Botulinum toxin (Botox) injection for spasticity
An injection of botulinum toxin into specific overactive muscles to relax them temporarily, used alongside therapy when stiffness in a few muscles is causing problems.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Botulinum toxin relaxes specific overactive muscles temporarily — it suits stiffness focused in a few muscles, not widespread spasticity.
- The effect wears off over about 3–4 months and is repeated; it is not a permanent cure.
- It works best combined with stretching, splinting and therapy, which make the most of the reduced stiffness.
- It is targeted and usually well tolerated, but it should follow clear, agreed goals and be given by a trained specialist.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Relaxes specific overactive muscles, easing tightness and spasm.
Widespread spasticity affecting many muscles is usually better managed with oral medicines or other approaches, as botulinum toxin is targeted to a few...
Minor soreness or small marks at the injection sites. You can usually return to normal activities straight away.
A clear, goal-based plan with therapy and splinting arranged around the injection.
Minor soreness or small marks at the injection sites. You can usually return to normal activities straight away.
The muscle-relaxing effect begins. A short-lived flu-like feeling is occasionally reported. From about this time...
The effect reaches its peak. This is often when therapy, stretching and splinting make the most difference.
The effect is at its most useful, then gradually starts to fade.
What is a botulinum toxin (Botox) injection for spasticity?
Botulinum toxin (often known by brand names such as Botox, Dysport or Xeomin) is a medicine injected into specific muscles to relax them. For spasticity, it is used when stiffness or spasm is focused in a few muscles and is causing problems — for example a tightly clenched hand, a bent elbow, or a foot that turns in and makes walking or shoes difficult.
The injection works by temporarily blocking the nerve signals that make the muscle overactive, so the muscle relaxes. It is targeted: it mainly affects the muscles injected, not the whole body, which is why it suits stiffness in a few specific muscles rather than widespread spasticity.
The effect is temporary. It usually starts within a few days, reaches its best at around two weeks, and wears off over roughly three to four months, so injections are repeated when they continue to help. It is not a one-off cure.
Crucially, the injection works best as part of a wider plan. It is given alongside stretching, splinting, positioning and therapy, which use the window of reduced stiffness to improve movement, comfort or care. On its own, without this physical work, the benefit is limited.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Upper limb injection
Into muscles of the shoulder, elbow, wrist, hand or fingers, for example to ease a clenched fist, bent elbow or tight wrist, helping with care, comfort or use of the arm.
Lower limb injection
Into muscles of the hip, thigh, calf or foot, for example to ease a stiff, inturned foot or tight calf, helping with standing, walking, footwear or positioning.
Guided injection
Ultrasound, electrical stimulation or EMG may be used to place the medicine accurately into the intended muscle, which can improve results and reduce unwanted spread.
Combined with a wider plan
Given alongside therapy, stretching, splinting or casting, and sometimes with oral medicines or nerve blocks as part of an overall spasticity plan.
Preparing for your procedure
- Discuss and agree clear goals with your specialist — what the injection is meant to improve.
- Bring a list of medicines and doses, and mention any blood-thinning medicines or bleeding problems.
- Tell the team about pregnancy or breastfeeding, any neuromuscular condition (such as myasthenia gravis or motor neurone disease), or a previous reaction to botulinum toxin.
- Mention any infection or skin problem over the muscles to be injected.
- Arrange any therapy, splinting or follow-up that should go alongside the injection.
- For children and young people, ask about numbing cream or other comfort measures. A young person who has enough understanding and the capacity to decide may consent for themselves; otherwise someone with parental responsibility (or another person with lawful authority) consents, while the child's own views and agreement are still sought.
- Wear clothing that allows easy access to the muscles being treated.
What happens
After examining you and confirming the goals, the specialist identifies the specific muscles to inject. They clean the skin and use a fine needle to inject small amounts of botulinum toxin into each target muscle. Ultrasound, electrical stimulation or EMG may be used to guide the needle accurately.
The procedure usually takes around 15–30 minutes and most people feel only brief discomfort, like small injections. There is normally no anaesthetic, though numbing cream may be used, particularly for children.
You can usually go home straight away and return to normal activities the same day. Therapy, stretching or splinting is often planned to start in the days afterwards, to make the most of the reduced stiffness.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Widespread spasticity affecting many muscles is usually better managed with oral medicines or other approaches, as botulinum toxin is targeted to a few muscles.
- A fixed contracture (a permanently shortened muscle or joint) will not respond and needs a different approach.
- Certain neuromuscular conditions (such as myasthenia gravis or motor neurone disease) make botulinum toxin unsuitable or higher risk.
- Infection or skin breakdown over the target muscles, or a previous serious reaction to the medicine.
- If there are no clear functional, care or comfort goals, injection may not be justified.
Delay or rearrange if…
- There is active infection at or near the injection site.
- You are pregnant or breastfeeding, where treatment is generally avoided unless specifically advised.
- Goals have not been agreed, so it is unclear which muscles to target or why.
- Aggravating factors such as a urine infection or constipation are temporarily worsening the spasticity.
- There is a bleeding problem or blood-thinning medicine that needs review first.
Alternatives to discuss
- Physical management alone — stretching, positioning, splinting and therapy.
- Oral spasticity medicines for more widespread stiffness.
- A nerve block for selected muscles or larger muscle groups.
- Specialist intrathecal baclofen pump assessment for severe, widespread spasticity.
- No injection if the stiffness is mild, useful, or better treated another way.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Relaxes specific overactive muscles, easing tightness and spasm.
- Can make washing, dressing, hand-opening, positioning or footwear easier.
- May reduce pain caused by tight muscles.
- Can improve a limb's position or, for some, its function or walking.
- Targeted action means the rest of the body is largely unaffected.
- Creates a window for therapy to improve movement and prevent contractures.
Risks & complications
- Mild soreness, bruising or small marks where the needle went in.
- More weakness than wanted in the injected muscle for a time.
- The effect wearing off over a few months, needing repeat treatment.
- Not every goal being fully met, so the dose or muscles chosen may be adjusted next time.
- Temporary flu-like feeling for a few days.
- Weakness spreading slightly to nearby muscles.
- Difficulty with fine tasks if a hand muscle becomes weaker than intended.
- Local infection at an injection site (uncommon with clean technique).
- The toxin's effect spreading beyond the injected muscles (a rare condition called iatrogenic botulism), causing difficulty swallowing or breathing, slurred speech, severe eyelid droop or generalised weakness. This usually starts about 4 to 8 days after treatment but can occur up to 4 weeks later — seek urgent help if it happens, especially after neck or upper-body injections.
- An allergic reaction to the medicine.
- Over time, occasionally a reduced response if the body forms antibodies.
Botulinum toxin is generally well tolerated and the dose is limited, but the main issues are temporary local weakness, the need to repeat treatment, and — rarely — the effect spreading beyond the target muscles. Tell your specialist about any neuromuscular condition or swallowing problems, and ask what to watch for. Targeting the right muscles, by a trained specialist, and pairing the injection with therapy, matters most.
Published figures to discuss
Botulinum toxin for spasticity is generally well tolerated, but exact complication rates vary by dose, muscles injected, technique and the underlying condition, and we will not invent precise figures. The most relevant points for patients are that local weakness and the need to repeat treatment are expected, while serious spread of effect (causing swallowing or breathing problems) is rare but important to recognise quickly. Response also varies between people and may lessen over time in a minority.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Temporary weakness in injected or nearby muscles | Common treatment effect | Weakness may be useful for reducing spasticity but can worsen transfers, grip or walking if goals are not clear. | MHRA — botulinum toxin type A: iatrogenic botulism warning (July 2026)gov.ukSource-linked context |
| Benefit wears off | Expected over about 3 months | Botulinum toxin is temporary and usually needs therapy, splinting or repeat injections to maintain gains. | Guide sourcesClinical context |
| Swallowing, breathing or generalised weakness | Rare but serious | Risk depends on dose, muscles treated and underlying neurological disease; urgent advice is needed if these symptoms occur. | MHRA — botulinum toxin type A: iatrogenic botulism warning (July 2026)gov.ukSource-linked context |
| Injection without therapy plan | Common failure mode | National spasticity guidance emphasises goal-setting and adjunctive therapy rather than injections alone. | MHRA — botulinum toxin type A: iatrogenic botulism warning (July 2026)gov.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is little physical recovery from the injection itself. 'Afterwards' is about the medicine taking effect over days, the therapy planned around it, and the effect gradually wearing off over a few months.
- Brief soreness or small bruises at the injection sites.
- The muscle gradually softening over the first days to two weeks.
- A feeling that the limb is looser or, sometimes, a little weaker.
- The effect slowly wearing off over a few months.
- Best results when stretches, splinting and therapy are kept up.
Aftercare
- Keep up the stretches, splinting, positioning and therapy planned around the injection — this is what makes it work.
- Move normally; there is usually no need to rest the limb.
- Watch the injection sites for the rare signs of infection (spreading redness, heat, swelling).
- Note what improves and what does not, to guide the next treatment.
- Report any difficulty swallowing or breathing, slurred speech, severe drooping eyelids or spreading weakness urgently — these signs of the toxin spreading can appear from about 4 days up to 4 weeks after treatment, especially after upper-body injections.
- Continue any oral spasticity medicines unless told otherwise.
- Attend your review so the effect and goals can be assessed.
- Clear, agreed goals for the injection
- Therapy, stretching or splinting arranged to follow
- An up-to-date medicines list, including any blood thinners
- Pregnancy, breastfeeding or neuromuscular conditions flagged
- A note of how the limb is before treatment, to compare after
- Knowing the warning signs to report urgently
- A review appointment booked
Scars and how they heal
There are no surgical scars. You may have a few tiny needle marks and occasional small bruises where the injections were given, which fade within days. No stitches or wound care are needed.
⚠ Get urgent help if…
- Signs that the toxin's effect has spread through the body (a rare condition called iatrogenic botulism): difficulty swallowing, slurred speech, severe drooping of the eyelids, double vision, generalised muscle weakness, or breathing problems. These usually appear about 4 to 8 days after treatment but can start at any time up to 4 weeks later. Seek urgent medical help straight away — this is more likely after neck or upper-body injections.
- Widespread or worsening muscle weakness beyond the area injected.
- Spreading redness, heat, swelling or discharge at an injection site (possible infection).
- A rash, facial swelling or breathing difficulty soon after the injection (possible allergy).
- Severe or unexpected weakness that affects safety, such as with walking or transfers.
- Any new symptom that worries you in the days after treatment.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result is meeting the agreed goal — for example an easier-to-open hand, a straighter foot, less pain, or easier care — during the months the injection is active, with therapy used to lock in as much benefit as possible. The effect peaks at around two weeks.
The injection cannot cure the underlying condition, and it does not work on a fixed contracture (a permanently shortened muscle or joint). Its effect is temporary, so repeat treatment is usually needed, and results vary from person to person depending on which muscles are involved and how therapy is combined with it.
The effect of each injection lasts roughly three to four months, after which it can be repeated if it is still helping and goals support continuing. To reduce the risk of the body becoming less responsive over time, specialists generally avoid injecting more often than about every three months. Over the longer term, needs are reviewed and treatment continued, changed or stopped accordingly.
Related tests, treatments or support
Botulinum toxin is almost always combined with physiotherapy, stretching, splinting or casting, which use the period of reduced stiffness to improve movement and prevent contractures. It may be used alongside oral spasticity medicines for more widespread stiffness, or with a nerve block for other muscles, as part of an overall plan coordinated by a rehabilitation team.
Follow-up & long-term care
You will usually be reviewed a few weeks after the injection to assess the effect against your goals, and again as it wears off to decide about repeating. Therapy continues alongside. Your specialist adjusts the dose or the muscles chosen at future sessions based on how you responded.
- Repeat injections, typically no more often than about every three months, when they continue to help.
- Ongoing stretching, splinting and therapy between injections.
- Review of goals and response at each cycle.
- Adjustment of dose or target muscles over time.
- Continued management of any widespread spasticity with other treatments.
Repeat, follow-on and what comes next
- Treatment is repeated, typically no more often than about every three months, when it continues to help.
- Dose and target muscles are commonly adjusted between sessions based on response.
- If a session does not meet goals, the plan is reassessed rather than simply repeated unchanged.
- A minority of people respond less well over time, sometimes due to antibody formation, prompting a review of options.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear, goal-based plan with therapy and splinting arranged around the injection.
- Review a few weeks later to assess the effect against goals.
- Clear written warning signs, especially about swallowing and breathing.
- A plan for repeating, adjusting or stopping treatment based on response.
- A named contact and joined-up communication with your team and GP.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The number of muscles and injection sessions needed.
- The dose and brand of botulinum toxin used.
- Whether ultrasound, electrical stimulation or EMG guidance is used.
- The specialist's fee and the clinic or facility fee.
- Therapy, splinting or equipment provided alongside, usually charged separately.
- How often injections need repeating and the frequency of review.
- The fee for each injection session, including the medicine.
- Whether injection guidance (ultrasound/stimulation/EMG) is included.
- What therapy or splinting is included or charged separately.
- How often repeat injections are expected and their cost.
- Whether a written plan and a letter to your GP are included.
- How review appointments are arranged and charged.
- What happens, and any cost, if the injection does not achieve the goal.
On the NHS? Botulinum toxin for focal spasticity is available on the NHS through specialist services when clinically indicated; private treatment is generally used for faster access or more choice rather than because it is unavailable on the NHS.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Promising a permanent result when the effect is temporary and repeated.
- Injecting without clear, agreed functional or comfort goals.
- Not arranging the therapy and splinting that make the injection work.
- Not warning about temporary local weakness or the rare risk of spread.
- Not checking for neuromuscular conditions or pregnancy before treating.
Marketing red flags
- Presenting the injection as a one-off 'cure' for spasticity.
- Offering injections without therapy, goals or specialist assessment.
- Downplaying that the effect wears off and needs repeating.
- No discussion of who is suitable, side effects or warning signs.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Which muscles will you inject, and what specific goal are we aiming for?
- How will the injection be guided to the right muscle?
- What therapy or splinting should I do afterwards to get the best result?
- How long should it last, and when would we repeat it?
- What side effects should I expect, and what should I report urgently?
- What is the plan if this injection does not achieve the goal?
- Is there any reason botulinum toxin is not suitable for me?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is this the same Botox used for wrinkles?
How long does it last?
Will it cure my spasticity?
Does it hurt?
Why do I still need physiotherapy?
Is it available on the NHS?
Who gives consent when the patient is a child or young person?
Can the effect spread to other muscles?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: RCP/BSRM — Spasticity in adults: management using botulinum toxin (national guidelines) Stroke Association — Spasticity and contractures MS Society — Treating spasms and stiffness NHS (East and North Herts) — Botulinum toxin injection for spasticity Electronic Medicines Compendium (emc) — Botox (onabotulinumtoxinA) information MHRA — botulinum toxin type A: iatrogenic botulism warning (July 2026) Scottish Government — children's consent guidance (Children (Scotland) Act 1995) Welsh Government — children's consent to specialist services (guidance for professionals)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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