ultrasound guidance may help identify and target selected muscles more precisely during injection-based spasticity treatment. This can be especially helpful when muscles are deep, anatomy is complex, or accurate placement is important for safety and effectiveness. Ultrasound guidance is not required for every case, but it may be considered when it supports better targeting. Treatment decisions depend on diagnosis, anatomy, muscle selection, dosing, and clinical goals.
Spasticity should be evaluated when stiffness, spasms, pain, reduced range of motion, difficulty walking, hand function loss, clonus, contractures, skin breakdown, falls, sleep disruption, or difficulty with daily care persists or worsens. Specialist evaluation is especially important when symptoms follow stroke, spinal cord injury, brain injury, multiple sclerosis, cerebral palsy, or another neurologic condition. Progressive symptoms, new weakness, or sudden neurologic changes require timely medical attention.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Spasticity occurs when the nervous system sends abnormal signals that cause muscles to remain tight, overactive, or resistant to stretch. It is often associated with conditions that affect the brain, spinal cord, or motor pathways, including stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, cerebral palsy, and other neurologic disorders.
Spasticity can range from mild stiffness to severe muscle overactivity that limits movement, walking, hand use, hygiene, sleep, positioning, and daily function. Some patients experience spasms, cramping, pulling, clonus, abnormal posture, or pain when trying to move or stretch.
Spasticity can cause pain through sustained muscle contraction and abnormal positioning. When a muscle remains overactive, it may place excess stress on nearby joints, tendons, ligaments, and soft tissues. Over time, this can contribute to stiffness, reduced mobility, compensatory muscle pain, tendon strain, or joint irritation.
Pain may also develop because the body compensates for the affected muscle pattern. For example, spasticity in the leg can alter walking mechanics and contribute to hip, knee, ankle, foot, or back pain. Spasticity in the arm or hand can affect shoulder position, elbow movement, wrist posture, grip, and daily tasks.
Spasticity can resemble other movement and muscle conditions, so diagnosis matters. Dystonia involves involuntary muscle contractions that may cause twisting, pulling, or abnormal postures. Muscle spasm may be temporary and related to local strain or irritation. Contracture involves structural shortening or restriction of a muscle, tendon, or joint.
These conditions can overlap, but they are not the same. A patient may have spasticity, dystonia, orthopedic stiffness, muscle guarding, joint restriction, or nerve-related pain at the same time. MPM evaluates the full pattern before recommending treatment.
MPM begins by reviewing the neurologic history, symptom timeline, affected muscles, pain location, range of motion, gait or movement impact, prior therapy, prior medication response, and daily function limitations. The evaluation may include strength testing, tone assessment, movement observation, joint motion review, pain mapping, and assessment of how stiffness affects walking, hand function, positioning, sleep, or care needs.
MPM also considers whether symptoms overlap with focal dystonia, cervical dystonia, orofacial dystonia, muscle pain, spine-related pain, peripheral nerve symptoms, or complex chronic pain. When appropriate, MPM coordinates with neurology, rehabilitation medicine, physical therapy, occupational therapy, orthopedics, and other specialists.
Spasticity care is often multimodal. Treatment may include physical therapy, occupational therapy, stretching programs, bracing or splinting, mobility support, medication management, and functional retraining. The goal may be to improve comfort, reduce spasms, maintain range of motion, support walking, improve hand use, make hygiene easier, reduce pain, or improve participation in therapy.
Botulinum toxin may be used for selected focal muscle overactivity when the affected muscles can be identified and treatment goals are clear. It works by reducing excessive muscle activity in the injected muscles for a temporary period. Treatment may need to be repeated when appropriate and should be paired with a broader rehabilitation or functional plan.
Botulinum toxin injections for spasticity require careful muscle selection, dosing, technique, and monitoring. This is not cosmetic Botox. It is a medical treatment used to reduce overactivity in specific muscles.
Ultrasound guidance may be used when it helps identify the correct muscle, avoid surrounding structures, and improve targeting. This can be especially relevant when muscles are deep, anatomy is complex, or prior treatment response has been incomplete. Ultrasound guidance is one tool, not a requirement for every injection.
Spasticity often requires coordinated care. Neurology may help evaluate the underlying neurologic condition. Rehabilitation medicine may guide tone management and functional planning. Physical and occupational therapy may support mobility, range of motion, strength, and daily activity. Pain medicine may help address painful muscle overactivity, injection candidacy, and overlapping musculoskeletal pain.
Patients should seek urgent evaluation for sudden weakness or numbness, facial droop, speech difficulty, vision changes, new severe headache, fever with neck stiffness, loss of bowel or bladder control, saddle anesthesia, trouble swallowing or breathing, major trauma, rapidly worsening stiffness, or new loss of function.
MPM approaches spasticity through a diagnosis-first, function-focused model. The goal is to understand the neurologic condition, affected muscles, pain pattern, movement limitation, and patient goals before recommending care.
For patients seeking spasticity treatment in Manhattan, MPM offers a careful pain medicine perspective focused on neurologic muscle overactivity, musculoskeletal pain, injection precision, and coordinated care. Treatment may include botulinum toxin, ultrasound-guided injections, medication coordination, rehabilitation support, and specialist collaboration when appropriate. The goal is to improve clarity, comfort, movement, and function without overpromising outcomes.
