Episode 003 -- Tone 101

Housekeeping

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Tone and Spasticity

 Infomercials and popular media talk about how the latest diet or the newest bow-nordi-master machine will help you build muscle and get toned. Tone in muscles is actually a bad thing in the PT/OT world.

A muscle with tone is basically flexed all the time. It's contracted and in a state of tension. When my fingers curl up in a tight ball and won't release, it's because I have too much muscle tone. It my arm gets toned, that mean the muscles tighten and it curls up, useless. Tone in my legs will prevent me from bending or unbending my hip, knee, or ankle. Or cause my toes to curl up in my shoe. A muscle with tone is useless.
One goal of the exercises I do with PT is to prevent tone from setting in. Working on range of motion, joint flexibility, and muscle strengthening prevents tone.

What most people think of as tone is probably definition. They want to see the muscles. We often make our muscles visible be flexing them. Tone is when your muscles essentially flex themselves and then stay that way, even when you want them to stop. Imagine flexing your bicep and then keeping it flexed all day as you go about your business.

That's why you don't want tone in your muscles.

Treatment

There are a number of ways to address tone. Some popular ones include:

• Movement therapy
• Stretching
• Tiring it out
• Massage
• Relaxation/mindfulness
• Accupuncture

There are also medicinal solutions.

Baclofen is a pill that can reduce tone. It can affect the whole body, though, and one of the main side affects is fatigue. Since many stroke survivors are already dealing with fatigue, this can be a challenge. Of course, not everyone experiences the side affects, and it can be a great solution.

Medtronic also makes a Baclofen pump. A surgeon implants it in the abdomen and runs a tube into the spine so the pump continually deploys small amounts of Baclofen into the spinal fluid. It can be a little more targeted than the pill, and because the dosage is much lower it has few side affects. The dosage is lower because unlike a pill, it doesn't have to make its way through the digestive system into the circulatory system, and then into the nervous system. On the other hand...surgery.

Botox is also an effective treatment. 

Based on Botulinum Toxin, Botox is used to treat both wrinkles and tone. The director uses electrodes to monitor the firing of nerves in a muscle, and then injects Botox directly into the toned muscle to put many of the nerves to sleep for a few months. This relaxes the toned muscles and gives the other muscles a chance to recover.

Hack of the Week

It took me a while to figure out how to take my shirt off, and not just because people scream when I do. It simply wasn't a skill we needed to focus on the hospital. Here is my current process.

1. Reach straight back over my head with my good hand -- follow the path of an imaginary Mohawk.
2. Grab the back of my shirt collar.
3. Pull that over my head.
4. Take my right sleeve in mouth and pull the sleeve off my right arm.
5. Grab the left sleeve with my right hand to remove that.

This process also works with jackets and hoodies. It works best with long sleeves, but my short-sleeved t-shirts work out okay, too. I just skip the sleeve biting there.

Where do we go from here?

• Do you have any tips or stories you'd like to share on a future episode? Email me at Bill@strokecast.com. I'd love to hear from stroke survivors, caretakers, medical professionals, and more.
• Share your thoughts on Episode 3 in the comments below.
• On the Apple platform , please leave a rating or review.
• Share this episode with anyone who might be interested.
• Don't get best...get better.

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