Musculoskeletal management
Patients with SCIs typically experience muscle spasticity as spinal shock recedes and reflexes return. Spasticity may take a flexor or extensor pattern or a combination.
Spasticity can reduce venous pooling and stabilize the thoracic
and abdominal muscles used in respiration. It’s also associated with chronic pain syndrome, sleep disturbance, fatigue, joint contracture, bone density loss, heterotopic ossification (presence of bone in soft tissue where it normally doesn’t occur), and skin breakdown.
Nonpharmacologic strategies to manage spasticity include range-ofmotion exercises, positioning techniques, weight-bearing exercises, electrical stimulation, and orthoses or splinting to prevent loss of muscle length and contractures. Pharmacologic therapy may include baclofen, benzodiazepines, alpha2-adrenergic agonists, and regional botulism toxin or phenol injection. In severe cases, surgical options (which are irreversible) may be used.