The neurotoxin known as Botox has proved useful in treating a number of medical conditions because of its ability to block nerve endings. These conditions include migraines, crossed eyes, overactive bladder, stomach issues and excessive sweating.
“Other conditions with which Botox can help are spasticity, contracture, post-stroke syndrome and cervical dystonia,” Cheryl Vinson, a nurse practitioner at Mercy Health – Paducah Physical and Pain Medicine, says. She’s one of a few providers in this region trained in using Botox to treat these conditions.
After having a stroke, patients are prone to contractures, a condition that describes the shortening and hardening of muscles, tendons or other tissues that can lead to deformity and rigidity of joints.
“Contractures affect a person’s ability to do activities of daily living,” Cheryl explains. “They can also lead patients to develop pressure sores in their hands and feet.”
Cheryl’s background is in long-term care treating patients with contractures and skin integrity issues.
“Using enough Botox, we can release those muscles and provide patients with hand care, like when the contracture has caused their fingernails to dig into the palms of the hand,” she shares. “Botox can also help with ambulation, or the ability to walk independently. It can loosen the muscle enough so that the foot can be flat on ground versus folded.”
Cheryl also uses Botox to treat spasticity, or involuntary muscle tensing related to cerebral palsy, traumatic brain injury, multiple sclerosis and stroke, as well as chronic muscle spasms and cervical dystonia.
According to the Mayo Clinic, cervical dystonia, also called spasmodic torticollis, is a painful condition in which the neck muscles contract involuntarily, causing the head to twist or turn to one side or uncontrollably tilt forward or backward.
“Some children have cervical dystonia, which is when the neck muscles contract involuntarily, because of how they lay in their belly,” Cheryl adds. “While adults can develop the condition from an injury, stress or medication sometimes we can work it out with physical therapy. Other patients benefit from Botox to loosen those muscles and ease the pain associated with the condition. If we treat them with Botox quickly enough, we can resolve the condition.”
Cheryl emphasizes that patients need a referral from their health care provider’s office to see her before she can perform an initial assessment to determine their treatment plan.
“I will target muscles that are causing the issue with an injection,” she says. “We start slowly to make sure they don’t have an adverse effect to the Botox.”
In the first two weeks following injection, the Botox goes into the muscles and spreads out. Patients are unlikely to feel any benefit during this initial period.
“Weeks three to six are when the results peak and that helps me determine the correct dosage for patients,” Cheryl says, and adds that she sees patients for an evaluation during this period.
At this stage, patients may undergo physical therapy to help straighten out a newly relaxing muscle or get help with their balance. Physical therapy at this stage can help patients get the maximum benefit from their injections.
“Botox lasts in the system for about 90 days, so a patient’s pain may return in weeks 10 to 12,” she says. “I see most of my patients who have chronic conditions every 90 days.”
Patients with acute muscle spasticity may only need two treatments – provided they also do at-home stretching exercises – to experience relief.