Flexor vs extensor spasticity

[shoshin]

I have recently been looking at the NMSS booklet Stretching for People with MS: An Illustrated Manual at http://www.nationalmssociety.org/download.aspx?id=331

On page 21, they talk about flexor and entensor spasticity as follows:

Flexor spasticity:
Common in people with multiple sclerosis. The hips and knees are maintained in a bent position with hips turned inward. Less frequently, hips and knees are turned outward. Knees are bent in a flexed position and feet tend to point in a downward direction.

Extensor spasticity:
Less common. The hips and knees are maintained in a straightened position, and the legs are very close together or crossed over, with the feet in a downward position.

They also have illustrations. They then go on to state that:

You want to refrain from active exercises that accentuate a position associated with any spasticity you experience. For example, if you have extensor spasticity, refrain from doing the active exercises that straighten the hip and knee.

So I am trying to figure out which one I have. My PT didn't say anything about this and gave me stretches that involve both straightening and bending my legs.

I am leaning toward the extensor one as my legs do tend to want to stay straight. I tend to walk without bending my knees very much (the PT independently noticed this). My ankles also tend to bend in and I periodically hit one foot with the other (the PT told me this was from ankle weakness, which I do seem to have). My knees feel very stiff. I don't think it's the joints--it's like they're stiff from the outside in.

On the other hand, when I am laying on my back I sometimes get this thing where my knees jump up, sort of like the flexor spasticity illustration but not exactly. It's like my knees briefly bend and then let go and lie flat again. Sometimes multiple times in a row.

Anybody have any thoughts on this or know any other ways to figure out what kind of spasticity you have.

sho

[marymoto]

Dear shadow i was just reading one of your posts about the spasticity. my heart goes out to you and everything you go through on a day to day basis.i know when i joined this site you sent me a welcome message which i really appreciated and just wanted to thank you again for your warm welcome.

[ShadowsSister]

I think you might also be having "Bone Pain" the way my Dr. explained it to me was, because the bones were Not being Supported as they normally would be by the muscles, it causes some damage to the bones, thus you can develop deep bone pain, like I have in the long bones in my legs and arms.. This is why I have the morphine pump.

The Cymbalta is helping with the pain in the bladder, rectum, etc... this is due to a large bundle of nerves misfiring that are between the bladder and rectum.. This pain is worse than the bone pain, but the morphine doesn't help at all in this area..

I hope I haven't added to the confusion...
Love & Hugs to all...{{{{~!~}}}} DJ

[saveone]

Sho, I had never paid conscious attention to the position of my legs.  Now thinking about it, when I stand of the morning to get out of bed, or I stand from a seated position I am bent at the back,  It looks like an old woman walking hunched over and my knees are bent and until I loosen up I usually walk in tiny steps with my feet flat or dragging.

Hurts like h3ll. Before anyone mentioned anything about my brain I thought I was getting really bad arthritis.  It never occurred to me the pain was in my muscles, not my joints or bones.

So I have learned something about myself.

take care and live well,

terry

[shoshin]

Thanks everybody. I'm not going to PT anymore so I can't ask her, but if I go back, I definitely will. I think I must mostly have the extensor type as, despite my stiff-leggedness, this doesn't seem to make it impossible to walk. Sometimes I lock my knees to stay upright.

DJ: That is truly awful to have so much spasms and spasticity. I wish the doctors would somehow find something to relieve it. I was glad to hear the Cymbalta, despite its drawbacks, is helping with the pain at least.

sho

[ShadowsSister]

Hi again,
Well I am so sorry to say, I have both types, that is, the feet, legs and hips, that's three types isn't it.. I loose count LOL... plus in my spine. which will twist and lock, these are what have been breaking my vertebra's,along with the MS Hugs..broke my ribs... NOT FUN!!  also there are times when my head snaps backwards to the middle of my spine, these cut off my air supply and I have to uncap the trachea tube. I can't describe the way this feels other than to say I feel like I am going to break in half..

I am unable to have any type of P/T because it causes too many attacks, anything repetitive does.. Dammmm if I do Dammmmm if I don't.

I know this sounds impossible, but my doctors have document these spasticity attacks, I use to panic, but have learned to wait it out rather than go to the ER where they make every thing so much worse.

The spasms in the bladder grabs a hold of the catheter tube and won't release it, or it clamps it off and stops the urine flow.. This really hurts so much... They all cause extreme pain... They have also hit the colon and below... if you get my drift.?!?
These also hit my hands... it is on both the left and right sides now, but more often on the right side.. The left side started a few years ago...

These are what keep me up all night, they are much worse when my body relaxes...
I don't want to scare any one. My Doctors have all told me this is Very Rare in even the PP MS... it's just the luck or I would say the "UN-LUCK of the draw...

I must admit every once in a while when they go nonstop, I wish it could just be over..., But after they calm down I am so grateful to be alive and still living on my own... I just need to get a care giver and soon...

Yes Lulu, I haven't forgotten the info you gavee me. If I don't hear from my IHSS Social Worker by Friday, I will call the Lady you gave me the info about...IHSS is almost impossible to work with IHSS because of all the cuts our Crazy Governator has made, he is hurting everyone who is limited in any way, especially children with special needs... It's just awful in California now...How his wife can stand to be in the same room with this FOOL I don't know..OH-OH I did it again... I am so sorry... I do go off once in awhile don't I...  SO SORRY !!!!!
OK I'll sign off...{{{{{~!~}}}}} DJ
PS: I am so sorry if I up set any one...

[Guitar_grrrl]

Ooooh!  Thanks for the tip!  I'm downloading it now.

Thanks,
Guitar_grrrl

[saveone]

Sho I just checked out the link.  This is a great booklet.  I saved my copy and fully intend to put it to use.

However, I am to brain dead tonight to offer any opinion.  

thanks for the link,
terry

[Quixotic1]

I take it back.  I can't find any data that says which is more common.  It really doesn't matter, tho.  The kind you have is the kind you have.  Also, it can be mixed, like extensor in the lower limbs and flexor above.

Sorry

Q

[Quixotic1]

Hmmm...I have read just the opposite, that exptensor spasticity is far more common, espeically in the lower extremities.  Also, as I watch the people at the MS clinic, they all demonstrate extensor spasticity.  Flexor spasticity makes walking almost impossible.

Foot drop caused by spasticity would be an example of extensor spasticity, pulling the toes down.

I'm going to look this up.  I bleieve that the NMSS says this, but it just isn't what I remember.

Q

[Sarahsmom46]

It sounds like you have a little of both.  Ask your PT what he/she thinks.  Mine was quick to tell me that mine is flexor driven spascicity (sp?), so I work a lot on my core muscles, abdomen, upper legs stretching.  

Thanks for sharing that link.  I probably would have never come across it on my own and it was helpful, very interesting.  

Let's see what other's have to say about this now.

Julie