Spasticity can make movement harder—but effective rehabilitation is about more than simply “loosening tight muscles.”

For people living with spinal cord injury, stroke, traumatic brain injury, cerebral palsy, multiple sclerosis, transverse myelitis, and other neurological conditions, spasticity can affect walking, transfers, balance, reaching, dressing, hygiene, sleep, comfort, and independence.

At Back to Independence Rehab (BTI Rehab) in Charlotte, NC, our approach is to look beyond muscle tone and ask a more important question:

What is the spasticity preventing you from doing?

The goal of neurorehabilitation is not necessarily to eliminate every bit of increased muscle tone. In some individuals, tone can actually provide useful support for standing or transfers. Instead, treatment should be individualized around function, safety, mobility, comfort, range of motion, participation, and quality of life.

Current evidence supports a multimodal, goal-directed approach that may combine active exercise, task-specific practice, positioning, stretching or range-of-motion work, electrical stimulation, orthotics, and—when appropriate—medical management such as botulinum toxin.

What Is Spasticity?

Spasticity is a form of abnormal muscle activity associated with upper motor neuron disorders. It can cause muscles to become more resistant to movement, particularly when a limb is moved quickly.

But spasticity is not simply “tight muscles.”

A person may have a combination of:

• Increased muscle tone
• Muscle weakness
• Abnormal reflex activity
• Reduced motor control
• Limited joint range of motion
• Muscle shortening
• Contracture
• Abnormal movement patterns
• Pain
• Fatigue
• Difficulty coordinating movement

This is why treating spasticity effectively requires more than simply stretching the affected muscle.

For example, a person with a stroke may have increased tone in the elbow and wrist flexors. Simply stretching those muscles may temporarily improve the position of the arm, but the larger rehabilitation question is:

Can the person use that arm more effectively during dressing, reaching, weight-bearing, or other meaningful activities?

That functional goal should drive the treatment plan.

Who Can Develop Spasticity?

Spasticity is commonly associated with neurological conditions affecting the brain or spinal cord.

At BTI Rehab, we frequently work with individuals with:

• Spinal cord injury
• Stroke
• Traumatic brain injury
• Cerebral palsy
• Multiple sclerosis
• Transverse myelitis
• Other acquired brain injuries
• Neuromuscular and neurological disorders
• 
  

Spasticity can develop or change over time. It may become more noticeable with illness, infection, pain, constipation, bladder problems, poor sleep, stress, changes in medication, or changes in activity.

That means a sudden increase in tone should not automatically be treated by simply doing more stretching.

The first step is determining why the person's tone has changed.

The Best Treatment for Spasticity Is Individualized

There is no single “best” spasticity exercise.

The most effective rehabilitation program depends on:

1. The neurological diagnosis
2. Location and severity of spasticity
3. Strength and motor control
4. Joint range of motion
5. Functional goals
6. Walking or wheelchair needs
7. Pain and comfort
8. Skin integrity
9. Presence of contracture
10. Medication and medical interventions
11. The person's activity level and environment

This is particularly important because reducing tone is not always the same thing as improving function.

A successful outcome might be:

“I can put my arm through my shirt.”

rather than:

“My Modified Ashworth Scale score decreased.”

Clinical measurements are important, but they should support functional goals—not replace them.

1. Task-Specific Training: Practice the Movement You Want to Improve

One of the most important principles in modern neurorehabilitation is task-specific practice.

If the goal is walking, rehabilitation should include walking.

If the goal is standing from a chair, practice sit-to-stand.

If the goal is improving reaching, practice meaningful reaching.

If the goal is improving transfers, practice transfers.

The brain and nervous system respond to repeated, purposeful practice.

The 2024 VA/DoD stroke rehabilitation guideline synopsis identifies task-specific practice among the areas where evidence is strongest for motor rehabilitation.

This principle is particularly important for people with spasticity because abnormal tone can interfere with efficient movement. Rather than avoiding movement because a muscle is “tight,” rehabilitation can use carefully selected movements to encourage more effective motor strategies.

At BTI Rehab, this may include:

• Gait training
• Overground walking
• Treadmill training
• Sit-to-stand practice
• Transfer training
• Reaching and grasping
• Weight shifting
• Stair training
• Wheelchair skills
• Balance activities
• Functional strengthening
• Repetitive practice of meaningful daily activities

The objective is better movement that carries over into real life.

2. Strength Training Is Not the Enemy of Spasticity

One of the most persistent misconceptions in neurorehabilitation is that people with spasticity should avoid strengthening.

For many individuals with neurological conditions, appropriately prescribed strengthening can be an important part of rehabilitation.

Weakness often contributes significantly to disability, even when spasticity is present.

A person may have a very “tight” leg but still lack enough functional strength to:

• Stand from a chair
• Control the knee during walking
• Clear the foot
• Maintain upright posture
• Transfer safely
• Propel a wheelchair
• Perform household activities

Strength training should therefore be individualized around the person's neurological status, fatigue, range of motion, and functional goals.

For people with MS, research supports individualized aerobic, resistance, flexibility, balance, and multimodal exercise as components of rehabilitation.

A 2026 systematic review also found that multiple forms of physical exercise were associated with reductions in spasticity in ambulatory individuals with MS, although the researchers noted substantial variation between exercise protocols and limitations in how spasticity was measured.

The takeaway: Strengthening should not automatically be avoided because someone has spasticity.

3. Stretching and Range-of-Motion Work: Useful, but Not the Whole Treatment

Stretching has traditionally been one of the first treatments recommended for spasticity.

It can be useful for:

• Maintaining available range of motion
• Positioning
• Comfort
• Preventing loss of mobility
• Preparing a limb for functional activity
• Supporting positioning after other interventions
• 
  

However, newer research reminds us that stretching should not be viewed as a stand-alone cure for spasticity.

A randomized controlled trial involving 231 people with MS found that education plus stretching and education plus range-of-motion exercises produced similar improvements in perceived spasticity.

That is an important distinction.

More stretching is not necessarily better rehabilitation.

Stretching should be selected based on the person's goals and combined with active movement and functional practice whenever possible.

For some individuals, prolonged positioning, orthotic management, casting, or other strategies may be more appropriate than repeated brief manual stretching.

4. Electrical Stimulation and NMES

Electrical stimulation can be another tool within a comprehensive neurorehabilitation program.

Depending on the individual, neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES) may be used to:

• Activate weak muscles
• Support functional movement
• Assist dorsiflexion during walking
• Encourage repetitive motor practice
• Support upper-extremity function
• Complement strengthening or task-specific training
• 
  

The 2024 VA/DoD stroke rehabilitation guideline identifies electrical stimulation as an evidence-supported intervention in selected stroke rehabilitation contexts.

For spinal cord injury, clinical practice guidelines also recognize functional electrical stimulation as an option for improving hand and upper-extremity function in selected people with cervical SCI.

Electrical stimulation should be prescribed based on the person's neurological presentation and functional objective rather than simply applying stimulation to a “tight” muscle.

5. What About TSS and Other Neuromodulation?

Emerging neuromodulation approaches—including transcutaneous spinal stimulation—are receiving increasing attention in neurorehabilitation.

At BTI Rehab, technologies such as transcutaneous spinal stimulation may be incorporated into a broader rehabilitation program when clinically appropriate.

The important point is that neuromodulation should support active rehabilitation rather than replace it.

The goal is not simply to produce a physiological response during a treatment session.

The goal is to use that window of opportunity to work on meaningful movement, strength, motor control, balance, gait, or functional activity.

As research continues to evolve, clinicians should be careful not to overstate the evidence for any individual stimulation technology or protocol. Neuromodulation is best viewed as one component of a larger, individualized rehabilitation strategy.

6. Botulinum Toxin Can Be Helpful for Focal Spasticity

For some individuals, rehabilitation alone is not enough.

Botulinum toxin type A (BoNT-A) is commonly used for focal spasticity, particularly when specific muscles are interfering with function, positioning, hygiene, mobility, or comfort.

But an injection should not be considered the entire treatment.

The strongest approach is often:

Identify the functional problem → identify target muscles → treat focal spasticity → use the resulting movement opportunity for rehabilitation.

Research supports combining botulinum toxin with rehabilitation rather than relying on injections alone. A systematic review found that combined therapy may provide additional benefit compared with botulinum toxin alone, although the studies varied considerably in their interventions and outcomes.

Expert consensus similarly emphasizes integrating rehabilitation with botulinum toxin treatment and using adjunctive therapies based on the individual's goals.

In other words: Botox can create an opportunity. Rehabilitation helps the person use it.

7. Orthotics, Splinting, Positioning and Casting

When spasticity contributes to abnormal positioning or loss of range, clinicians may consider:

• Ankle-foot orthoses
• Hand splints
• Resting splints
• Serial casting
• Taping
• Positioning programs
• Seating modifications

These interventions should be selected according to the person's functional goals and tolerance.

Research examining adjunctive treatments after botulinum toxin has found evidence supporting some forms of sustained positioning, casting, and orthotic management, while the evidence for simple low-dose manual stretching is less compelling.

This reinforces a larger principle: Spasticity management should be individualized rather than based on a one-size-fits-all stretching program.

8. Treat the Whole Person—Not Just the Muscle

One of the most important parts of spasticity management is identifying factors that may be increasing tone.

A sudden increase in spasticity may be associated with:

• Urinary problems
• Infection
• Constipation
• Pain
• Skin irritation
• Pressure injuries
• Poor positioning
• Illness
• Fatigue
• Stress
• Sleep disruption
• Medication changes

For someone with spinal cord injury, for example, a sudden change in tone may be an important clinical signal rather than simply a reason to stretch more.

This is why communication between the rehabilitation team, physician, therapist, caregiver, and patient is so important.

9. Spasticity After Stroke: Early Intervention Matters

Spasticity can become a significant secondary complication after stroke.

A 2026 American Heart Association scientific statement emphasizes early recognition and intervention for post-stroke spasticity because it can affect mobility, independence, pain, range of motion, skin integrity, and caregiver burden.

Modern stroke rehabilitation increasingly emphasizes:

• Early identification
• Functional assessment
• Task-specific practice
• Active movement
• Strength and motor control
• Positioning
• Appropriate orthotic management
• Electrical stimulation when indicated
• Botulinum toxin for appropriate focal patterns
• Ongoing reassessment

The goal is not simply to make the limb “less tight.”

The goal is to help the person use the limb more effectively.

10. Spasticity and Cerebral Palsy: Function Over Tone

People with cerebral palsy may live with spasticity throughout childhood and adulthood.

Importantly, adults with CP often have different rehabilitation needs than children.

Long-term management may focus on:

• Maintaining mobility
• Strength
• Walking efficiency
• Energy conservation
• Pain management
• Joint protection
• Orthotic management
• Preventing secondary musculoskeletal problems
• Maintaining independence

Evidence-based motor rehabilitation guidelines for people with cerebral palsy support physical activity and gait training, with strengthening also recommended as an important intervention for adults with CP.

For adults with CP, rehabilitation should not stop simply because someone has reached adulthood.

The goal is lifelong movement and participation.

11. Spasticity and Multiple Sclerosis: Don't Stop Moving

MS can create a particularly challenging combination of:

• Spasticity
• Weakness
• Fatigue
• Balance problems
• Reduced endurance
• Heat sensitivity
• Changes in motor control

Exercise programs therefore need to be carefully dosed.

Current research supports individualized exercise rather than avoidance of physical activity.

A 2026 systematic review found that physical exercise—including flexibility, aerobic, resistance, neuromotor, and multicomponent programs—was associated with reductions in spasticity in ambulatory people with MS, although the authors noted that the evidence remains heterogeneous.

For someone with MS, the right question isn't:

“Should I exercise because I have spasticity?”

It is:

“How should exercise be dosed and modified for my neurological symptoms?”

What Does an Evidence-Based Spasticity Program Look Like?

A comprehensive neurorehabilitation program may combine several components:

Assess

Determine the person's movement limitations, tone, strength, ROM, pain, functional limitations, and goals.

Identify the Problem

Determine whether increased tone is actually limiting function—or whether weakness, motor control, contracture, or another issue is the bigger problem.

Prepare

Use positioning, range-of-motion work, stretching, electrical stimulation, or other preparatory strategies when appropriate.

Activate

Encourage active muscle recruitment and voluntary movement.

Strengthen

Build the strength necessary for functional movement.

Practice

Use repetitive, task-specific practice.

Integrate

Practice the skills needed in real life: walking, transfers, reaching, dressing, wheelchair mobility, stairs, or other meaningful activities.

Reassess

Measure whether the intervention is actually improving function.

This approach reflects the larger shift in neurorehabilitation from treating an impairment in isolation to improving function and participation.

Why “Reducing Spasticity” Isn't Always the Goal

This is one of the most important concepts for patients and families to understand.

Spasticity is not always bad.

For some people, increased tone may help them:

• Stand
• Transfer
• Maintain posture
• Support a limb

If you eliminate all tone without considering function, you could potentially make some activities more difficult.

Therefore, the goal may be:

Manage the spasticity—not necessarily eliminate it.

The best treatment is the amount of tone that allows the person to function as safely, comfortably, and independently as possible.

When Should You Seek a Spasticity Evaluation?

Consider a comprehensive neurorehabilitation evaluation if you notice:

• Increasing muscle tightness
• New difficulty walking
• Changes in transfers
• Increasing difficulty dressing
• Loss of hand function
• Reduced range of motion
• Pain associated with muscle tone
• Difficulty with hygiene or positioning
• New problems with wheelchair positioning
• Increasing falls
• Difficulty sleeping because of spasms
• A sudden unexplained increase in spasticity

A sudden change in spasticity—especially after spinal cord injury—should also prompt consideration of underlying medical triggers.

A Better Way to Think About Spasticity

Instead of asking:

“How do I get rid of my spasticity?”

Ask:

“What is my spasticity preventing me from doing?”

That question changes the rehabilitation plan.

Maybe the answer is:

• Walking farther
• Getting out of bed
• Putting on a shirt
• Opening the hand
• Standing independently
• Transferring into a car
• Getting on and off the floor
• Exercising without pain
• Using a wheelchair more efficiently
• Participating in family or community activities

Those are the outcomes that matter.

Neurorehabilitation for Spasticity in Charlotte, NC

At Back to Independence Rehab (BTI Rehab) in Charlotte, our neurorehabilitation approach is designed for people living with neurological conditions who want to continue working toward greater strength, mobility, independence, and participation.

Our community includes individuals living with:

Spinal cord injury • Stroke • Brain injury • Cerebral palsy • Multiple sclerosis • Transverse myelitis • Parkinson's disease • Neuromuscular disorders and other neurological conditions

Depending on the individual's needs, rehabilitation may incorporate:

• Neuro fitness
• Functional strengthening
• Gait training
• Treadmill training
• Balance training
• Task-specific practice
• Electrical stimulation
• FES
• Transcutaneous spinal stimulation
• Range-of-motion and positioning strategies
• Splinting and orthotic considerations
• Aquatic therapy
• Adaptive exercise
• Functional mobility training

The goal is simple:

Don't just manage the muscle. Train the person.

If spasticity is interfering with your movement, independence, comfort, or quality of life, a comprehensive neurorehabilitation evaluation can help determine what is actually limiting your function—and develop a plan around your goals.

Ready to Take the Next Step?

You don’t have to navigate spasticity alone. Whether you’re living with a spinal cord injury, stroke, brain injury, cerebral palsy, MS, or another neurological condition, our team can help you explore options to improve movement, strength, function, and independence.

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Frequently Asked Questions About Spasticity

Can exercise make spasticity worse?

Not necessarily. Appropriately dosed exercise is an important component of rehabilitation for many people with neurological conditions. Exercise should be individualized based on diagnosis, fatigue, strength, cardiovascular status, range of motion, and functional goals. Research in MS, for example, suggests that several types of exercise can be associated with improvements in spasticity.

Should I stretch every day if I have spasticity?

Stretching may be helpful for some people, but evidence does not support assuming that more stretching automatically produces better outcomes. Stretching and ROM should be incorporated into a broader program based on the individual's goals.

Is Botox a cure for spasticity?

No. Botulinum toxin can reduce focal muscle overactivity, but the most effective approach often combines medical treatment with rehabilitation designed around the person's functional goals.

Can electrical stimulation help spasticity?

Electrical stimulation can be useful in selected neurological rehabilitation programs, particularly when the goal is to facilitate muscle activation or functional movement. Evidence supports its use in selected stroke and spinal cord injury rehabilitation contexts.

Can people with chronic spinal cord injury improve?

Yes. Rehabilitation goals change over time, but chronic neurological injury does not automatically mean that meaningful functional improvements are impossible. Training can target strength, endurance, motor control, mobility, transfers, wheelchair skills, and participation according to the individual's abilities and goals.

Selected Evidence & Scholarly Sources

• American Heart Association. Early Recognition and Intervention for Poststroke Spasticity: A Scientific Statement. Stroke, 2026.
• VA/DoD Clinical Practice Guideline. Stroke Rehabilitation: Synopsis of the 2024 VA/DoD Clinical Practice Guidelines. Annals of Internal Medicine, 2025.
• González-Mingorance L, et al. Effects of physical exercise on spasticity in people with multiple sclerosis: A systematic review. Physiotherapy, 2026.
• Hugos CL, et al. Stretching is not essential for managing MS spasticity: A randomized controlled trial. Multiple Sclerosis Journal, 2024.
• Francisco GE, et al. A practical guide to optimizing the benefits of post-stroke spasticity interventions with botulinum toxin A. Journal of Rehabilitation Medicine, 2021.
• Allart E, et al. Adjunct therapies after botulinum toxin injections in spastic adults: Systematic review and SOFMER recommendations. Annals of Physical and Rehabilitation Medicine, 2022.
• Glinsky JV, et al. Safety and efficacy of intensive task-specific training in people with recent spinal cord injury. Lancet Neurology, 2026.
• Verschuren O, et al. Evidence-Based, Implementable Motor Rehabilitation Guidelines for Individuals With Cerebral Palsy.
• Mehraban Jahromi M, et al. Stretching exercises in managing spasticity: effectiveness, risks, and adjunct therapies. 2024.