Tone & Spasticity in incomplete spinal cord injury:
What, why, and how to address it
Tone and spasticity after spinal cord injury are real sources of frustration for anyone with an incomplete spinal cord injury, making it even more challenging to sleep, move, work out or be productive.
We've received many questions on how to best address unwanted tone and spasticity after SCI, but to understand why our strategies work, we first need to discuss why this seemingly unrelenting tone exists post-spinal cord injury.
During and after trauma, the body tenses up in response to perceived threats or unsafe conditions. The issue with neurological trauma and spinal cord injury is that the body remains stuck in this “threat response” long after the aggressing stimulus has passed. It’s like the nervous system has not yet detected safety, even though the conscious mind knows everything is okay.
Tone in the Deep Front fascial line
The most common areas that experience hypertonicity (high tone) are located within the Deep Front fascial line. These areas include:
jaw/mouth
neck stabilizers and flexors
trunk stabilizers (incl. diaphragm)
hip flexors
pelvic floor
adductors
bottoms of feet
Collectively, these are the same areas that pull the body into a "fetal position" when we feel "unsafe” or prepare us for “flight” (as in the popular “fight or flight” description).
This further encourages the idea that tone and Deep Front line spasm patterns are a primitive response to protect vital organs from further trauma or during stressful times.
Reflexive synergy patterns
Most individuals with incomplete spinal cord injury also experience reflexive synergy patterns, where the body spasms in either full flexion (hip flexion, knee flexion & dorsiflexion at the ankle), or full extension (legs kick straight, toes pointed). This triple flexion or triple extension is a reflex pathway initiated by a sudden change in position, which itself might be perceived by the nervous system as a kind of threat. We consider this generally by anthropomorphizing the nervous system: since paralysis prevents that system from resisting these positional changes, there is some sense that it can’t defend itself, and therefore reacts with these spastic patterns.
Want to learn more about reflexive synergy patterns? Watch this video.
How to decrease unwanted tone & spasticity
Many individuals turn to muscle relaxants to calm tone, or have been told to use a standing frame and use electrical stimulation to “tire” the muscles out. However, these are merely temporary solutions in which the relentless tone lingers in the background, ready to return the next day.
Now that we understand tone as a nervous system issue and response, it should be clear that we must address it with directed nervous system interventions.
If Deep Front Line activation is a protective reaction induced by trauma, stress, or sub-optimal internal states, then efforts to decrease hypertonicity should primarily focus on:
Decreasing emotional and physical stress
Increasing awareness of surroundings
Increasing awareness of internal states (interoception)
Creating a balance between parasympathetic and sympathetic nervous system activity
Mobilizing and strengthening any of the areas of the Deep Front fascial line
We'll be using this "roadmap" to guide us through the process of decreasing unwanted tone and spasticity.
Address the stress: Work on improving your mental health and deal with the emotional aspects of your trauma and decrease life stressors. As "movement people," we can address and improve mental states through strategic movement progressions, however, we always encourage SCI athletes to consider working with a talk therapist specializing in trauma.
Build internal awareness of your own body: Check in with your body often: increase interoception (what’s happening inside your body) with frequent 'body scans' and proprioception (where your limbs are) with sensory interventions. As the first stage in our Framework for Recovery (and one that takes over TWO chapters in our book, From The Ground Up), this stage should not be swept under the rug!
Heighten your senses: When your body has a better sense of the world around you, it'll feel more relaxed and "safe." Take time to orient your body before moving. Train your senses (eyes, vestibular, sensation) to better process external environments.
Talk to the parasympathetic nervous system: Increase parasympathetic tone through breath-work and self-massaging specific access points in your body. Some of these involve the Deep Front Line.
Work with the Deep Front Line: Work with the most available points along the Deep Front Line to release tension in the entire line.
Strengthen joints: Muscles tense when they are unable to protect a joint from unsafe movements (again, neurological response to “unsafe” situations!). Strengthen muscles in wide ranges of motion to give the joint "confidence" to move freely.
Some of these interventions may seem too simple to make a difference, however, these interventions are grounded in neuroscience and are already used by so many professionals to aid in all types of healing, not just healing after spinal cord injury.
We are fully aware that these techniques are not new, but we do feel they are lacking in the SCI rehab conversation.
Practice daily
Breaking down neurological tone in a way that creates lasting results requires consistency. The nervous system is incredibly powerful and can yield dramatic changes in full body tone, however, interventions need to be practiced daily (sometimes multiple times a day).
The few individuals that I know of who have committed to this endeavor (we’re taking lifestyle changes in several areas to improve their healing environment) were able to significantly decrease tone and increase their mobility.
