Stretching is not essential for managing MS spasticity: A randomized controlled trial.

Stretching has long been treated as a first-line, almost unquestioned treatment for spasticity in multiple sclerosis, recommended by guidelines and expert opinion even though it had not been tested in a fully powered trial. This study set out to fill that gap by comparing a structured education-plus-stretching program against an education-plus-range-of-motion-exercise program in ambulatory people with self-reported MS spasticity, delivered in group classes that shifted from in-person to virtual sessions during the COVID-19 pandemic. Spasticity impact scores improved in both groups over one and six months, but there was no statistically significant difference between the stretching program and the range-of-motion program at one month.

In other words, both approaches were followed by similar improvement, and stretching did not show an advantage over the alternative exercise approach. The main limitation is that this compares two active programs rather than testing stretching against doing nothing, so it speaks to relative effectiveness of exercise types rather than whether exercise in general helps.

If you live with MS and have been told that daily stretching is essential for managing spasticity, this study offers a different perspective worth understanding. Researchers compared two group programs, one built around education plus stretching exercises, the other around education plus gentler range-of-motion exercises, in people with self-reported MS spasticity.

Both groups saw improvement in how much spasticity affected their lives at one month and six months later, but the stretching program did not outperform the range-of-motion program. What this suggests is that structured exercise and education together may help, but stretching specifically may not be the essential ingredient it's often assumed to be. It's important to know that this trial compared two active programs, not stretching against no treatment at all, so it can't tell us whether either program is better than doing nothing.

The findings challenge a long-standing assumption in MS care rather than closing the book on how best to manage spasticity.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This randomized controlled trial addressed a genuine evidence gap: daily stretching is widely recommended as first-line treatment for MS spasticity based on guidelines and expert consensus, yet had not been evaluated in an adequately powered trial. Of 231 enrolled participants, groups received either a guideline-based spasticity education and stretching program or an education plus range-of-motion exercise control, matched for duration and delivered face-to-face and later virtually due to COVID-19.

The primary outcome, Multiple Sclerosis Spasticity Scale score at one month, showed no statistically significant between-group difference (mean difference 0.28, 95% CI -9.45 to 10.01, p = 0.955), and this null finding persisted through six months. Both groups demonstrated significant within-group improvement on the spasticity scale and most secondary outcomes, but these within-group changes cannot be attributed to either specific intervention component given the absence of a no-treatment control arm. The trial's strength is its adequate power to detect a between-group difference that guideline-based practice assumes exists; its main limitation is that it compares two active exercise-based programs rather than testing stretching against no intervention, so it cannot establish whether exercise itself, regardless of type, drives the observed improvement.