Understanding Spasticity After Stroke: Causes Management and What Really Works
NeuroRehab Team
Thursday, June 26th, 2025
Spasticity affects up to one-third of stroke survivors, turning daily tasks into frustrating battles against stiff, uncontrollable muscles. While it’s one of the most common consequences of a stroke, it’s also one of the most misunderstood — and often mismanaged — parts of recovery.
Let’s break down what spasticity really is, why it happens, what the evidence says about treatment, and how patients and therapists can work together to manage it effectively.
Should You Strengthen Spastic Muscles After Stroke? What the Research Actually Says
NeuroRehab Team
Wednesday, November 23rd, 2022
Great question—and the answer is ABSOLUTELY!
For many clinicians, the idea of strengthening spastic or hyperactive muscles in stroke survivors has long been controversial. The thought of asking a patient to squeeze a spastic hand or flex a tight bicep can make some therapists cringe. Historically, such interventions were discouraged, often based on tradition and outdated clinical beliefs rather than scientific evidence.
Outdated Assumptions About Spasticity and Strength Training
Early in their careers, many therapists were advised not to “trigger abnormal movement patterns” in patients with hemiparesis. Strengthening hyperactive muscles was thought to increase spasticity, reinforce abnormal synergies, and even cause pain. But this guidance was based on anecdote, not data—passed down from one generation of clinicians to the next, without being questioned.
The reality is this: these warnings had no research backing them. They were based on assumptions and fear, not evidence.
What the Evidence Tells Us Now
Fast-forward to today, and a wealth of research supports strength training for individuals with spastic hemiparesis. According to the Evidence-Based Review of Stroke Rehabilitation (EBRSR), 33 randomized controlled trials (RCTs) have evaluated strength training for upper extremity motor recovery. The findings? Strength training is beneficial—and none of the studies concluded that it increased spasticity or pain.
In fact, strengthening programs were associated with improved function, greater independence, and better motor outcomes. As with all therapy, dosage and technique matter, but the research overwhelmingly supports strength training as a safe and effective intervention post-stroke.
From Old-School Theory to Modern Science
The neurorehabilitation landscape has shifted dramatically over the past two decades. We’ve moved away from concepts like:
- Avoiding contact on the palmar surface of a spastic hand
- Overemphasis on tone-reduction modalities
- Avoiding strengthening in fear of “reinforcing” spasticity
And we’ve embraced interventions supported by science, such as:
- Repetitive task-specific training
- Constraint-Induced Movement Therapy (CIMT)
- Functional strength training and resistance exercises
Studies by Patten, Butefisch, Sharp, Teixeira-Salmela, and Wolf have all demonstrated the benefits of these modern strategies. These techniques don’t just improve strength—they promote true neuroplastic change and real-world functional gains.
Spasticity vs. Weakness: A Critical Distinction
One of the most important shifts in perspective has been recognizing that muscle weakness—not spasticity—is often the primary barrier to movement. While spasticity can create resistance, studies show that focusing on reducing tone alone does not lead to improved function. On the other hand, targeting strength deficits often leads to better control, improved coordination, and enhanced use of the affected limb.
Research by Harris, Ada, and Patten supports this modern approach: treat weakness first.
The Future of Neurorehabilitation
Occupational therapy has come a long way. As the profession celebrates more than 100 years of evolution, AOTA’s Centennial Vision continues to ring true: “Occupational therapy is a powerful, science-driven, and evidence-based profession.” And nowhere is that more evident than in the ongoing transformation of stroke rehabilitation practices.
As we adopt smarter technology, more robust clinical trials, and modern protocols, we empower therapists and stroke survivors alike to pursue outcomes that were once thought impossible. The goal is no longer just compensating—it’s recovering.
Final Thoughts
Strengthening spastic muscles after stroke is not only safe—it’s necessary. The evidence is clear, and the tools are available. Let’s continue to challenge outdated ideas, embrace evidence-based care, and give every stroke survivor the opportunity to achieve their fullest potential.
Are You Overstretching Your Spastic Muscles?
Lynette Diaz, COTA/L
Monday, December 23rd, 2019
Stretching can be a very important part of recovery especially following a stroke, when feeling, sensation and movement are returning to a previously flaccid limb. However, is it possible to stretch too much or too hard? Yes it is.
Clinicians frequently see patients handle their affected limbs rather aggressively in an effort to “make it move” or “get it loose”, often stretching their fingers, wrist, elbows and shoulders too far too fast. This may partly be due to lack of sensation or awareness.
Muscle Tone Following Stroke
Dorothee Zuleger, MOT, OTR/L, DRS
Thursday, November 21st, 2019
Following a stroke, abnormal muscle tone is a common complication. A single muscle or a muscle group may become completely paralyzed. This is known as hypotonic or flaccid or a muscle may increase in muscle tone. This is known as hypertonic or spastic. This abnormal tone usually occurs in the side of the body opposite to the side of the brain lesion.
Best Spasticity Treatment Ideas Following Stroke
Dorothee Zuleger, MOT, OTR/L, DRS
Tuesday, July 3rd, 2018
Spasticity is a condition in which a muscle or group of muscles is hyperactive and unable to turn off and relax. After an injury to the brain or nervous system signals to and from a muscle are not regulated as they should be and therefore create abnormal muscle tone. This constant state of contraction can cause, pain, stiffness and shortening of soft tissue limiting normal range of the joint. The degree of spasticity can range from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms.
