Spasm
Involuntary sustained contraction of a muscle
Extrinsic (CRAMP) - Reflex muscle guarding/contraction
-involuntary mm protective mechanism aka. muscle splinting/guarding
- prolonged contraction is occurring in response to painful stimulus
- generally when insult is removed, spasm goes away
Intrinsic muscle spasm (protective, guarding)
- prolonged contraction related to alteration in circulatory or metabolic functioning of mm itself
- resulting from direct or indirect trauma, emotional tension, post athletic event fatigue, cold, immobilization, inflammation or infection
- can be a perpetuating pain/spasm cycle where it stays even after insult is removed or after relex mm guarding is no longer acute
Self Perpetuating Cycle of intrinsic muscle spasm
- Reflex muscle contraciton
- Resisted mvmt
- circulatory stasis
- Pain
- muscle spasm
- restricted mvmt
Causes of mm spasm (6)
- pain
- circulatory stasis
- increased gamma neuron firing
- chilling of mm
- an impaired nutritional supply
- lack of vitamin d
Palpation for spasm
- mm may be hot due to acute congestion or cool due to ischemia
- mm point tender due to ischemia
- acutely spasmodic = firm, dense & congested
- intrinsic spasm = hard/fibrous
- mm, antagonists & synergists = increased STT
if DVT is present
positive Homan’s Sign
Tx Goals for Spasm
- break pain/spasm cycle and decrease spasm
- do not completely decrease reflex mm guard
- decrease perceived pain
- increase local circulation
- decrease tone/STT
- Tx antagonists/synergists
- increase ROM once spasms decrease
Tx Goals intrinsic vs extrinsic (cramp)
Intrinsic
- remove cause
- address metabolic fxn
- warm tisse
- remove mm balance
Extrinsic
- remove cause
- correct jt dysfunction
- decrease mm guarding
- restore mm balance
Reciprocal inhibition for spasm
- Reciprocal inhibition
- GTO
- O+I
- Muscle approx
- Heat
Hydrotherapy for spasm
Ice - reflex mm guarding in response to acute injury
Heat - intrinsic spasm in chronically tense/ischemic mm (deep moist) or contrast application
Contraindications for Spasm
- do not completely decrease guarding
- do not force a stretch to acutely spasmodic mm
- no heat if acute injury
- local massage to DVT
