This article is based on my personal experience and research. It’s not medical advice.  Want to add your story? Email me — contact info is at the bottom.
Introduction
Muscle tone refers to the resistance felt during passive movement. It’s present even when the body is at rest. After neurological injury, tone can become exaggerated or misregulated, leading to conditions like spasticity, dystonia, or rigidity.
In my case, tone became unpredictable. Muscles would seize or stiffen.  I could look strong from the outside, but inside, I was fighting against my own body’s involuntary motor signals.  These involuntary motor signals to me, feels like my muscles are constantly flexing/squeezing to the point to where I can feel the tension around my bones.  In many cases, someone can feel my affected area, which is almost always my quadriceps, for example, and they will feel hard as a rock like I’m flexing when I’m trying to relax.
From my understanding, and correct me if I’m wrong or contribute to this by emailing me at my email address on the bottom of this page,but everybody has some tone.
Tone is what keeps us upright, helps us balance, and prevents us from flopping around like a wet noodle. Â When tone becomes a problem is when it becomes abnormally high, which is commonly referred to as hypertonia, and this is where spasticity manifests.
Treatments for Tone
Treatments for tone, that I am aware of from firsthand experience are as followed (and by the way, if you can contribute to this list or correct me, please email me at the address at the bottom of the page):
Medication Treatments for tone that I experienced include:
Muscle Relaxers:
Baclofen (120 mg pill form)
Dantrolene
Tizanidine (At night)
Botox/ Serial Casting
Nerve Block:
Phenol Injections (explained below)
Botox and Serial Casting
After my injury, my ankle became stuck at a -19° angle, like I was permanently wearing a high heel, and it began to deform.  To avoid surgery, my care team started with the least invasive options—first muscle relaxers, which didn’t work, and then Botox, which showed real promise. When Botox began relaxing the muscles in my posterior tib, they paired it with serial casting, placing my foot in the most neutral position possible to retrain its alignment. Each time the Botox wore off, they repeated the process: more injections, more casting.
You can actually see in the picture how many rounds I went through—casts were everywhere, stacked across my couch and around my arms in the photo.
Even though serial casting didn’t completely return my foot to neutral, the good news is that it showed enough improvement to qualify me as a strong candidate for Achilles tendon lengthening, which ended up happening.
Additionally, after the surgery the surgeon still injected Botox and casted my legs just for good measure.
Surgeries for Tone
When muscle relaxers, Botox, and stretching failed to correct my contractures and deformities, it became necessary to take a more invasive and aggressive approach to managing my tone. Â Surgeries for managing my tone that I have had, and therefore most familiar with, were in my:
Achilles tendon (bilateral)
Post Tibula (bilateral)
Hamstrings (bilateral)
Adductors (bilateral)
Bilateral foot reconstruction
All ten toes (bilateral)
Achilles Tendon Lengthening
I needed tendon lengthening surgery because both of my heels were stuck in an upward position, as if I were wearing high heels. The original goal was to avoid surgery by using Botox, which is a muscle relaxer. We hoped that by injecting Botox into the areas affected by high tone and spasticity, and then applying body weight—sometimes enhanced with a weight vest—it would help stretch out the Achilles tendons over time. Unfortunately, despite our efforts, surgery became necessary.
The surgeries themselves were relatively simple and delivered immediate results. It’s worth noting that the surgeon also injected Botox into the surgical areas and casted my legs in a neutral position. Once the casts were removed, I was finally able to stand with both feet flat on the ground. Before surgery, I couldn’t stand properly because of my ankle deformities—I was standing on the side of my feet, and they wouldn’t lie flat. Now that my feet are flat, I’ve been able to practice standing.
That weight-bearing position continues to help keep my Achilles tendons lengthened. It’s been about six years since the surgery, and I’m now practicing walking. Thankfully, I have no issues with the tendons today. While I still deal with tone and spasticity, which can cause tightness in my ankles, I manage it through regular stretching. But stretching is important for everyone—not just those of us with tone and spasticity. At this point, maintaining flexibility is part of my routine, just like it is for any able-bodied person.
Watch the video below to see my entire journey with Botox and Achilles tendon lengthening surgery.
Other surgeries I had for
for Tone and Spasticity
Achilles tendon (bilateral)
Post Tibula (bilateral)
Hamstrings (bilateral)
Adductors (bilateral)
Bilateral foot reconstruction
All ten toes (bilateral)
In the video below, I explain my surgeries in greater detail.
Tendon Lengthening Helped Me — But Ongoing Care Is Key for Managing Spasticity
Tendon lengthening surgery is often used to relieve spasticity and improve flexibility/ range of motion. Tendon lengthening surgery works best when spasticity is limited to specific areas and followed by therapy, stretching, and sometimes medication and/or Botox- at least that’s how it was in my case. When I had my tendon lengthening surgeries the surgeon also did Botox and I still take Baclofen to this day as well. Â
Tendon lengthening surgery does not fix brain or spinal cord damage, so spasticity can return or shift to other muscles over time. Without proper follow-up care, tightness may come back. One example is that I need to attend a follow-up appointment every three months at the Spasticity Clinic here in San Jose, and I have been doing so every three months for the past eight years for spasticity and tone management, as seen in this photo.
🔧 Will tendon lengthening permanently fix the problem?
It can help significantly, but it’s not always a permanent, brace-free fix — especially after a brain injury. It depends on a few key things:
✅ What tendon lengthening can do:
Reduces spastic pull
Improves range of motion, for example, allowing your foot to get flatter on the ground
Can make it easier for the extremity to be neutral
🚫 What tendon lengthening can’t do alone:
It doesn’t fix the brain or spinal damage that causes spasticity — so the tone can return
Spasticity may shift to other muscle groups over time
If not followed by proper stretching, therapy, and maintenance, the tightness can recur
In some people, especially with severe or ongoing tone issues, bracing may still be needed for stability or safety
Download my free stretching bundle for tone! Click on the image below 👇👇👇Â
How Phenol Injections Helped Loosen My Tight Adductors
Phenol injections are a type of nerve block used to reduce spasticity by calming overactive nerves. I received phenol injections in my adductors because they were so tight my legs would cross when I walked, making it almost impossible to transfer to bed, use the toilet, or even wipe after using the bathroom.
Even at rest, I had to keep a yoga block between my knees because they would clamp together. The phenol injections provided temporary relief by blocking the overactive nerves causing the tightness. The doctor used electrical stimulation and ultrasound to locate the nerve before injecting the phenol. Because I responded well to the injections, they also helped confirm that surgery to release my adductors would likely give me lasting results.
Watch the video below, where I walk you through the phenol injection process step-by-step.
✅ What Makes Tone (Spasticity) Better
Warm temperatures – Help relax muscles and improve circulation.
Massage therapy – Can reduce tension and encourage relaxation.
Stretching – Especially slow, sustained stretching helps reduce spasticity.
Proper hydration – Supports healthy muscle function and flexibility.
Regular physical therapy or gentle movement – Helps prevent stiffness and maintain mobility.
Rest and adequate sleep – Reduces fatigue-induced spasticity.
Use of orthotics or positioning aids – Can help reduce tone if fitted and used correctly.
Warm baths or hydrotherapy – The warmth and buoyancy can reduce tone significantly.
Range-of-motion exercises – Keep joints mobile and muscles lengthened.
Botox or phenol injections – Help reduce overactive muscles.
Serial casting or splinting – Can lengthen muscles gradually over time.
Electrical stimulation (e-stim) – When used appropriately, can reduce spasticity.
Medications (like Baclofen, Tizanidine, Diazepam) – May help manage tone under a physician’s guidance.
🔻 What Makes Tone (Spasticity) Worse
Cold temperatures – Can increase muscle stiffness and make tone worse.
Fatigue – Overexertion or tiredness can increase spasticity.
Stress and anxiety – Heightened emotional states can increase muscle tone.
Pain – Pain from any source can trigger or worsen spasticity.
Rapid movements or sudden position changes – These can trigger spastic reflexes.
Infections (e.g., UTI or cold) – Can make tone flare up unexpectedly.
Lack of movement or immobility – Leads to joint stiffness and increased tone over time.
Tight clothing or braces – Can act as sensory triggers, increasing spasticity.
Dehydration – Affects muscle function and can worsen tightness.
Improper positioning during sleep or rest – Can lead to stiffness and increased tone.
Overexcitement or overstimulation – Especially common in individuals with neurological injuries.
Temperature fluctuations – Even rapid changes (hot to cold) can cause increased tone.
Certain medications – Some drugs may increase muscle stiffness as a side effect.
🛑 Disclaimer:
This article is for informational purposes only and does not constitute medical advice. Â If you have concerns about PTSD, TBI, or any other medical condition, please consult a qualified healthcare professional.
Let’s Build This Together 💪
If you have any experience with this topic, and want to share your story, contact me!  My goal is to create a resource-rich community for survivors, caregivers, and students.
 Want to contribute? Email me — my contact info is at the bottom of this pageÂ
Tendon lengthening surgery does not fix brain or spinal cord damage, so spasticity can return or shift to other muscles over time. Without proper follow-up care, tightness may come back. One example is that I need to attend a follow-up appointment every three months at the Spasticity Clinic here in San Jose, and I have been doing so every three months for the past eight years for spasticity and tone management, as seen in this photo.
 Want to contribute?
