Stretching for MS Spasticity: Is It Essential? A New Look at the Evidence

For decades, daily stretching has been a cornerstone of MS spasticity management. This brief dives into a major 2024 randomized controlled trial that challenges this long-held belief, suggesting that general range of motion exercises may be just as effective when combined with proper patient education.

Research: July 2024

Key Findings

1A large 2024 RCT found no significant difference in spasticity improvement between a formal stretching program and a general range of motion (ROM) program.
2Both the stretching group and the ROM group showed significant improvements in spasticity, walking, fatigue, and quality of life.
3Patient education and consistent daily movement appear to be key therapeutic ingredients, regardless of the specific exercise type (stretching vs. ROM).
4The long-held belief that daily static stretching is an *essential* first-line treatment for MS spasticity is challenged by this high-quality evidence.
5Clinicians can be more flexible, prescribing either stretching or ROM exercises based on patient preference, as both appear similarly effective when combined with education.

Hey colleague, let's talk about something we do every day: prescribing stretching for MS spasticity. It's been the first-line recommendation for as long as I can remember. But what if I told you a major new study is making us question if it's the stretching itself that's doing the heavy lifting? A big, high-quality study just came out in 2024 from Cinda Hugos and her team at Oregon Health & Science University. It was a randomized controlled trial (RCT) with 231 ambulatory people with MS, which is a solid size. They compared two programs. The first was called 'MS Spasticity: Take Control' (STC), a program based on current guidelines that includes spasticity education and a daily 15-30 minute static stretching routine. The second was an active control group that received education on different exercise topics and performed a daily 15-30 minute routine of general range of motion (ROM) exercises. The results were surprising. After one month, there was **no significant difference** in the impact of spasticity between the stretching group and the ROM group. Both groups got significantly better on almost all measures—spasticity impact (MSSS-88), walking, fatigue, and quality of life—and these improvements were maintained at 6 months. The takeaway here isn't that stretching is useless, but that it's likely not *more* effective than a program of active ROM exercises. The common denominator and likely the most powerful ingredient? Both groups received structured education and performed daily, consistent movement. This suggests the real magic is in empowering patients with knowledge and getting them to move every single day, rather than the specific act of holding a static stretch.

Clinician's Note

This one was a bit of a surprise for me. I've been preaching daily stretching for MS spasticity since I graduated. This new RCT from Hugos and her team at OHSU is making me rethink my approach. It seems the 'secret sauce' isn't the stretching itself, but the combination of education and consistent, daily movement. It’s a good reminder that empowering our patients with knowledge and finding a routine they’ll actually stick with is probably more important than the specific exercise we prescribe.

Clinic Action Plan

1. Re-evaluate Your Spasticity Script: Shift the focus from "you must stretch" to "you must move daily and understand your spasticity". 2. Educate First: Dedicate time to explaining spasticity triggers, the impact on daily life, and the goal of self-management. Use the study's 'MS Spasticity: Take Control' (STC) program as a model. 3. Offer a Choice: Present both a traditional static stretching routine and a general ROM routine as valid options. Let the patient choose the one they are more likely to adhere to. 4. Prescribe a Daily Dose: Instruct patients to perform their chosen routine for 15-30 minutes every day, emphasizing consistency over intensity. 5. Focus on Function: Frame the goal not just as 'reducing stiffness' but as improving walking, sleep, and participation in daily activities. 6. Monitor with Validated Scales: Use the MS Spasticity Scale (MSSS-88) or a simple 0-10 Numeric Rating Scale (NRS) to track the impact and severity of spasticity over time. 7. Troubleshoot Adherence: If a patient isn't improving, investigate adherence to the daily program and reinforce the educational components before escalating to other interventions.

Common Mistakes to Avoid

•Assuming stretching is superior: Believing that static stretching is the only or best way to manage spasticity.
•Neglecting education: Focusing only on the exercises without explaining the 'why' behind spasticity self-management.
•One-size-fits-all prescription: Not offering patients a choice between stretching and ROM, which can hurt long-term adherence.
•Focusing only on intensity: Emphasizing how deep the stretch is, rather than how consistently the patient performs their daily routine.

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