614 - Botulinum Toxin for Spasticity Management in a Para-Athlete Sprinter with Cerebral Palsy: A Case Report

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SM

Sojeong Mun, MD

Doctor
Hallym University Sacred Heart Hospital
Santa Clara, California, United States

Co-Author(s)

KS

Kai Sheng Khor, MD

Postdoctoral Research Fellow
Johns Hopkins Hospital
Baltimore, Maryland, United States
MS

Melissa Schwartz, MD, MS

Resident
Johns Hopkins Hospital
Baltimore, Maryland, United States
CC

Cecilia Cordova-Vallejos, MD

Attending Physician
Johns Hopkins Hospital
Baltimore, Maryland, United States

Submitter(s)

SM

Sojeong Mun, MD

Hallym University Sacred Heart Hospital
Santa Clara, California, United States

Case Diagnosis: A 33-year-old para-athlete with spastic hemiplegic cerebral palsy (CP) presented with right-sided spasticity interfering with safe, efficient running. He received serial botulinum toxin injections to reduce functional barriers to training and competition.

Case Description: Before treatment, the patient showed right-sided spasticity worsening with exertion, causing asymmetric arm swing, right hip drop, impaired balance, and frequent falls after long-distance runs. Spasticity hindered sprint starts, sustained pacing, and safety. He was unable to maintain a three-point stance or perform split squats and bounding drills due to right leg buckling and coordination deficits.

He underwent botulinum toxin injections every three months from August 2024 to June 2025, titrated from 200 to 300 units. Target muscles included the rectus femoris, iliopsoas, tensor fascia lata, and hip adductors. Following treatment, he achieved full-depth split squats, held a three-point stance for 15-20 seconds, and increased box jump height by three inches. He no longer collapsed after races and reported improved hip drive with reduced limb tightness. 400-meter time improved by 0.5 seconds. Daily function was enhanced, including easier stair climbing. Overall satisfaction was rated 8-9/10, with no adverse effects reported.

Discussions: While botulinum toxin is known to improve gait in individuals with CP, few reports have examined its effects on running, especially in para-athletes. This case suggests that functionally targeted injections may be a safe and effective intervention for spasticity-related impairments in CP runners, improving range of motion, coordination, and motor control. Outcomes were based on patient-reported data and functional tasks, as validated tools for assessing running-specific spasticity are lacking. Upper limb spasticity persisted, as injections were directed toward the lower limbs. Future guidelines are warranted to support spasticity management in CP para-athletes.

Conclusions: Targeted botulinum toxin injections reduced spasticity-related impairments and supported safer training in a high-functioning CP para-athlete.