What is spasticity after a spinal cord injury?

Spasticity is involuntary muscle stiffening, spasms, jerking and increased tone below the injury, caused by the injury disrupting the nerve signalling that lets the brain regulate reflexes. It is very common and ranges from mild stiffness to strong spasms. It can be a problem but is sometimes useful for standing, transfers or maintaining muscle bulk.

How are spasticity and pain managed after a spinal cord injury?

Both are usually managed with a combination of approaches rather than a single fix – stretching, positioning, physiotherapy, activity modification, good seating, conditioning, and self-management techniques, plus medicines or injections a specialist may consider. Neuropathic (nerve) pain can be stubborn, so a realistic goal is often to reduce and cope with it.

Why does a sudden increase in spasticity or pain need checking?

Because reduced sensation means these changes can be the body’s only signal of an underlying problem below the injury you cannot feel – such as a urinary infection, pressure injury, constipation, an ingrown toenail or a fracture. A sudden change can also be linked to autonomic dysreflexia, a medical emergency. Always get a sudden change assessed.

Why do wheelchair users often get shoulder pain?

The shoulders take on heavy work they were not designed for – propulsion, transfers and pressure reliefs – so overuse pain is common and accumulates over time. Protect the shoulders early with good technique, conditioning, lightweight well-set-up equipment, and side-to-side or forward-lean pressure reliefs. Address persistent shoulder pain early rather than pushing through.

Spasticity and Pain After Spinal Cord Injury (Singapore)

Written & reviewed by the BestDoctors.sg editorial team · Last updated 29 Aug 2026 · General information, not medical advice

Quick answer. Spasticity – involuntary muscle stiffness, spasms and increased tone below the injury – is very common after a spinal cord injury, and can be both a problem and, at times, useful. Pain is also common, and comes in two main forms: nerve (neuropathic) pain, often burning or electric, and musculoskeletal pain, such as shoulder pain from wheelchair use. Both are managed with a combination of approaches rather than a single fix. Importantly, a sudden increase in spasticity or new pain can be a warning sign of an underlying problem – such as a urinary infection, pressure injury or trigger for autonomic dysreflexia – so it should be checked, not just treated.

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In a medical emergency, or for severe or sudden symptoms such as breathing difficulty, chest pain, fainting or stroke signs, call 995 immediately.

What spasticity is

Spasticity is involuntary muscle stiffening or tightening, spasms, jerking, exaggerated reflexes and increased muscle tone below the level of injury. It happens because the injury disrupts the nerve signalling that normally lets the brain regulate reflex muscle responses, so the reflexes below the injury become over-active. Some clinicians use the broader term “tone.” Spasticity is very common after a spinal cord injury, and it varies from mild stiffness to strong, uncomfortable spasms. Understanding it as a predictable consequence of the injury, rather than something going newly wrong, helps you and your team manage it steadily over time.

A problem, but sometimes useful

Spasticity has two sides. On the downside, it can interfere with movement, sleep, comfort, positioning and transfers, and can cause pain or, over time, contractures – permanent tightening – if not managed. On the other hand, some people learn to use predictable spasms or tone to help with standing, transfers or emptying the bladder, and a degree of tone can help maintain muscle bulk and circulation. A change in spasticity can also act as an early warning sign of another problem. This is why the goal is usually to manage spasticity to a helpful level rather than to abolish it entirely, guided by what works for your daily life.

Managing spasticity

Spasticity is usually managed with a combination of approaches, reviewed over time. Regular stretching and range-of-movement exercises, good positioning and seating, weight-bearing or standing programmes, splinting, physiotherapy and electrical stimulation all play a part. Where these are not enough, a doctor may consider further options, including oral medicines, targeted injections, or, in severe cases, an implanted pump – all specialist-directed and described here only in general terms. Effective management typically blends several of these, tailored to you. Keeping up daily stretches and positioning between appointments is one of the most useful things you can do to keep spasticity under control.

Nerve pain and musculoskeletal pain

Pain after a spinal cord injury broadly falls into two types. Neuropathic, or nerve, pain comes from an over-excitable spinal cord or nerve roots sending pain signals without an external cause; it is often described as burning, stabbing, electric, tingling or numb, can occur at or below the level of injury, and frequently does not respond to a single treatment. Musculoskeletal pain comes from muscles, joints and bones, including overuse injuries – especially the shoulders, from wheelchair propulsion, transfers and pressure reliefs – as well as neck and back pain and spasm-related pain; it is typically worse with movement and better with rest.

Managing pain

As with spasticity, pain is usually best managed with a combined approach rather than expecting a single fix. Physiotherapy, modifying activities that aggravate pain, exercise and conditioning, weight management, good wheelchair seating and set-up, and psychological and self-management techniques such as relaxation, mindfulness and pacing all help, alongside medicines a specialist may consider. Neuropathic pain in particular can be stubborn, and a realistic goal is often to reduce it and cope better rather than to eliminate it. Working with your team to find the combination that helps you, and sticking with it, tends to work better than searching for one perfect remedy.

Protecting your shoulders

Shoulder pain from overuse is very common in wheelchair users, because the shoulders take on work they were not designed for, through propulsion, transfers and pressure reliefs. Because this damage accumulates over time, it is far better to protect the shoulders early than to treat problems once they are established. Good propulsion technique, conditioning of the shoulder-stabilising muscles, well-set-up and lightweight equipment, and using side-to-side or forward-lean pressure reliefs rather than repeated push-ups all help. If you notice persistent shoulder pain, address it early with your physiotherapist rather than pushing through, to keep your shoulders healthy for the long term.

When a change is a warning sign

One of the most important safety messages is that a sudden increase in spasticity, new spasms, or new or worsening pain should be checked, not simply treated as a spasm. Because sensation is reduced, these changes can be the body’s only signal of an underlying problem below the injury that you cannot feel – such as a urinary infection, a pressure injury, constipation, an ingrown toenail, a fracture or, in women, issues related to menstruation. A sudden change can also be linked to autonomic dysreflexia, a medical emergency covered in its own guide. Rarely, an unexplained change with new weakness needs specialist review. Always get a sudden change assessed.

Sources

MSKTC – Spasticity and spinal cord injury: msktc.org
MSKTC – Pain after spinal cord injury: msktc.org
Christopher & Dana Reeve Foundation – Spasticity: christopherreeve.org
Spinal Injuries Association – Knowledge Hub: spinal.co.uk

General information only. This guide supports, but does not replace, advice from your own doctor and spinal injury care team. Learn to recognise autonomic dysreflexia if your injury is at the upper level (around the mid-back and above): a sudden pounding headache, sweating or flushing above the injury, a blocked nose or a slow pulse can mean a dangerous rise in blood pressure. Sit upright straight away, loosen anything tight, and look for and remove the cause – most often a full bladder (check the catheter for kinks) or a full bowel. Call 995 if it does not settle quickly, as it is a medical emergency. Check your skin every day and act on any red or broken area. If you are struggling emotionally, you are not alone: the Samaritans of Singapore (SOS) are on 1767 and mindline.sg on 1771.

Spasticity & Pain After Spinal Cord Injury