{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:50:53Z","timestamp":1791273053415,"version":"4.1.0"},"reference-count":40,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["DTB"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>The management options for spasticity include non-pharmacological approaches, oral antispasticity drugs, botulinum injections, intrathecal baclofen, neuromodulation techniques and surgery. Effective management necessitates a tailored approach grounded in a comprehensive understanding of pathophysiological mechanisms, disease progression and functional outcomes. Spasticity does not always require treatment. The management should be oriented towards goals which are meaningful for individual patients. This process requires a multidisciplinary team with treatment modalities to reduce spasticity categorised into physical methods, pharmacotherapy, interventional and focal therapies as well as surgical methods<\/jats:p>","DOI":"10.1136\/dtb.2026.000018","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T17:20:26Z","timestamp":1781284826000},"page":"154-159","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Update on spasticity: part-2 \u2013 physical, pharmacological and surgical management"],"prefix":"10.1136","volume":"64","author":[{"given":"Ikechukwu","family":"Chukwuocha","sequence":"first","affiliation":[{"name":"Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4004-2315","authenticated-orcid":false,"given":"Krishnan Padmakumari Sivaraman","family":"Nair","sequence":"additional","affiliation":[{"name":"Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"2026100523551535000_64.10.154.1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g4737","article-title":"The management of spasticity in adults","volume":"349","author":"Nair","year":"2014","journal-title":"BMJ"},{"key":"2026100523551535000_64.10.154.2","unstructured":"Royal College of Physicians, British Society of Rehabilitation Medicine, The Chartered Society of Physiotherapy, Association of Chartered Physiotherapists in Neurology and the Royal College of Occupational Therapists . Spasticity in adults: management using botulinum toxin. National guidelines. London: RCP, 201835."},{"key":"2026100523551535000_64.10.154.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.rehab.2017.10.001"},{"key":"2026100523551535000_64.10.154.4","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2020.00126","article-title":"Management of Spasticity After Traumatic Brain Injury in Children","volume":"11","author":"Enslin","year":"2020","journal-title":"Front Neurol"},{"key":"2026100523551535000_64.10.154.5","unstructured":"Owens J , Davis DD . Seating and wheelchair evaluation. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2025."},{"key":"2026100523551535000_64.10.154.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-015-0813-x","article-title":"Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions","volume":"16","author":"Paleg","year":"2015","journal-title":"BMC Musculoskelet Disord"},{"key":"2026100523551535000_64.10.154.7","doi-asserted-by":"crossref","first-page":"134479","DOI":"10.1016\/j.neulet.2019.134479","article-title":"Influence of positional changes on spasticity of the upper extremity in poststroke hemiplegic patients","volume":"712","author":"Qin","year":"2019","journal-title":"Neurosci Lett"},{"key":"2026100523551535000_64.10.154.8","doi-asserted-by":"crossref","DOI":"10.3389\/fresc.2023.1169087","article-title":"Emerging theory of sensitization in post-stroke muscle spasticity","volume":"4","author":"Suputtitada","year":"2023","journal-title":"Front Rehabil Sci"},{"key":"2026100523551535000_64.10.154.9","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20100265"},{"key":"2026100523551535000_64.10.154.10","unstructured":"Bielecki JE , Tadi P . Therapeutic exercise. In: StatPearls. StatPearls Publishing, 2025."},{"key":"2026100523551535000_64.10.154.11","article-title":"Stretching exercises in managing spasticity: effectiveness, risks, and adjunct therapies","volume":"34","author":"Mehraban Jahromi","year":"2024","journal-title":"Eur J Transl Myol"},{"key":"2026100523551535000_64.10.154.12","first-page":"423","article-title":"Rehabilitation procedures in the management of spasticity","volume":"46","author":"Smania","year":"2010","journal-title":"Eur J Phys Rehabil Med"},{"key":"2026100523551535000_64.10.154.13","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.593673"},{"key":"2026100523551535000_64.10.154.14","doi-asserted-by":"crossref","DOI":"10.3390\/brainsci11010015","article-title":"Effectiveness of Shock Wave Therapy as a Treatment for Spasticity: A Systematic Review","volume":"11","author":"Mart\u00ednez","year":"2020","journal-title":"Brain Sci"},{"key":"2026100523551535000_64.10.154.15","unstructured":"Spasticity in under 19s: management. NICE. Available: https:\/\/www.nice.org.uk\/guidance\/cg145\/chapter\/Recommendations [Accessed 2 Aug 2025]."},{"key":"2026100523551535000_64.10.154.16","unstructured":"Human Metabolome Database: Showing metabocard for Baclofen (HMDB0014327). Available: https:\/\/www.hmdb.ca\/metabolites\/HMDB0014327 [Accessed 2 Aug 2025]."},{"key":"2026100523551535000_64.10.154.17","unstructured":"Ghanavatian S , Derian A . Baclofen. In: StatPearls. StatPearls Publishing, 2025."},{"key":"2026100523551535000_64.10.154.18","unstructured":"Tizanidine. Available: https:\/\/go.drugbank.com\/drugs\/DB00697 [Accessed 2 Aug 2025]."},{"key":"2026100523551535000_64.10.154.19","unstructured":"Dantrolene. Available: https:\/\/go.drugbank.com\/drugs\/DB01219 [Accessed 2 Aug 2025]."},{"key":"2026100523551535000_64.10.154.20","unstructured":"Diazepam. Available: https:\/\/go.drugbank.com\/drugs\/DB00829 [Accessed 2 Aug 2025]."},{"key":"2026100523551535000_64.10.154.21","doi-asserted-by":"crossref","unstructured":"Cimino V , Grazia Chisari C , Patti F . Spasticity and dystonia: a brief review. In: Neurostimulation and neuromodulation in contemporary therapeutic practice. IntechOpen, 2020.","DOI":"10.5772\/intechopen.91780"},{"key":"2026100523551535000_64.10.154.22","doi-asserted-by":"publisher","DOI":"10.1191\/1352458504ms1048oa"},{"key":"2026100523551535000_64.10.154.23","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2005.070136"},{"key":"2026100523551535000_64.10.154.24","unstructured":"Cannabis based medicinal products (NG144). NICE; 2021."},{"key":"2026100523551535000_64.10.154.25","unstructured":"Rivelis Y , Zafar N , Morice K . Spasticity. In: StatPearls. StatPearls Publishing, 2025."},{"key":"2026100523551535000_64.10.154.26","unstructured":"Botulinum toxin type A, Available: https:\/\/go.drugbank.com\/drugs\/DB00083 [Accessed 2 Aug 2025]."},{"key":"2026100523551535000_64.10.154.27","first-page":"73","article-title":"Botulinum toxin: description of injection techniques and examination of controversies surrounding toxin diffusion","volume":"117","author":"Lim","year":"2008","journal-title":"Acta Neurol Scand"},{"key":"2026100523551535000_64.10.154.28","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.toxicon.2018.01.019","article-title":"Evidence on botulinum toxin in selected disorders","volume":"147","author":"Zakin","year":"2018","journal-title":"Toxicon"},{"key":"2026100523551535000_64.10.154.29","first-page":"401","article-title":"Managing spasticity with drugs","volume":"46","author":"Simon","year":"2010","journal-title":"Eur J Phys Rehabil Med"},{"key":"2026100523551535000_64.10.154.30","unstructured":"D\u2019Souza RS , Warner NS . Phenol nerve block. In: StatPearls. StatPearls Publishing, 2025."},{"key":"2026100523551535000_64.10.154.31","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.1002\/(SICI)1097-4598(1997)6+<61::AID-MUS6>3.0.CO;2-H","article-title":"Traditional pharmacological treatments for spasticity. Part I: Local treatments","volume":"6","author":"Gracies","year":"1997","journal-title":"Muscle Nerve Suppl"},{"key":"2026100523551535000_64.10.154.32","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1016\/j.pmrj.2009.07.016","article-title":"Surgical management of spasticity in persons with cerebral palsy","volume":"1","author":"Lynn","year":"2009","journal-title":"PM R"},{"key":"2026100523551535000_64.10.154.33","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1227\/ons.0000000000001011","article-title":"Modified Selective Dorsal Rhizotomy Exposure Method for Adults With Spastic Paralysis of the Lower Limbs","volume":"26","author":"Pu","year":"2024","journal-title":"Oper Neurosurg (Hagerstown)"},{"key":"2026100523551535000_64.10.154.34","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1007\/s00381-023-06247-x","article-title":"Selective dorsal rhizotomy: Analysis of two rootlet sectioning techniques","volume":"40","author":"Mantese","year":"2024","journal-title":"Childs Nerv Syst"},{"key":"2026100523551535000_64.10.154.35","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1007\/s00701-022-05265-z","article-title":"Combined selective peripheral neurotomy in the treatment of spastic lower limbs of spinal cord injury patients","volume":"164","author":"Liu","year":"2022","journal-title":"Acta Neurochir (Wien)"},{"key":"2026100523551535000_64.10.154.36","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.rehab.2018.07.008","article-title":"Botulinum toxin type A or selective neurotomy for treating focal spastic muscle overactivity?","volume":"62","author":"Deltombe","year":"2019","journal-title":"Ann Phys Rehabil Med"},{"key":"2026100523551535000_64.10.154.37","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1615208"},{"key":"2026100523551535000_64.10.154.38","doi-asserted-by":"crossref","first-page":"E100","DOI":"10.1093\/neuros\/nyy041","article-title":"Contralateral C7 Nerve Root Transfer Restores Hand Function After Central Cerebral Injury","volume":"82","author":"Kolcun","year":"2018","journal-title":"Neurosurgery"},{"key":"2026100523551535000_64.10.154.39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5535\/arm.23003","article-title":"Intrathecal Baclofen Therapy: Pros and Cons","volume":"47","author":"Cho","year":"2023","journal-title":"Ann Rehabil Med"},{"key":"2026100523551535000_64.10.154.40","first-page":"131","article-title":"The role of intrathecal baclofen therapy in the upper motor neuron syndrome","volume":"40","author":"Francisco","year":"2004","journal-title":"Eura Medicophys"}],"container-title":["Drug and Therapeutics Bulletin"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/dtb.2026.000018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:55:32Z","timestamp":1791269732000},"score":1,"resource":{"primary":{"URL":"https:\/\/dtb.bmj.com\/lookup\/doi\/10.1136\/dtb.2026.000018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":40,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,9,28]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/dtb.2026.000018"],"URL":"https:\/\/doi.org\/10.1136\/dtb.2026.000018","relation":{},"ISSN":["0012-6543","1755-5248"],"issn-type":[{"value":"0012-6543","type":"print"},{"value":"1755-5248","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}