If you have spasticity, a physiotherapist and occupational therapist may assess you for stretching and splinting. Your physiotherapist can teach you stretching exercises to avoid contractures. They should also show your family or carers how to help you with exercises. Your physiotherapist will also give advice and pictures for positioning your arms and legs when in bed or sitting up.

In some circumstances, an occupational therapist may provide a splint to wear, to help keep a good position and range of movement in your limbs.

Botulinum toxin type A works by blocking the action of the nerves on the muscle, reducing your muscle’s ability to contract. It has several brand names including Botox, Dysport and Xeomin. It reduces muscle tone, which can help you to straighten out your limbs.

Botulinum toxin type A is given as an injection directly into the muscle. It is mainly used in the hands, wrists and ankles. The muscle-relaxing effects usually last for about three months and you should not notice any changes in sensation in your muscles. Treatment with botulinum toxin type A is given along with physiotherapy and other possible techniques, like a splint, brace or electrical stimulation, to ensure that any range gained in the muscle is maintained. You should be assessed three to four months after the treatment, and you may be offered further treatments if helpful.

You may be offered a muscle relaxant medication. This can help if you have spasticity in many areas of your body, or if botulinum treatment does not work for you. Muscle relaxants can reduce the stiffness and the pain that often accompanies muscle spasms. They can make it easier to straighten or bend your affected limbs and may reduce muscle spasms.

There are different types of drugs available that work in a number of ways:

• Baclofen and tizanidine are muscle relaxants that work on the central nervous system to reduce nerve activity in the spinal cord. Baclofen and tizanidine can be taken orally (swallowed). In certain circumstances, a specialist may prescribe baclofen via a pump under the skin.
• Diazepam and clonazepam work on the chemicals that transmit messages between brain cells. They often make you drowsy, so might be used at night.
• Gabapentin and pregabalin also affect brain chemicals and are often used as epilepsy treatments, but have many other treatment uses.
• Dantrolene works on muscle cells to relieve tightness.

Cannabinoid medications are a newer treatment sometimes offered to people with multiple sclerosis to help with spasticity. These medications are not given for use after stroke, as the current evidence does not show how effective they are.

These medications should only be prescribed by a doctor who specialises in managing spasticity.

You may need to try more than one or take a combination that works for you. Each type of drug has different benefits. Possible side effects may include drowsiness or dizziness. Your doctor and pharmacist can support you with practical advice on the best way of taking your medication.

Do not stop taking your medication without speaking to your doctor first, as stopping it suddenly may cause side effects.

Neuromuscular electrical stimulation (NMES) treatment may also be recommended in certain types of spasticity, alongside stretches and exercises. It uses a small device to deliver electrical impulses via electrodes.

If you develop contractures, your therapist may use a splint or a cast that moulds to or lies along your affected limb and holds it in place. This treatment helps to stretch out the muscles in your tight limbs and is usually combined with physiotherapy. Sometimes this treatment is used to try to prevent contractures from forming by making sure that your body is not in an abnormal position.

Unfortunately, splints and casts can sometimes be uncomfortable. Talk to your physiotherapist about what would be best for you.