Beyond Baclofen: Modern Spasticity Management in MS

This brief outlines practical, evidence-based strategies for managing spasticity in your MS patients. It moves beyond just medication, focusing on targeted physiotherapy and what the latest research says about what really works.

Research: April 2026

The Modified Ashworth Scale is a key tool for objectively grading spasticity and tracking treatment effectiveness.

Key Findings

1Physical activity programs, either alone or in combination with other treatments, have moderate to low-certainty evidence for improving spasticity in MS.
2Targeted stretching and strengthening exercises are fundamental to managing spasticity and maintaining range of motion.
3Transcranial magnetic stimulation shows promise as an emerging intervention for spasticity in MS.
4The evidence for modalities like vibration and shockwave therapy is currently limited, requiring further research.

Spasticity is a common and often debilitating symptom for people with Multiple Sclerosis, but it's not something they just have to live with. While oral medications like baclofen have their place, a 2024 systematic review of 32 randomized controlled trials, involving over 1,400 patients, found moderate to low-certainty evidence for the effectiveness of physical activity programs in managing MS-related spasticity. This includes both standalone exercise programs and those combined with other treatments. The review, published in the Annals of Rehabilitation Medicine, highlights that interventions like targeted stretching, strengthening, and even transcranial magnetic stimulation can make a real difference. For example, a daily stretching protocol of 2-3 sets of 30-60 second holds for major muscle groups can help to maintain range of motion and reduce stiffness. Similarly, a 2014 study in Acta Neurologica Scandinavica emphasized the importance of a comprehensive approach, combining physiotherapy with medication to improve quality of life. The key is to move beyond a passive approach and actively engage patients in a structured rehabilitation program. While the evidence for some modalities like vibration and shockwave therapy is still emerging, the consensus is that a proactive, individualized physical therapy plan is a cornerstone of effective spasticity management.

Clinician's Note

In my experience, the biggest mistake we make with spasticity is under-dosing our interventions. A few minutes of stretching at the end of a session isn't going to cut it. You need to be prescriptive and consistent. I've found that a home exercise program with clear photos and instructions, reviewed at every session, is crucial for adherence. Also, don't forget to look at the whole picture. Is their seating and positioning optimized? Are they getting enough sleep? These factors can have a huge impact on spasticity.

Clinic Action Plan

1. Patient Qualification: Any patient with MS reporting spasticity that impacts their function or quality of life. 2. Initial Assessment: Use the Modified Ashworth Scale to establish a baseline measure of spasticity. Also, assess range of motion, strength, and functional limitations. 3. Intervention Protocol: Prescribe a daily stretching program (2-3 sets of 30-60 second holds for affected muscle groups) and a strengthening program (2-3 sets of 10-15 repetitions for antagonistic muscles). Consider modalities like TENS or vibration therapy as adjuncts, but prioritize active interventions. 4. Progression Criteria: Progress strengthening exercises as tolerated. For stretching, focus on increasing duration and frequency. Re-assess with the Modified Ashworth Scale every 4-6 weeks. 5. Red Flags: Watch for any sudden increase in spasticity, which could indicate an underlying infection or other medical issue. Also, be mindful of over-stretching, which can sometimes exacerbate spasticity.

Common Mistakes to Avoid

•Under-dosing stretching and strengthening exercises.
•Focusing solely on passive modalities instead of active interventions.
•Failing to address contributing factors like poor positioning or sleep.
•Not using a standardized outcome measure like the Modified Ashworth Scale to track progress.

Frequently Asked Questions

Premium Deep Dive

This brief includes an extended deep-dive section with clinical nuance, dosing details, edge cases, and special population considerations.

Unlock with Premium — $99/yr

GRADE-graded with DOI links Evidence verified

This brief is for educational purposes only. Always verify clinical decisions with peer-reviewed sources and your professional judgment.

Want more from NeuroDash?

Save protocols, track CEU hours, download PDFs, and get unlimited AI access.

Explore Premium — $99/yr

More in MS

HIIT for MS: A Practical Guide to Improving Fatigue and Exercise Capacity

This brief provides a practical, evidence-based guide to implementing High-Intensity Interval Training (HIIT) for patients with Multiple Sclerosis. It covers the why, the how, and the what-to-watch-out-for, so you can confidently prescribe this powerful intervention to improve patient outcomes.

A Practical Guide to Fall Prevention in Multiple Sclerosis

Falls are a serious and frequent problem for people with Multiple Sclerosis, but they are not inevitable. This brief provides practical, evidence-based strategies you can use to significantly reduce fall risk in your patients with MS, focusing on targeted exercise and functional training.

Mastering Gait in MS: A Practical Guide to Task-Oriented Rehab

This brief breaks down how to use task-oriented training to improve walking in your patients with MS. It’s a practical, evidence-based guide to move beyond generic exercises and create targeted interventions that get real results.

Aerobic Exercise Prescription for MS Fatigue Management

This brief provides a practical guide to prescribing aerobic exercise for patients with Multiple Sclerosis to manage fatigue. It covers evidence-based dosing, patient selection, and progression, drawing on recent systematic reviews to offer actionable clinical insights.

Related Videos