Spasticity after stroke

What is post-stroke spasticity?

It is quite common for people to experience spasticity after a stroke. This is called post-stroke spasticity, and it happens when signals between the brain and certain muscles are disrupted. These muscles contract involuntarily and can feel tight, stiff, or hard to move, especially when stretched. Untreated spasticity can be painful and distressing, and can lead to deformity of the affected limb and difficulties performing everyday activities.¹

While there are no cures for post-stroke spasticity, it can be treated with a tailored rehabilitation programme. This can help improve the often frustrating and painful symptoms over time.²

Understanding stroke

Stroke happens when the blood supply to the brain is disrupted, either by a blood clot (ischaemic stroke) or burst blood vessel (haemorrhagic stroke).³ Starved of oxygen, brain cells die, leading to a range of symptoms depending on where in the brain the stroke has occurred.⁴ The resulting brain damage can leave stroke survivors with lasting impacts such as speech problems and impaired mobility, as well as impacts on cognition and mental health.⁵

The quicker a stroke is detected and treated, the quicker blood flow can be restored to the brain – thereby reducing damage to the brain. Emergency treatment in hospital can remove or dissolve blood clots in the brain while specialist acute stroke care can improve outcomes and help prevent a second stroke.⁵ Early rehabilitation in hospital, such as physical therapy and speech and language therapy, can help stroke survivors recover skills and functions that may have been impacted.⁶ This type of support is vital in the weeks and months following a stroke.⁷

1 in 4

adults

over the age of 25 will have a stroke in their lifetime⁸

101M

people

in the world have experienced a stroke⁹

87%

of strokes

are ischaemic strokes¹⁰

45%

of stroke survivors

can expect to develop spasticity within 3 months¹¹

Effects of stroke

Stroke can lead to psychological, physical, cognitive, and communication problems, including:

Neurological deficits – tingling, numbness, a drooping mouth, or paralysis¹²
Cognitive issues – difficulties with concentration, memory loss, hearing, spatial awareness, and comprehension¹²
Fatigue¹³
Impaired speech (aphasia)¹²
Vision problems¹²
Mental health challenges – anxiety and depression¹³
Lack of body control – muscle weakness, tightness, or spasms¹²

Stroke and spasticity

Upper Motor Neuron Syndrome

When someone has a stroke, the part of the brain that controls voluntary movement can be damaged. This is known as Upper Motor Neuron Syndrome. On the one hand, this damage can be described by what is lost: motor skills, strength, or motor control, for example. On the other hand, it can be characterised by continuous and unwanted muscle activity – uncontrollable movements, spasms, or involuntary muscle contractions.¹⁴

Measuring spasticity

The impact of spasticity can be measured using the Ashworth Scale, which is used to^15,16:

Assess resistance to passive stretching
Measure muscle tone using a five-point scale (six in the modified version)
Assess the impact on a person’s ability to move around and their independence
Differentiate between mild and severe spasticity

Recognising spasticity after stroke

While spasticity after stroke can go unnoticed, it´s important to recognise the signs and symptoms to be able to manage and treat the condition effectively.¹⁷

Is it spasticity?

Post-stroke spasticity can be difficult to recognise among other symptoms and may be overlooked in the early or mild stages. Spasticity looks and feels different for everyone, but there are some common symptoms to watch out for.¹⁶

Signs to look for

Muscles that feel stiff, tight, rigid, numb, heavy, or paralysed¹⁷
Making them resistant to movement or difficult to bend or straighten through a full range of motion
Muscle weakness or paralysis¹⁷
Affecting one side of the body (known as hemiparesis)
Muscles remaining “frozen” or “locked” in certain positions¹⁷
Such as an elbow bent against the chest, a clenched fist, or pointed toes
Spasms¹⁷
Involuntary jerking or kicking movements, or uncontrolled bouncing, tremors, twitches, or shakes
Movement difficulties¹⁷
Making it difficult to walk, balance or stand up straight
A lack of body control that makes it hard to complete daily tasks¹⁷
Such as getting dressed, cooking, and cleaning

Treatment and rehabilitation exercises for post-stroke spasticity

Detailed clinical and neurological assessments by stroke specialist rehabilitation teams can help to determine a personalised treatment plan. Goals can include everything from relieving pain and improving mobility to resuming everyday activities or gaining more independence.

Treatment can include physical, occupational, and speech therapies (many stroke survivors report that they continue to see improvement even after many months of therapy). Mobility aids, assistive technologies (orthoses), and medical interventions can also help to reduce spasticity symptoms. At-home exercises are also important to improve mobility and reduce acute muscle tightness.¹⁸

References

¹Jacinto J, Camões-Barbosa A, Carda S, Hoad D, Wissel J. A practical guide to botulinum neurotoxin treatment of shoulder spasticity 1: Anatomy, physiology, and goal setting. Front Neurol. 2022 Oct 17;13:1004629. doi: 10.3389/fneur.2022.1004629.

²American Stroke Association. Spasticity After Stroke fact sheet. American Stroke Association. 2022. Available at: https://www.stroke.org/-/media/Stroke-Files/Support-Group-Resources/Spasticity-After-Stroke-Fact-Sheet.pdf [accessed September 2025].

³Barthels D, Das H. Current advances in ischemic stroke research and therapies. Biochim Biophys Acta Mol Basis Dis. 2020 Apr 1;1866(4):165260. doi: 10.1016/j.bbadis.2018.09.012.

⁴National Institute of Neurological Disorders and Stroke (NINDS). April 2020. Post-stroke rehabilitation. NIH Publication No. 20-NS-4846. National Institutes of Health. Available at: https://catalog.ninds.nih.gov/sites/default/files/publications/post-stroke-rehabilitation.pdf [accessed September 2025].

⁵Royal College of Physicians and Royal College of Physicians of Ireland. National Clinical Guideline for Stroke for the United Kingdom and Ireland. Chapter 3: Acute care. 2023 edition.

⁶Heart and Stroke Foundation of Canada. Rehabilitation and recovery following stroke. Canadian Best Stroke Practices Recommendations. 2022b. Available at: https://www.strokebestpractices.ca/recommendations/stroke-rehabilitation [accessed September 2025].

⁷Kernan WN, Viera AJ, Billinger SA, Bravata DM, Stark SL, Kasner SE, Kuritzky L, Towfighi A; American Heart Association Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; and Council on Peripheral Vascular Disease. Primary care of adult patients after stroke: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2021 Aug;52(9):e558-e571. doi: 10.1161/STR.0000000000000382.

⁸GBD 2016 Lifetime Risk of Stroke Collaborators, Feigin VL, Nguyen G, et al. Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. N Engl J Med. 2018;379(25):2429-2437.

⁹“101M people worldwide experience a stroke.” Reference: Roth G. A., Mensah G. A., Johnson C. O., Addolorato G., Ammirati E., Baddour L. M., et al. Journal of the American College of Cardiology, 2020, 76, 2982–3021.

¹⁰Virani, SS, et al. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021; 143(8), e254–e743.

¹¹Schinwelski MJ, Sitek EJ, Wąż P, Sławek JW. Prevalence and predictors of post-stroke spasticity and its impact on daily living and quality of life. Neurol Neurochir Pol. 2019; 53(6):449-57.

¹²National Heart, Lung and Blood Institute. 2023. Stroke: Symptoms. Last updated 26 May 2023. National Institutes of Health. Available at: https://www.nhlbi.nih.gov/health/stroke/symptoms [accessed September 2025].

¹³Royal College of Physicians and Royal College of Physicians of Ireland. National Clinical Guideline for Stroke for the United Kingdom and Ireland. Chapter 4: Rehabilitation and recovery. 2023 edition.

¹⁴Thibaut A, Chatelle C, Ziegler E, Bruno MA, Laureys S, Gosseries O. Spasticity after stroke: physiology, assessment and treatment. Brain Inj. 2013;27(10):1093-105. doi: 10.3109/02699052.2013.804202.

¹⁵Escaldi S, Bianci F, Bavikatte G, Molteni F, Moraleda S, Deltombe T, Francisco G. Module 1: pathophysiology and assessment of spasticity; goal setting. J Int Soc Phys Rehabil Med. 2022 5(Suppl 1):S3-S22. doi: 10.4103/2349-7904.347807.

¹⁶Luo Z, Lo WLA, Bian R, Wong S, Li L. Advanced quantitative estimation methods for spasticity: a literature

¹⁷Glaess-Leistner, S., Ri, S. J., Audebert, H. J., & Wissel, J. (2020). Early clinical predictors of post stroke spasticity. Topics in Stroke Rehabilitation, 28(7), 508–518. https://doi.org/10.1080/10749357.2020.1843845 [Accessed September 2025].

¹⁸Royal College of Physicians. Spasticity in adults: management using botulinum toxin. National Guidelines. 2018. Available at: https://archive-rcplondon.zedcloud.co.uk/file/12449/download%202018 [accessed September 2025].