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PT Question About Tendons & Muscles
I've started aquatic PT. My neuro wants me to go 3x a week. I had an evaluation yesterday for PT and the therapist said that my tendons are tight. My spasticity in my muscle groups in the left side is also bad and preventing free movement. Her plan is to help loosen the tendons, and gradually stretch the muscles in the hope that some of the tightness & spasticity gives. My left ankle no longer bends down all the way, or up. I've walked with a limp since 2008 because of this.
Do tendons become tight in MS? If I have MS, will the tendons and spasticity loosen up with PT... Will I be able to walk normally again? What is the scenario if I do have MS, no DMDs, and just PT...will I regain what I've lost?
A side note: I decided to try another local neuro. I like my current local neuro, but I can't keep going like this...I need help and I need someone who will step up to the plate and diagnose. I decided to try Rita's doc. I've heard he can "think outside the box" so I'm ready to give it another try..wish me luck.
Do tendons become tight in MS? If I have MS, will the tendons and spasticity loosen up with PT... Will I be able to walk normally again? What is the scenario if I do have MS, no DMDs, and just PT...will I regain what I've lost?
A side note: I decided to try another local neuro. I like my current local neuro, but I can't keep going like this...I need help and I need someone who will step up to the plate and diagnose. I decided to try Rita's doc. I've heard he can "think outside the box" so I'm ready to give it another try..wish me luck.
does the word spasticity refer to spasming muscles that pull on tendons?I have something that appears to me to be all my tendons tightening creating tendonitis symptoms throughout my body and its steadily getting worse. This is the first time google has come up with something that sounds like the description matches what I feel! Seeing a Neuropathic on July 2nd ... how much hope should I pin on this visit for answers or solutions?Any suggestions on how to get the most from this long awaited visit?
Thank you for your input. I didn't know there was a difference in PT and this is all new to me. A professional did DX my spasticity and all my neuros have agreed that I do suffer from it. I guess in my own words I would describe it, for example, my left arm will be in a flexed state even though I'm relaxed. The muscles in both my left arm and leg will be hard and firm. When I try to move the arm or leg in it's free range of motion, it will not go. It reaches a certain point, and it will no longer go further by my own will. My left arm will go, if forced by another, and if I try very, very hard, but it feels like I'm lifting 1,000 lbs. rather than my arm.
I have spasticity that runs down the entire left leg. I can't spread my hips to it full extent from the side or forward. I can bend the ankle a little down, but not all the way compared to the right ankle. As far as bringing the ankle or toes towards me, it stops at a 90 degree angle (the same angle as if I'm flat footed on the ground). I do have a lot of weakness on the entire left side including that ankle and it has gradually became worse from year to year.
I have complained for years about these issues, especially when I began to limp in 2008. I'm not sure why my doctors haven't address these issues, other than throwing medication at it. They would see me and tell me that it looks like my spasticity is acting up worse so I should up my Baclofen.
I'll have to see about a rehab specialist that is trained in neuro disorders because I would love to walk again without the use of a cane and a limp.
Thanks Again for your Input
I have spasticity that runs down the entire left leg. I can't spread my hips to it full extent from the side or forward. I can bend the ankle a little down, but not all the way compared to the right ankle. As far as bringing the ankle or toes towards me, it stops at a 90 degree angle (the same angle as if I'm flat footed on the ground). I do have a lot of weakness on the entire left side including that ankle and it has gradually became worse from year to year.
I have complained for years about these issues, especially when I began to limp in 2008. I'm not sure why my doctors haven't address these issues, other than throwing medication at it. They would see me and tell me that it looks like my spasticity is acting up worse so I should up my Baclofen.
I'll have to see about a rehab specialist that is trained in neuro disorders because I would love to walk again without the use of a cane and a limp.
Thanks Again for your Input
Hi there,
So sorry it took me a bit to get back to this, I had a busy weekend and then had an infusion so I'm just now getting back to things.
Ok, let's see...
"Do tendons become tight in MS?"
Yes, If the muscle is not used through the full range, or not used with proper coordination, then you can develop muscle tightness. I believe that if a muscle is tight enough to prevent full proper range of motion then it is definitely shortened. I don't really see a way that you can say that something is tight and not short. The tendon is a non-contractile extension of the muscle connecting to the bone.
The other issue that can develop is joint capsule tightness because the joint isn't moving through it's full range. The way you are describing a stopage point makes me think that there is more to stretch than just the muscle, and joint mobilizations are probably needed to allow the joint movement. along with muscle stretching.
"If I have MS, will the tendons and spasticity loosen up with PT... Will I be able to walk normally again? What is the scenario if I do have MS, no DMDs, and just PT...will I regain what I've lost?"
Can you describe the symptoms that you are using the word spasticity for? Was that told to you by a medical professional? Consistent stretching can definitely address shortened muscles, but it does have to be daily at a minimum and aggressive. With long hold times (30-60 seconds) and at least 5 reps.
I can't really talk to being able to walk normally again - it's hard to predict. I had foot drop develop 5 years ago, it's gradually gotten better, and now I don't wear an AFO anymore and only get foot drop when tired. How is about the strength in your ankle? Your drag could be purely from your lack of motion, which could be from old or current weakness. (all my shoes are torn on the left toes - kind of a bummer)
"Does tendons issue happen because of spasticity? Would upping my Baclofen help some of flexibility?"
Muscle tightness is different than spasticity. Spasticity is velocity dependent when moving the limb, and muscle tightness is not. Spasticity can be treated with Baclofen, but has side effects that my patients don't tolerate well. Baclofen alone doesn't help regain motion, and should be accompanied with aggressive stretching. Some medical professionals use night splinting or dynamic splinting as Quix said. Research isn't great on these, and the wear time is usually too many hours each day for patients to be compliant. Splinting is usually only used in extreme cases, and many PTs don't even know about the option.
There is a HUGE HUGE HUGE difference between an orthopedic PT and a neuro PT. Neuro trained PTs should know more about how to address orthopedic issues resulting from a neurological condition. Regardless of the diagnosis being hung up on MRI, the PT should be going by if your movement and weakness patterns present as neurological
I second a Physiatrist/rehab MD. They are great at coordinating PT and equipment needs. I can't say about the need for an AFO. AFOs can help with a lot more than just anterior tib weakness. Some AFOs require a minimum range of motion to be effective with the mechanism they use. Classic foot drop is weakness in the anterior tib, as stated, but foot drag can have other sources (weakness with push off, knee flexion, and hip strength can cause problems with foot clearance - the whole chain needs to be addressed).
Aquatic therapy is great for gentle strengthening and endurance. Not really the place for aggressive stretching though, and not possible to really even address the need to joint mobs, unless this PT gets you on your back in the pool - which is really rare. They really shouldn't be putting someone with suspected MS in a hot pool either. From my understanding, DMDs don't improve symptoms, just give you some increased time between relapses, which allows for more improvement before the next symptom arises.
woooooooo - If I didn't answer something then please just yell at me. I hope this makes sense I get really frustrated with orthopedic PT on the neuro population. It just isn't appropriate and then it's a waste of time and money. Good neuro PT needs to hands on and one on one. You can have great hands on in an aquatic setting, but that's not what most aquatic PT is - they don't have the proper education in real aquatic rehab techniques. There is a difference between exercising in the pool and aquatic rehab. blah blah blah. soapbox. the end.
So sorry it took me a bit to get back to this, I had a busy weekend and then had an infusion so I'm just now getting back to things.
Ok, let's see...
"Do tendons become tight in MS?"
Yes, If the muscle is not used through the full range, or not used with proper coordination, then you can develop muscle tightness. I believe that if a muscle is tight enough to prevent full proper range of motion then it is definitely shortened. I don't really see a way that you can say that something is tight and not short. The tendon is a non-contractile extension of the muscle connecting to the bone.
The other issue that can develop is joint capsule tightness because the joint isn't moving through it's full range. The way you are describing a stopage point makes me think that there is more to stretch than just the muscle, and joint mobilizations are probably needed to allow the joint movement. along with muscle stretching.
"If I have MS, will the tendons and spasticity loosen up with PT... Will I be able to walk normally again? What is the scenario if I do have MS, no DMDs, and just PT...will I regain what I've lost?"
Can you describe the symptoms that you are using the word spasticity for? Was that told to you by a medical professional? Consistent stretching can definitely address shortened muscles, but it does have to be daily at a minimum and aggressive. With long hold times (30-60 seconds) and at least 5 reps.
I can't really talk to being able to walk normally again - it's hard to predict. I had foot drop develop 5 years ago, it's gradually gotten better, and now I don't wear an AFO anymore and only get foot drop when tired. How is about the strength in your ankle? Your drag could be purely from your lack of motion, which could be from old or current weakness. (all my shoes are torn on the left toes - kind of a bummer)
"Does tendons issue happen because of spasticity? Would upping my Baclofen help some of flexibility?"
Muscle tightness is different than spasticity. Spasticity is velocity dependent when moving the limb, and muscle tightness is not. Spasticity can be treated with Baclofen, but has side effects that my patients don't tolerate well. Baclofen alone doesn't help regain motion, and should be accompanied with aggressive stretching. Some medical professionals use night splinting or dynamic splinting as Quix said. Research isn't great on these, and the wear time is usually too many hours each day for patients to be compliant. Splinting is usually only used in extreme cases, and many PTs don't even know about the option.
There is a HUGE HUGE HUGE difference between an orthopedic PT and a neuro PT. Neuro trained PTs should know more about how to address orthopedic issues resulting from a neurological condition. Regardless of the diagnosis being hung up on MRI, the PT should be going by if your movement and weakness patterns present as neurological
I second a Physiatrist/rehab MD. They are great at coordinating PT and equipment needs. I can't say about the need for an AFO. AFOs can help with a lot more than just anterior tib weakness. Some AFOs require a minimum range of motion to be effective with the mechanism they use. Classic foot drop is weakness in the anterior tib, as stated, but foot drag can have other sources (weakness with push off, knee flexion, and hip strength can cause problems with foot clearance - the whole chain needs to be addressed).
Aquatic therapy is great for gentle strengthening and endurance. Not really the place for aggressive stretching though, and not possible to really even address the need to joint mobs, unless this PT gets you on your back in the pool - which is really rare. They really shouldn't be putting someone with suspected MS in a hot pool either. From my understanding, DMDs don't improve symptoms, just give you some increased time between relapses, which allows for more improvement before the next symptom arises.
woooooooo - If I didn't answer something then please just yell at me. I hope this makes sense I get really frustrated with orthopedic PT on the neuro population. It just isn't appropriate and then it's a waste of time and money. Good neuro PT needs to hands on and one on one. You can have great hands on in an aquatic setting, but that's not what most aquatic PT is - they don't have the proper education in real aquatic rehab techniques. There is a difference between exercising in the pool and aquatic rehab. blah blah blah. soapbox. the end.
bumping for Ashley....also, I was reading the other day about foot drop..Does my situation with my left leg/ankle sound like classic foot drop?
SB - I'm so mad at your doctors I could just spit!
I am eagerly awaiting what Ashley will say about neurological PT and the difference between sports rehab and chronic spasticity.
Meanwhile, please try to get an appointment with a Rehab MD or a Physical Medicine Doc. One place to look would be by calling the largest spinal rehab center near you or contacting the local MS Clinic and asking for a list of qualified PTs.
Quix
I am eagerly awaiting what Ashley will say about neurological PT and the difference between sports rehab and chronic spasticity.
Meanwhile, please try to get an appointment with a Rehab MD or a Physical Medicine Doc. One place to look would be by calling the largest spinal rehab center near you or contacting the local MS Clinic and asking for a list of qualified PTs.
Quix
The PT that I'm going to, I don't think, is trained in neurological disorders. I told her that several of my doctors do suspect MS, but are hung up on the MRI scans. I told her of my problems getting into my vehicle ( I go butt first) because I have issues with being on one leg (balance & weakness). I also told her about the main issue..walking. I walk with a limp. The weakness/spasticity is really bad through out the whole left side. I can't get up on my toes..they won't bend up or down all the way. My ankle is the same way. It stops when I try to bring it towards me (bring it up) at a 90 degree angle. If I try to spread my hips, it stops short as well.
When I had water PT last week, she had me walk laps forward, backwards, get up on my tippy toes while holding a bar, stretch out both legs from side, front and back, do scissor exercises, act like I was riding a bike, go to a stair and hang my heels over to stretch the tendons, and she had me put my leg over two stairs and lean into my leg...etc.
Some of these exercises scared me because I was balancing myself with my upper body strength. Right arm is good, but not the left and the pool in some areas was not deep. The pool felt more like a hot tub too, rather than a pool.
I asked her if my tendons had become short and that's why I couldn't move my leg properly anymore. She said they were tight..not short, even though I explained I've walked with a limp since 2008 and the spasticity came on since 2007. You can't force the left side to go into normal range of movement anymore...it just stops.
Although my arm can be forced as she did when she did my assessment. (She asked me to lift my arm straight up. I thought my left arm was straight up but then she said "You can't lift that straight up"..she came over to me and forced it all the way up..and then remarked on how tight it was.)
I didn't realize that PT needed to be done so rigorous and frequent, although I'm not sure if this is the proper PT I need to get me back in order. My local neuro ordered PT after I complained of the loss of mobility.
When I hang my feet over the end of a couch, my right leg will follow the couches form. My left leg will follow it's own form and the ankle, even in a relaxed state, it will be stuck in that 90 degree angle. My doctors have never mentioned anything about an AFO..but look what doctors I've dealt with LOL.
Any info that you can give me about PT would be appreciated...
When I had water PT last week, she had me walk laps forward, backwards, get up on my tippy toes while holding a bar, stretch out both legs from side, front and back, do scissor exercises, act like I was riding a bike, go to a stair and hang my heels over to stretch the tendons, and she had me put my leg over two stairs and lean into my leg...etc.
Some of these exercises scared me because I was balancing myself with my upper body strength. Right arm is good, but not the left and the pool in some areas was not deep. The pool felt more like a hot tub too, rather than a pool.
I asked her if my tendons had become short and that's why I couldn't move my leg properly anymore. She said they were tight..not short, even though I explained I've walked with a limp since 2008 and the spasticity came on since 2007. You can't force the left side to go into normal range of movement anymore...it just stops.
Although my arm can be forced as she did when she did my assessment. (She asked me to lift my arm straight up. I thought my left arm was straight up but then she said "You can't lift that straight up"..she came over to me and forced it all the way up..and then remarked on how tight it was.)
I didn't realize that PT needed to be done so rigorous and frequent, although I'm not sure if this is the proper PT I need to get me back in order. My local neuro ordered PT after I complained of the loss of mobility.
When I hang my feet over the end of a couch, my right leg will follow the couches form. My left leg will follow it's own form and the ankle, even in a relaxed state, it will be stuck in that 90 degree angle. My doctors have never mentioned anything about an AFO..but look what doctors I've dealt with LOL.
Any info that you can give me about PT would be appreciated...
The answer is that tendons are inactive and it's the muscles they are attached to that first become shortened. The spasticity causes chronic tightening of the muscles. The muscles are attached to the bone by the tendons. Over time the tendons shorten and continue shortening until the joint involved becomes permanently contractured. the other thing that can cause shortening of the tendons is atrophy of its muscle - like from paralysis or immobilization.
Stretching a shortened tendon is a long, and sometimes painful endeavor. The stretching exercises must be with some force and last long enough to cause some post-stretch discomfort. If they have been shortened too tong and too much sometimes the only way is to surgically lengthen them. EVERYTHING possible should be done before surgery is resorted to.
Stretching exercises should be done multiple times a day - at least 4 to 5 - I', glad you have a PT, but it is critical that he or she be trained in neurological disorders. The kind of stecthing that athletes depend on just won't cut it when the tendons are already short. Are you also seeing a rehab MD specialist? Try to hook in with one.
My right lower leg has now been partially immobilized for 2 and 1/2 weeks and today I realized that I cannot bring my toes up like I could before. I'm concerned that my right tibialis anterior is atrophying - it was already weak.
As tendons are stretched the rehab docs will often brace them - like with an AFO for foot drop - to prevent the part from reshortening in the rest period between stretches and at night. All of these things need to be addressed, in addition to rigorous and frequent PT.
I think this stuff should be added to the pertinent HP.
I would appreciate any words from any of our PTs on the forum.
Quix
Stretching a shortened tendon is a long, and sometimes painful endeavor. The stretching exercises must be with some force and last long enough to cause some post-stretch discomfort. If they have been shortened too tong and too much sometimes the only way is to surgically lengthen them. EVERYTHING possible should be done before surgery is resorted to.
Stretching exercises should be done multiple times a day - at least 4 to 5 - I', glad you have a PT, but it is critical that he or she be trained in neurological disorders. The kind of stecthing that athletes depend on just won't cut it when the tendons are already short. Are you also seeing a rehab MD specialist? Try to hook in with one.
My right lower leg has now been partially immobilized for 2 and 1/2 weeks and today I realized that I cannot bring my toes up like I could before. I'm concerned that my right tibialis anterior is atrophying - it was already weak.
As tendons are stretched the rehab docs will often brace them - like with an AFO for foot drop - to prevent the part from reshortening in the rest period between stretches and at night. All of these things need to be addressed, in addition to rigorous and frequent PT.
I think this stuff should be added to the pertinent HP.
I would appreciate any words from any of our PTs on the forum.
Quix
Thanks LuLu. I'm hoping that some of the flexibility can be recovered as well. It would be nice to not ruin my new shoes because my left leg won't lift right too :) My new sandals have scuff marks on the tip of the shoe.
She had me do a lot of exercises that stretch the tendons...The bad part of it, was that my left leg was not doing it. My left side would go only so far before it stopped, which wasn't far. It didn't even matter if my body weight was going against it, it still would not bend.
She would have me get up on my tippy toes, but I could feel on the left side that the exercise would roll my foot from the pad to the toes, but there was no lift. I was worried that my toes would get smashed on the left side. I can lift on the right though, even though I'm starting to feel some stiffness & weakness in that ankle as well.
Does the tendons just tighten up on their own, or is it secondary to the muscles tightening up? Does tendons issue happen because of spasticity? Would upping my Baclofen help some of flexibility?
She had me do a lot of exercises that stretch the tendons...The bad part of it, was that my left leg was not doing it. My left side would go only so far before it stopped, which wasn't far. It didn't even matter if my body weight was going against it, it still would not bend.
She would have me get up on my tippy toes, but I could feel on the left side that the exercise would roll my foot from the pad to the toes, but there was no lift. I was worried that my toes would get smashed on the left side. I can lift on the right though, even though I'm starting to feel some stiffness & weakness in that ankle as well.
Does the tendons just tighten up on their own, or is it secondary to the muscles tightening up? Does tendons issue happen because of spasticity? Would upping my Baclofen help some of flexibility?
Hi, You'll have to keep us posted on how the water therapy goes - personally I love the idea of exercising in water. I have no idea about the flexibiility of the tendons being something that can be recovered - my GUESS is yes, some improvement can be made. But that is just my uneducated guess.
Going to a new neuro makes a lot of sense - you are getting no where with the one you are seeing and perhaps a fresh look at you and your history will yield results. Rita and I have talked a lot about her neuro and he sounds like a keeper to me.
wishing you lots of luck!
L
Going to a new neuro makes a lot of sense - you are getting no where with the one you are seeing and perhaps a fresh look at you and your history will yield results. Rita and I have talked a lot about her neuro and he sounds like a keeper to me.
wishing you lots of luck!
L
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