Changes in spasticity after spinal manipulation in cerebral palsy

What Is Spasticity?

Spasticity is one of the main causes of daily fatigue, pain, and movement limitations in children and adults with cerebral palsy (CP). It makes simple actions – such as dressing, hygiene, play, or learning – much more difficult.
According to international research, most people with CP experience spasticity, and it is often what limits independence and reduces quality of life.

At the Kozyavkin International Rehabilitation Clinic, we have been addressing this challenge for over 20 years. In this article, we’ll explain in simple terms what spasticity is, how we measure it objectively, and why spinal manipulation can make a difference.

Spasticity occurs when the central nervous system is affected. Muscles respond with excessive tension to stretching – the faster you try to move an arm or a leg, the stronger the resistance.

Importantly, spasticity is both a symptom (an exaggerated reflex) and a syndrome that includes “positive symptoms” (hyperreflexia, spasms, dystonia) and “negative symptoms” (weakness, fatigue, slow or clumsy movement).
This creates a double challenge – the muscle is both overactive and exhausted.

In spastic forms of CP, not only nerve control changes but also the structure of the muscle and connective tissue – they become less elastic.
That’s why working with spasticity always means addressing both sides: calming the excessive nerve response and improving the mechanics of the muscle.

How We Measure Spasticity Objectively

Most common scales are subjective.
To achieve the most objective assessment possible, we use the NeuroFlexor device (developed by the Karolinska Institute and Ageromatec).
The instrument moves a limb segment at different speeds and separates total resistance into three components:

• Neural – actual spasticity
• Elastic – stiffness of the tissues
• Viscous – friction or “stickiness” of the tissues

This allows us to identify which factor is limiting movement in your specific case and measure changes in newtons (N) rather than just in scores.

Why We Focus on Spinal Manipulation

In a retrospective analysis of over 10,000 patient histories, we observed a reduction of spasticity in 94% of patients after undergoing the Intensive Neurophysiological Rehabilitation System (Kozyavkin Method).

This led us to hypothesize that spinal manipulation – a precise, safe influence on the thoracic, lumbar, and cervical spine – may play a key role in the rapid reduction of the neural component of spasticity.

A pilot study involving 29 cases showed that after just one manipulation, spasticity decreased by an average of 1.65 N and continued to improve by the end of a two-week program
(Journal of Chiropractic Medicine, 2016).

Randomized Study: What We Tested

To obtain stronger evidence, we conducted a randomized controlled trial with 78 children (ages 8–18) with spastic forms of CP, levels I–III on the MACS (Manual Ability Classification System).

• Experimental group (n=40): received spinal manipulation according to Prof. V. I. Kozyavkin’s method
• Control group (n=38): received simulated manipulation

Assessments were done before and 5 minutes after the procedure using:

• NeuroFlexor – to measure the neural component (spasticity)
• Box and Block Test – to assess hand dexterity (how many cubes a child can move in one minute). A full explanation is available in the Box and Block Test overview.

Results:

• Spasticity: decreased from ~5.53 N to ~3.35 N in the experimental group – statistically significant.
  The control group also showed some improvement, but it was not statistically significant.
• Hand dexterity: both groups improved (experimental ≈ +4 blocks/min), but not significantly – likely due to the short observation period or absence of follow-up hand training.

What This Means for Patients and Families

Quick response.
Some patients notice easier passive movements within minutes after the session.
It’s not a miracle – it’s neurophysiology: the overactive nerve response is temporarily calmed.

A window of opportunity for training.
When spasticity decreases, it becomes easier to work on strength, precision, and speed – helping the brain learn movement more effectively.

Easier daily care.
Parents find it simpler to dress, bathe, or stretch their child – less pain, fewer tears, and more chances to practice independence.

Realistic expectations.
Spinal manipulation doesn’t replace core rehabilitation – it enhances it.
The best results come from combining manipulation with targeted exercises, occupational therapy, orthoses, and home programs.

Who May Benefit from Spinal Manipulation

• Children with spastic forms of CP and a noticeable “velocity-dependent” spasticity (when quick movements cause sudden stiffness).
• Patients at MACS levels I–III, who can participate in hand training once spasticity is reduced.
• Families ready for a comprehensive approach – manipulation plus active exercises during and after the course.

Safety and Clinical Selection

The method is performed by specialists with years of experience in CP rehabilitation.
Before starting, every patient undergoes a neurological evaluation to determine indications and contraindications.
If there are additional medical conditions, decisions are made individually with the supervising physician.

About the Evidence

Our findings show that within just a few minutes after spinal manipulation, the neural component of spasticity – the excessive nerve signal that “tightens” the muscles – significantly decreases.
Further studies with longer follow-up and combined therapy protocols are needed to fully understand how this impacts daily function.

Watch the Video

Watch the presentation by Anna Kushnir at the online Neuroorthopedics Conference – discussing how spinal manipulation affects spasticity and hand dexterity in patients with cerebral palsy.

About the author

Anna Kushnir

Pediatrician and senior research fellow specializing in pediatric rehabilitation. Member of EACD and AACPDM.