Spasticity Treatment & Surgery in Delhi

After a stroke, a head injury, a spinal cord injury, or in children with cerebral palsy, many people find that their muscles become stiff, tight and resistant to movement. A hand may be clenched into a fist, an elbow held bent, a foot pointed downwards so that walking becomes difficult, or the legs pulled together so tightly that hygiene and dressing become a struggle. This condition is called spasticity. It affects millions of people worldwide and can be as disabling as the weakness that accompanies it - causing pain, deformity, difficulty with walking and daily activities, and a heavy burden on caregivers.

Spasticity is treatable. A range of options exists - from physiotherapy and medicines to targeted injections and precise neurosurgical procedures - and the right combination can reduce stiffness, relieve pain, prevent deformities and improve function and care. Dr. (Prof.) Sumiet Snha, former Professor of Neurosurgery at AIIMS, New Delhi, and Principal Director - Neurosurgery & Spine Surgery at Max Hospital, Dwarka, has special expertise in nerve root sectioning for spasticity after brain and spinal cord injury and in peripheral nerve surgery, working closely with rehabilitation specialists to design individual treatment plans.

What Is Spasticity?

Muscle tone - the slight tension present in muscles at rest - is normally controlled by a balance between signals from the brain and reflexes in the spinal cord. When the brain or spinal cord is injured, the "braking" signals that normally travel down from the brain to calm the spinal reflexes are reduced. As a result, the stretch reflexes in the spinal cord become overactive. When a spastic muscle is stretched, especially quickly, it contracts excessively - producing the characteristic "catch" and resistance to movement. Spasticity is described as velocity-dependent: the faster the muscle is stretched, the stronger the resistance.

Spasticity often occurs together with other features of upper motor neuron damage - weakness, loss of fine control, muscle spasms, clonus (rhythmic jerking, often at the ankle) and exaggerated reflexes. Over time, muscles held in shortened positions can develop permanent shortening (contractures), making joints stiff even when the spasticity itself is reduced. This is why early management matters.

Conditions That Cause Spasticity

Effects of Spasticity on Daily Life

• Difficulty walking - toe-walking, scissoring of the legs, stiff-knee gait, frequent falls.
• Loss of hand function - inability to open the hand to grasp or release objects.
• Pain from muscle spasms and joint strain.
• Contractures and deformities - fixed tightening of muscles and joints, hip dislocation in children.
• Problems with hygiene and care - difficulty cleaning the palm or groin, dressing and changing.
• Pressure sores and skin breakdown from abnormal postures.
• Sleep disturbance due to spasms at night.
• Difficulty sitting in a wheelchair or positioning in bed.

It is worth noting that spasticity is not always harmful. In some people with weak legs, a degree of stiffness helps them stand and transfer. The goal of treatment is therefore not to eliminate all tone, but to reduce the problematic spasticity while preserving any useful tone - which requires careful assessment.

Assessment of Spasticity - Setting Goals

Successful management begins with a thorough assessment by a multidisciplinary team, including the neurosurgeon, rehabilitation physician, physiotherapist and occupational therapist. The assessment includes:

1. History - the underlying condition, how spasticity affects daily life, current treatments and the goals of the patient and family.
2. Examination - grading spasticity in each muscle group (for example, using the Modified Ashworth Scale), measuring range of motion, distinguishing dynamic spasticity from fixed contractures, and assessing strength and selective motor control.
3. Gait analysis - observing walking, sometimes with video, to understand which muscles are causing problems.
4. Diagnostic nerve blocks - temporarily numbing a specific nerve with local anaesthetic to predict the effect of a permanent procedure and to distinguish spasticity from contracture.
5. Imaging - of the brain or spine to understand the underlying condition, and X-rays of the hips in children.

Goals are then set together with the patient and family. These may be functional (to walk better, to open the hand), comfort-related (to reduce painful spasms), care-related (to allow easier hygiene and dressing) or preventive (to avoid contractures and hip dislocation). Clear goals help choose the right treatment and measure success.

Non-Surgical Treatment

For many people, these measures are sufficient. When spasticity remains troublesome despite optimal non-surgical care, or when the benefits of injections are short-lived and repeated injections become burdensome, neurosurgical options can provide lasting relief.

Neurosurgical Options for Spasticity

1. Selective peripheral neurotomy

For focal spasticity affecting a specific muscle group - such as a pointed foot (ankle plantar flexors), a clenched hand (finger flexors), a bent elbow or tightly adducted thighs - the nerve supplying the overactive muscles is exposed through a small incision. Using a nerve stimulator under the microscope, the surgeon identifies the motor branches responsible and partially sections a precise proportion of their fascicles. This permanently reduces spasticity in those muscles while preserving their strength and sensation. Common targets include the tibial nerve (for spastic foot), the musculocutaneous nerve (bent elbow), the median and ulnar nerves (clenched wrist and fingers) and the obturator nerve (thigh adduction). Dr. Snha's expertise in peripheral nerve microsurgery is central to this procedure.

2. Selective dorsal rhizotomy (SDR)

SDR is performed on the sensory nerve rootlets in the lower spine. Through a small opening in the lower back, the nerve roots are exposed, and the sensory rootlets are tested with electrical stimulation. A selected proportion of those producing abnormal responses are cut, reducing the excessive sensory input that drives spasticity in the legs. SDR is best established for carefully selected children with spastic diplegic cerebral palsy who have good underlying strength and the potential to walk, and it can lead to lasting improvement in walking when followed by intensive physiotherapy.

3. DREZ-otomy for spasticity and pain

Microsurgical lesioning at the dorsal root entry zone of the spinal cord can reduce severe spasticity and associated pain in selected patients, particularly those with spinal cord injury or severe, disabling spasticity with little functional movement. It is also highly effective for pain after brachial plexus avulsion.

4. Intrathecal baclofen (ITB) therapy

For severe, generalised spasticity - after spinal cord injury, multiple sclerosis or severe brain injury - baclofen can be delivered directly into the fluid around the spinal cord through a small catheter connected to a programmable pump implanted under the skin of the abdomen. Because the medicine is delivered directly to its site of action, much lower doses are needed than with tablets, with fewer side effects such as drowsiness. A test dose through a lumbar puncture is given first to confirm response. The pump is refilled every few months in the clinic, and the dose can be adjusted precisely. ITB requires commitment to regular follow-up, as abrupt interruption of therapy must be avoided.

5. Spinal cord stimulation

In selected patients, especially after spinal cord injury, spinal cord stimulation may help reduce spasticity and pain as part of a broader programme - see our spinal cord stimulator page.

6. Orthopaedic procedures

When fixed contractures or bony deformities have developed, orthopaedic surgery - tendon lengthening, tendon transfers, osteotomies and hip reconstruction - may be needed, often combined with neurosurgical tone reduction for lasting results.

Choosing the Right Treatment

The choice depends on the distribution of spasticity, the underlying condition, the presence of useful voluntary movement, contractures and the goals:

• Focal spasticity (one or a few muscle groups) - botulinum toxin, or selective peripheral neurotomy for a lasting effect.
• Bilateral leg spasticity in children with cerebral palsy who can walk - selective dorsal rhizotomy in carefully selected cases.
• Severe generalised spasticity - oral medicines, intrathecal baclofen, or ablative procedures such as DREZ in selected patients.
• Fixed contractures - orthopaedic procedures, combined with tone management.

Diagnostic nerve blocks are very helpful in predicting the outcome of neurotomy and in showing patients and families what to expect.

Results of Spasticity Surgery

When patients are carefully selected, neurosurgical procedures produce meaningful and lasting reductions in spasticity. After selective peripheral neurotomy, patients often see a clear improvement in foot position and walking, or easier hand opening and hygiene, and the effect is permanent in most cases - avoiding the need for repeated injections. After SDR, children commonly show smoother, more efficient walking over the following months with intensive physiotherapy. Intrathecal baclofen offers substantial reduction in generalised spasticity and spasms. In all cases, the best results come from combining surgery with dedicated rehabilitation.

Risks of Surgical Treatment

Risks depend on the procedure and include infection, bleeding, temporary numbness or tingling, excessive weakness if too much tone is reduced, and recurrence of spasticity over time in some patients. For ITB, there are device-related risks such as catheter problems and infection, and the need for regular refills. For SDR, temporary sensory changes and the need for prolonged rehabilitation are expected. These risks are discussed carefully during planning.

Recovery and Rehabilitation

Spasticity After Stroke - Don't Accept a Clenched Hand

Many stroke survivors and their families are told that the stiffness in the arm and leg is simply part of the stroke and must be accepted. In reality, post-stroke spasticity is a treatable condition. A clenched fist that cannot be opened can lead to skin breakdown in the palm, pain and difficulty washing and dressing. A pointed, inward-turned foot can make walking unsafe and footwear difficult. Early physiotherapy, splinting and botulinum toxin injections can prevent contractures and improve function. For those who need repeated injections, or whose spasticity is severe, selective peripheral neurotomy offers a permanent reduction in the targeted muscles. Even years after a stroke, treatment can improve comfort, care and sometimes function.

Spasticity in Spinal Cord Injury

After spinal cord injury, spasticity and spasms below the level of injury are very common. Some degree of tone can be helpful - aiding standing, transfers and circulation - but severe spasms can throw people out of their wheelchairs, disturb sleep, cause pain and interfere with bladder management and sexual function. Management begins with identifying triggers such as bladder infections, stones, constipation and pressure sores. Medicines, stretching and positioning are the first steps. For severe generalised spasticity, intrathecal baclofen is highly effective. In selected patients, ablative procedures like DREZ-otomy can reduce both spasticity and pain. For people with cervical spinal cord injuries, nerve transfer procedures may also help restore hand function - see our nerve transfers after spinal cord injury page.

Children With Cerebral Palsy

For children with spastic cerebral palsy, spasticity management is part of a lifelong journey involving parents, therapists, paediatricians, orthopaedic surgeons and neurosurgeons. In early childhood, the focus is on therapy, orthoses and botulinum injections to support motor development and prevent contractures and hip displacement. Hip surveillance X-rays are important. For selected children with spastic diplegia who walk or have the potential to walk, SDR performed at the right age can give lasting improvement. Children with focal spasticity may benefit from selective neurotomy. The goal is always to help the child achieve their best possible independence, participation in school and play, and comfort.

Why Choose Dr. (Prof.) Sumiet Snha for Spasticity Surgery?

Cost Factors for Spasticity Treatment

• Type of treatment - injections, neurotomy, SDR, DREZ or intrathecal baclofen pump.
• Number of nerves or levels treated.
• Device costs for pumps.
• Hospital stay and rehabilitation requirements.
• Insurance coverage.

Spasticity, Rigidity or Dystonia? Why the Distinction Matters

Not all muscle stiffness is spasticity. Several different conditions make the limbs feel tight or cause abnormal postures, and they respond to different treatments. A procedure that helps spasticity may do little for rigidity caused by Parkinson's disease, and dystonia may need a completely different approach. Before any treatment is recommended, the specialist examines how the stiffness behaves - whether it changes with the speed of movement, whether it is present at rest, and whether it varies with posture, emotion or activity. This careful distinction avoids unhelpful procedures and directs the patient to the right therapy.

In practice, several of these features can coexist - particularly in children with cerebral palsy and in adults after severe brain injury, where spasticity and dystonia frequently overlap and contractures develop over time. Diagnostic nerve blocks and examination under anaesthesia are useful in such mixed cases, because they reveal how much of the stiffness is dynamic and treatable with tone-reducing procedures, and how much is fixed and needs orthopaedic correction.

Spasticity After Brain Injury and in Multiple Sclerosis

Traumatic brain injury

After a severe head injury, spasticity can appear within days or weeks and may affect one side of the body or all four limbs. During the early recovery phase, positioning, stretching and splinting are vital, because muscles held in shortened positions during a long stay in intensive care can quickly develop contractures, especially at the ankles and elbows. Botulinum toxin is often used during this phase to allow casting and positioning. As recovery continues over many months, spasticity patterns may change, so permanent surgical procedures are generally deferred until the neurological picture has stabilised. Dr. Snha's background in neurotrauma, including his role as President of the Neurotrauma Society of India, informs this staged approach.

Multiple sclerosis

In multiple sclerosis, spasticity commonly affects the legs and may fluctuate from day to day - worsening with heat, infection, fatigue or a relapse. Because MS can progress, treatment plans must be flexible and reviewed regularly. Stretching, exercise and oral medicines form the basis of care, with botulinum toxin for focal problems. For people with severe leg spasticity and spasms that interfere with sitting, sleep or care, intrathecal baclofen is often particularly suitable because the dose can be adjusted as needs change. Close coordination with the patient's neurologist ensures that spasticity treatment fits alongside disease-modifying therapy.

Daily Life With Spasticity: Practical Tips at Home

Whatever treatment is chosen, what happens at home every day has a large influence on comfort and long-term results. Spasticity tends to worsen when muscles are left in the same position for long periods, and it can be eased by regular, gentle movement. Therapists usually teach a short home programme that patients or caregivers can follow once or twice daily. The aim is not to push through pain but to keep muscles long and joints moving, so that the benefit of injections or surgery is maintained.

• Stretch slowly and hold - because spasticity is triggered by fast stretch, slow, sustained stretches of 30 seconds or more are more effective than quick movements.
• Change position regularly - alternate between sitting, lying and, where possible, standing with support; lying on the front for short periods can help stretch the hips.
• Wear splints as advised - night splints for the hand or ankle help keep muscles at length while spasticity is lower during sleep.
• Keep warm but avoid overheating - cold can increase stiffness, while heat may worsen symptoms in multiple sclerosis.
• Watch for triggers - a sudden increase in stiffness may signal a urinary infection, constipation, a pressure sore or an ingrown toenail.
• Use supportive seating - a well-fitted wheelchair or chair reduces abnormal postures and spasms.

Caregivers should also protect their own backs when helping with transfers and stretching. A therapist can demonstrate safe handling techniques and suggest simple equipment - such as transfer boards or grab rails - that make daily care easier and safer for everyone.

Preparing for Your Spasticity Assessment

A spasticity consultation is most productive when the team can understand how stiffness affects everyday life. Before the visit, it helps to note which activities are most difficult - walking, dressing, hygiene, sleeping or using the hand - and what you or your family would most like to change. Short videos taken at home, showing walking, getting in and out of a chair or attempts to open the hand, are extremely useful, because spasticity often looks different in a clinic room than it does during daily routines.

Please bring previous brain or spine scans, reports of earlier botulinum toxin injections (including doses and the muscles treated, if available), a list of current medicines, and any splints or orthoses you use. For children, growth records and hip X-rays are helpful. Families living outside Delhi can share reports on WhatsApp at +91-8448877746 or arrange a video consultation for a preliminary opinion before travelling to Max Hospital, Dwarka. To arrange a visit, please book an appointment or contact the clinic.

Spasticity in Adults With Cerebral Palsy

Cerebral palsy is often thought of as a childhood condition, but children with cerebral palsy grow into adults, and their needs change over time. The brain injury itself does not progress, yet many adults notice increasing stiffness, joint pain, fatigue and a gradual decline in walking ability in their twenties, thirties and beyond. Years of spasticity and abnormal postures can lead to early wear of the hips and knees, back problems and nerve compression. Unfortunately, the structured support available in childhood often fades after school, leaving adults without regular specialist review.

Adults with cerebral palsy benefit from the same careful assessment of goals as children, with added attention to pain, work, independence and long-term joint health. Botulinum toxin, targeted stretching and strengthening programmes remain useful. For focal problems such as a spastic, inward-turned foot or a tightly flexed wrist, selective peripheral neurotomy may offer a lasting reduction in tone without the need for repeated injections. Intrathecal baclofen may be considered for severe generalised spasticity. Where fixed deformities have developed, orthopaedic procedures may be combined with tone management. It is never too late to ask for an assessment - even in adulthood, appropriate treatment can improve comfort, ease of care and quality of life.

Frequently Asked Questions

Move More Freely

If spasticity is limiting movement, causing pain or making care difficult, a specialist assessment can identify the right combination of treatments. Book a consultation with Dr. (Prof.) Sumiet Snha at Max Hospital, Dwarka, New Delhi. Related pages: nerve transfers, brachial plexus surgery and paediatric neurosurgery.