This article reviews the neuromuscular maladaptation in spastic muscles, including motor unit remodeling, muscle fiber changes, and the accumulation of hyaluronan in the extracellular matrix, and fibrosis of connective tissues and fascia thickening. It highlights how these neural and muscular changes interact and contribute to muscle stiffness, weakness, and contractures, limiting function and mobility. The article also examines the effects of spasticity interventions, such as botulinum toxin, phenol neurolysis, hyaluronidase, dry needling, and fasciotomy, on neuromuscular adaptations. Understanding neuromuscular maladaptation is crucial for tailoring individualized, multimodal treatment strategies that balance the reduction of spasticity.