Injections
Botox injection for spasticity
Botulinum toxin is injected directly into overactive muscles to reduce spasticity — the involuntary stiffness that follows an injury to the brain or spinal cord. It blocks the chemical signal from nerve to muscle where the two meet, so the injected muscle contracts less forcefully. The effect is deliberately local, partial and temporary: the aim is to reduce tone enough that stretching, bracing, hygiene or movement become possible, not to render the limb inert.
How it is done
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Choosing the muscles
The posture of the limb points to the muscles responsible. A flexed elbow, a clenched hand and an inverted foot each implicate a particular group, and the assessment is what decides where the dose goes.
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Confirming the target
Electromyography or ultrasound is commonly used to confirm the needle is in the intended muscle. This matters most for small muscles and for deep ones, where surface landmarks are unreliable.
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Dividing the dose
A total dose is divided between the chosen muscles and, within a large muscle, between several injection sites. There are upper limits on total dose per session.
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Time taken
A few minutes per muscle. No anaesthetic is normally needed, and there is no recovery period afterwards.
What to expect afterwards
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Onset
Weakening of the injected muscle begins around three to seven days after the injection and is usually at its fullest by two weeks.
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Duration
Around three months is typical, though it varies with the muscle, the dose and the individual. The effect fades gradually rather than stopping.
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Repeat interval
Injections are not usually repeated at intervals shorter than twelve weeks, partly for effect and partly to reduce the chance of the body developing antibodies to the toxin.
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What has to happen in between
The period of reduced tone is the opportunity. Stretching, splinting and therapy during it are what turn a temporary reduction in stiffness into lasting range of movement. Without them the limb returns to where it started.
What it does and does not change
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Tone, not contracture
Once muscle and surrounding tissue have shortened permanently, reducing the nerve signal does not lengthen them. Distinguishing spasticity from established contracture is part of the assessment, because the second does not respond.
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Not a treatment for weakness
The weakness caused by the original injury is unaffected. Reducing tone in a limb that is already weak can make it feel more unwieldy, not less.
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Spasticity is sometimes useful
Stiffness in a leg can be what a person is standing on. Removing it without regard to how the limb is used can cost more function than the spasticity was costing.
Risks
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Too much weakness
The commonest problem is an injected muscle that ends up weaker than intended, affecting grip or the way a limb is positioned. It wears off with the rest of the effect.
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Local and general effects
Soreness or bruising at the injection sites, and occasionally a few days of flu-like symptoms.
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Spread beyond the injection site
Botulinum toxin products carry a boxed warning about effects spreading away from where they are injected. Difficulty swallowing and breathing have been reported, most often in children treated for spasticity with larger doses. It is rare. Any difficulty swallowing, speaking or breathing in the days after an injection needs urgent attention.
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Reduced response over time
A minority of people develop antibodies to the toxin and stop responding to it. Keeping intervals long and doses no higher than necessary reduces the chance of it.
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When it is not given
Existing neuromuscular disease such as myasthenia gravis, infection at the injection site, pregnancy and breastfeeding, and known hypersensitivity are all reasons not to proceed or to reconsider.
Common questions
Is this the same as cosmetic Botox?
The same family of medication. The doses and the targets are entirely different: spasticity treatment uses many times the cosmetic dose, placed in limb muscles rather than in the face.
Does the injection hurt?
It is comparable to any intramuscular injection — brief, and repeated once per site. Where electromyography is used to locate the muscle the needle stays in a little longer.
Will it need repeating indefinitely?
Often, yes, if the underlying injury is permanent. What can change is how much is needed, particularly where range of movement has been recovered and maintained between treatments.
How soon can therapy start afterwards?
Straight away. The window while tone is reduced is the point of the injection, and stretching and splinting are usually intensified during it.
General reference information, and not advice about your own case. It may not reflect the most recent guidance or what is offered on a given day — call (201) 408-5151 to check.
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Dr. Yoo Rehab Clinic welcomes new patients from across Northern New Jersey and New York City, including Englewood, Teaneck, Fort Lee, Palisades Park and Ridgefield. Call today to learn more about insurance, scheduling, and how we can help.
