Spasticity is the word your child’s therapist uses most, and the one they explain least. Your child’s muscles are tight. Their legs scissor. Their ankles turn in. Their fists clench. You stretch them every day, and by dinner the tightness is back. If you are wondering what else can be done, this guide maps the full landscape of spasticity management, from the stretching you are already doing to the interventions you may not know exist yet.
What Is Spasticity?
Spasticity is velocity-dependent increased muscle tone caused by damage to the brain’s motor pathways. When you try to move a spastic muscle quickly, it resists. The faster you move it, the more it fights back. In cerebral palsy, spasticity is the most common motor impairment, affecting approximately 80% of all children with CP.
Spasticity is not all bad. Some degree of increased tone can be functional: it helps some children bear weight for standing, maintain posture in a wheelchair, and stabilize joints during transfers. The goal of treatment is not to eliminate spasticity entirely. It is to reduce the spasticity that causes pain, limits function, or creates orthopedic problems while preserving tone that serves your child.
The Spasticity Management Ladder
Treatment follows a progressive approach, starting with the least invasive and advancing as needed:
| Level | Intervention | What It Does |
|---|---|---|
| 1. Conservative | Stretching, positioning, PT/OT | Maintains range of motion, prevents contractures |
| 2. Orthotic | AFOs, splints, serial casting | Holds joints in corrected position, prevents shortening |
| 3. Focal medical | Botulinum toxin (Botox) injections | Reduces tone in specific muscles for 3 to 6 months |
| 4. Systemic medical | Oral baclofen, diazepam, tizanidine | Reduces overall body tone (affects entire body) |
| 5. Surgical/device | Intrathecal baclofen pump (ITB) | Delivers medication directly to spinal fluid for severe generalized spasticity |
| 6. Surgical | SDR, tendon lengthening, bony corrections | Permanent reduction of spasticity or correction of structural deformity |
If CP resulted from a birth injury, compensation can fund the lifetime of treatment your child may need.
Level 1: Stretching and Therapy
This is the foundation that never goes away, regardless of what other treatments are added. Daily stretching maintains range of motion and slows the progression of contractures. Your child’s PT will design a stretching program targeting the most affected muscle groups (typically calves, hamstrings, hip adductors, and wrist/finger flexors). Consistency matters more than intensity.
Level 2: Orthotics
AFOs (ankle-foot orthotics), hand splints, and serial casting hold joints in corrected positions for extended periods, providing prolonged stretch that daily exercises alone cannot achieve. Serial casting, which involves applying a series of gradually adjusted casts over weeks, is especially effective when combined with Botox injections.
Level 3: Botulinum Toxin (Botox)
Botox injections are the most common medical intervention for focal (localized) spasticity in children with CP. The toxin is injected directly into the overactive muscle, blocking the nerve signals that cause it to contract excessively. Effects begin within days and last 3 to 6 months.
A 2013 systematic review (Novak et al., DMCN) confirmed Botox as an evidence-based intervention for reducing spasticity and improving function in CP. It is most effective when combined with intensive therapy, casting, or splinting during the window of reduced tone.
Level 4: Oral Medications
When spasticity is generalized (affecting the whole body), oral medications may be added:
- Baclofen: Most commonly used. Reduces overall muscle tone. Side effects include drowsiness and tolerance over time.
- Diazepam (Valium): Effective muscle relaxant. Causes sedation and has potential for dependency.
- Tizanidine: Alternative to baclofen with potentially fewer sedating effects.
- Dantrolene: Works directly on muscles rather than the nervous system. Requires liver function monitoring.
Our team helps families navigate complex medical decisions after birth injuries.
Level 5: Intrathecal Baclofen Pump
For children with severe, generalized spasticity that does not respond adequately to oral medications, a surgically implanted intrathecal baclofen (ITB) pump delivers medication directly to the fluid surrounding the spinal cord. This provides powerful spasticity reduction with much lower doses and fewer systemic side effects. The pump requires surgical placement, periodic refills (every 1 to 6 months), and eventual replacement (every 5 to 7 years).
Level 6: Surgical Options
Selective dorsal rhizotomy (SDR) permanently reduces spasticity by selectively cutting nerve fibers in the spinal cord that contribute to excessive tone. It is most effective in ambulatory children with spastic diplegia (legs affected more than arms) who have good underlying strength. Orthopedic surgeries (tendon lengthening, muscle releases, bony corrections) address the structural consequences of long-standing spasticity such as fixed contractures and hip displacement.
Our team works with families across all 38 states. No cost, no commitment. Just answers.