A feeling of stiffness often is symptomatic of spastic-ity, although it may occur for other reasons. If you have cramps in your calves, especially at night, the problem is probably spasticity, for which there are a number of different therapies. If, however, a feeling of stiffness is due to impaired sensation in the legs, these treatments will not help.
Runners and other athletes use stretching of muscles to relieve muscle cramps. Not surprisingly, the first proven approach to the treatment of spasticity con sisted of stretching the affected muscles. In the last 3 decades, several drugs have been proven to be helpful, including Valium (diazepam), Lioresal (baclofen), and Zanaflex (tizanidine). A single 5-mg dose of Valium at night is often sufficient for milder forms of spasticity. It has the advantage of being very long acting, and thus, if the spasticity is not severe, a single dose at nighttime may be sufficient for the entire day.
Baclofen (Lioresal) can be effective, but many patients do not get an effect that is proportional to the dose (that is, they have a poor dose response). Actually, Val-ium and baclofen have the same biochemical effect that reduces spasticity. Usually there is no need to give additional daytime doses of Valium. If 5- to 10-mg doses of Valium cause excessive daytime sedation or if these doses are insufficient to control stiffness or muscle cramps, the use of baclofen or tizanidine may be necessary. Tizanidine (Zanaflex) is a newer drug that has the advantage of not trading spasticity for weakness. However, it may produce drowsiness and intolerable dryness of the mouth. Baclofen and tizanidine can be used together for additional benefit. Tizanidine is not usually prescribed with Valium because of excessive sedation. Another drug, dantrolene hydrochloride (Dantrium), is used infrequently because of its potential liver toxicity. Although they are commonly used, all of these drugs should be prescribed and monitored by a neurologist who can assess their effectiveness.
Spasticity for me has ranged from slight stiffness to extreme stiffness that makes me look like a mechanical doll. In between the extremes is tightness. IfI get into the wrong position, I require another person to "untangle meSometimes there is a lot of pain, and other times it is painless.
My first experience with Baclofen left me so weak from one pill that I could barely sit up or function for 3 days; thus, I have not retried it. When I took Tegretol, I threw up from each dose and felt very unlike myself-—almost altered and distanced from my own being. So I have not retried it either. When I took Neurontin, I immediately threw up despite the minor dose.
During a severe episode of spasticity, we were reluctant to try medication. I spent 3 days stiff and in extreme pain. In desperation, my husband carried me into the swimming pool that we are fortunate enough to have in our back yard. My muscles relaxed, and I fell asleep in his arms. My husband is very intelligent; however, he had not thought through what to do in this circumstance: 2 AM, holding a sleeping wife in a pool with no phone or book nearby. He lasted 3 hours and woke me with both of us resembling prunes! For the next few days, when I would start to stiffen up, I would get into the pool, and it would pass. After several nights of splashing, moans, and groans coming from our side of the fence, our neighbors finally got up the nerve to ask us what exactly we were doing in the middle ofthe night!
For more "normal" spasticity, I stretch at yoga class and ballet class. In addition, I have others stretch me: professionals help two times a week, and my family is now trained at leaning, kneading, and pushing the various parts of me that need it. I am not always able to do the yoga or ballet, and sometimes, the most that I can manage is getting into a leotard (not an easy feat at my age in any event) and getting to class. Yet the training and muscle memory and the feeling of doing things for my body that are not strictly therapeutic or medicinal are very empowering. It stretches me to places I thought I would never go.
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