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Movement and muscles

Spasticity and stiffness

Muscles that are stiff and resist being moved, sometimes with sudden tightening, which can make movement harder and less comfortable.

The clinical word for this is .

Still being checked

What this is

Stiffness is different from weakness and different from cramp. A stiff muscle resists being moved and stays that way, which affects how you walk, how you are positioned and how comfortable you are. Keeping joints moving is the mainstay, and there are medicines for when stiffness is limiting what you can do.

What people often describe

  • Legs feeling heavy or tight, especially first thing
  • A limb that resists when someone helps you move it
  • Movement feeling jerky or catching rather than smooth
  • Stiffness making transfers, dressing or positioning harder for whoever helps you

Important distinctions

  • A cramp comes on suddenly and releases. Stiffness is a sustained resistance to movement. The same person can have both, and the medicines used are not the same.

  • A contracture is a joint that has become fixed in one position. Stiffness is one of the things that contributes, which is why keeping joints moving is part of what is offered here.

What may help

This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.

Practical and self-management

Things people do themselves, or with whoever is helping them.

  • Positioning

    How you sit and lie changes how stiff you get. Good alignment in sitting or lying can reduce muscle tone, and it helps with pain, contractures and pressure areas at the same time.

    Highlighted: shows the sources for this statement

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Allied health

What a therapist can assess, teach or adjust.

  • Stretching and range-of-motion exercises

    Keeping joints and muscles moving is a common part of physiotherapy. Exercises are usually adapted to the person rather than following one standard programme.

    Highlighted: shows the sources for this statement

    Discuss with

    Compass explains

  • Heat or hydrotherapy

    Warmth before movement, and warm-water exercise where it is available and safe.

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    Compass explains

Medicines

Named here only where a guideline names them for this problem.

A medicine is named here only where a published guideline names it for this problem, and the guideline's own words are shown beside it. Compass does not advise on doses, and does not say which medicine is right for anyone.

  • An antispasmodic medicine

    Medicines that reduce muscle tone. They are considered where stiffness is limiting what you can do and where muscle strength is still relatively unaffected. Reducing tone can also take away support a stiff muscle was providing, so whether they suit you is a clinical judgement about your own strength.

    Highlighted: shows the sources for this statement
    • Which one suits you, and whether any does, is a clinical decision. Part of it is how much your muscle strength is relying on that tone.

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    Compass explains

Equipment

Devices and physical aids.

  • Riser recliner chair

    Cushions, specialist seating, a sleep system or head and neck support, so that good positioning holds without effort.

    Discuss with

    Compass explains

Who may help

Where Compass explains this

Questions

Cards

Other problems

Words explained

About this page

This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.

Evidence for this page

The sources behind the statements on this page, and where to find them. Compass does not decide which option is right for anyone.

  1. Statement 1 of 3. How you sit and lie changes how stiff you get. Good alignment in sitting or lying can reduce muscle tone, and it helps with pain, contractures and pressure areas at the same time.

    • Supports this. Guidelines for the physiotherapy management of MND — Irish Motor Neurone Disease Association · Clinical guideline · 2014

      An MND physiotherapy guideline recommends positioning in good alignment, sitting or lying, and lists reducing spasticity, contractures, pain and pressure sores among what it can help with.

      “Positioning of the patient in a good alignment while sitting or supine can decrease abnormal muscle tone; prevent or reduce spasticity, contractures, and pain; prevent the development of pressure sores; and minimise the effort required for respiration.”

      Key recommendations, 3.4b.1O

      Link checked August 2026

  2. Statement 2 of 3. Keeping joints and muscles moving is a common part of physiotherapy. Exercises are usually adapted to the person rather than following one standard programme.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      A condition on how movement is offered rather than a statement that it eases stiffness: NICE says an exercise programme should be matched to the person, taking postural needs and fatigue into account.

      “Take into account factors such as postural needs and fatigue.”

      1.8.6

      Link checked August 2026

  3. Statement 3 of 3. Medicines that reduce muscle tone. They are considered where stiffness is limiting what you can do and where muscle strength is still relatively unaffected. Reducing tone can also take away support a stiff muscle was providing, so whether they suit you is a clinical judgement about your own strength.

    • Supports this. Guidelines for the physiotherapy management of MND — Irish Motor Neurone Disease Association · Clinical guideline · 2014

      An MND physiotherapy guideline reports a systematic review of spasticity in MND concluding that these medicines should be considered where spasticity limits function, with the caution about strength that goes with it.

      “A systematic review of spasticity in MND concluded that judicious use of antispasmodic agents should be considered where spasticity is limiting function, but where muscle strength remains relatively unimpaired.”

      Section 3.4b.2 Evidence, item K

      Link checked August 2026

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      NICE tells teams to discuss the treatment options available for muscle problems, and to review how a treatment is working.

      “Discuss the available treatment options for muscle problems.”

      1.8.1

      Link checked August 2026