Section 7

 

COPING WITH SPASMS


Many people with MS have problems with one, two or even all four limbs going into spasm at different times.  Although it is difficult to prevent spasms there are measures you can take that may help in managing and therefore relieving some of the symptoms.  There is of course a range of drugs available which can also help but I am only going to describe physical, non-invasive techniques here.  Spasm will happen in a pattern, so if you learn to “break” the pattern then you can reduce the symptoms.  To be able to affect the pattern of spasm, posture and positioning are very important factors.  The simple act of standing up can help to decrease the incidence of spasm in the legs.  This is partly why it is so important to try and stand each day.  When you stand you must make sure that you get your weight evenly over the whole sole of each foot.  Keep your weight forward over the foot to enable your toes to stay in contact with the floor and try not to stick your rear end out! Tilt beds and standing frames can also help if you have access to them.

               
When sitting the legs can go into spasm and make you feel as if they are totally independent of you! Jumping feet This can occur when the ball of the foot is on the ground but the heel is up and jumps up and down repeatedly.  Make sure the foot is in a position where the whole sole can be in contact with the floor.  Bring the trunk well forward over the hips, then push down onto the knee with a steady downward pressure - or get the help of someone else to lean down onto the knee. 

 

Shooting legs

If your legs shoot out straight, you need to bring your trunk forward over your hips and lean forwards.  This should break the spasm and the legs should gradually relax.  If, however, the spasm is very strong and pushes you back in the chair so that you are unable to come forward then you need the help of another person to push you forward from behind, leaning their body weight against your back and shoulders.  Many people with MS have problems with one, two or even all four limbs going into spasm at different times.  Although it is difficult to prevent spasms there are measures you can take that may help in managing and therefore relieving some of the symptoms.  There is of course a range of drugs available which can also help but I am only going to describe physical, non-invasive techniques here.  Spasm will happen in a pattern, so if you learn to “break” the pattern then you can reduce the symptoms.  To be able to affect the pattern of spasm, posture and positioning are very important factors.  The simple act of standing up can help to decrease the incidence of spasm in the legs.  This is partly why it is so important to try and stand each day.  When you stand you must make sure that you get your weight evenly over the whole sole of each foot.  Keep your weight forward over the foot to enable your toes to stay in contact with the floor and try not to stick your rear end out! Tilt beds and standing frames can also help if you have access to them.


Knees clamping tightly together This can be a problem sometimes if travelling in a car and being jostled about - or it can happen if something just touches the legs.  Sometimes it can be stopped by gently lifting the leg, when bent, from behind the knee.  This can also help with jumping feet.  A pommel between the thighs can help stabilise the pelvis and therefore reduce the spasm.  To make a pommel you need two towels approximately 24” x 46” (62cms x 116cms).  Fold the first towel in 4 lengthways and roll it up tightly, then fold the second towel and roll it around the first one.  You can secure it with a scarf or bandage or some non-allergenic tape.  You should end up with a pommel approx.  5-6ins (14-15cms) in diameter and 6ins (15cms) long.  Position the pommel between the fleshy part of the thighs (not the bony part of the knees) with the flat side uppermost.  Once in position the legs should start to relax.  Although this may look a little odd many people find it very comfortable, and cat lovers might like to note that cats prefer expanded laps!
Spasm when lying down Getting from the sitting position to the lying position can itself cause spasm, with one or both legs shooting out straight, and sometimes the trunk becoming tight and stiff.  The “pattern” of the spasm is trying to push the whole body out straight - and sometimes it does! When moving from sitting to lying, it can lessen the likelihood of spasm if both knees and hips are bent up. 

 

A lot of people find that lying on their back increases spasm, often with the legs pushing out straight and the thighs clamping together.  Sleeping on the side is therefore more comfortable though this too can cause problems, encouraging the “windswept” look where one leg drops down onto the other and consequently tilts the pelvis and makes it unstable.  This can lead to the legs going into spasm or “jumping” during the night and disturbing sleep.  This position can also be a problem for people with back pain because of the pull on the pelvis.  To counteract both problems of pain and spasm you need a “sausage” to support the top leg and stabilise the pelvis.  This “sausage” or positioning roll is available commercially* but it is worth making your own temporary version first with a pillow and towel to see if it helps.
Fold the pillow in half lengthways, then roll it tightly in the towel.  Feather pillows usually squash down too much; man-made seem to work better.  The “sausage” should end up the length of the pillow and 6ins (15cms) in diameter.  Position the roll in the fleshy part of the thighs with the longest part behind to prevent any rolling backwards.  Check the position of the ankles. 

 

A folded piece of sheepskin might be needed to prevent the bony points from rubbing together.  Once the roll is in position, the top leg is supported and level with the bottom leg leaving the pelvis in a stable position.  If you can only lie on your back, you may find a T roll will help – a combination of the “sausage” and the pommel used in sitting, with the “sausage” under the knees and the pommel between the thighs.  This will minimise the “windswept” look and decrease any spasm.  You will also need to put a pillow under the feet to relieve pressure from the calves.  When using positioning rolls of any sort it is very important to check the effect of the rolls on the skin.  Any redness or soreness must be monitored carefully in case of pressure sores developing.  It may be sensible to limit the amount of time you use a roll and also to discuss positioning with your physiotherapist or nurse.