Cramps

Jai Ganesh · 2025-01-23 17:39:39

Cramps

Gist

Cramps are usually harmless but may sometimes be symptomatic of an underlying medical disorder, such as atherosclerosis (narrowing of the arteries). Regular cramping or severe cramping that lasts longer than a few minutes should always be investigated by your doctor.

A muscle cramp can happen after working a muscle too hard or straining it, losing body fluids through sweat or simply holding a position for a long time. Often, however, the cause isn't known. Most muscle cramps are harmless.

A muscle cramp is a sudden, unexpected tightening of one or more muscles. Sometimes called a charley horse, a muscle cramp can be very painful. Exercising or working hard, especially in heat, can lead to muscle cramps.

Summary

Muscle cramps are sudden, involuntary contractions that occur in various muscles. These contractions are often painful and can affect different muscle groups.

Muscles affected by cramps are often those in the back of your lower leg, the back of your thigh, and the front of your thigh.

You may also experience cramps in your:

* abdominal wall
* arms
* hands
* feet

The intense pain of a cramp can awaken you at night or make it difficult to walk.

A sudden, sharp pain, lasting from a few seconds to 15 minutes, is the most common symptom of a muscle cramp. In some cases, a bulging lump of muscle tissue beneath the skin can accompany a cramp as well.

Causes of muscle cramps

Muscle cramps have several causes. Some cramps result from overuse of your muscles. This typically occurs while you’re exercising.

Muscle injuries and dehydration can also trigger cramps. Dehydration is the excessive loss of fluids in the body.

Low levels of any of the following minerals that contribute to healthy muscle function may also cause muscle cramps:

* calcium
* potassium
* sodium
* magnesium

Low blood supply to your legs and feet can cause cramping in those areas when you exercise, walk, or participate in physical activities.

In some cases, a medical condition can cause muscle cramps. These conditions include:

* spinal nerve compression, which can cause muscle cramps in your legs when walking or standing
* alcoholism
* pregnancy
* kidney failure
* hypothyroidism, or low thyroid gland function

Other times, the cause of muscle cramps is unknown.

Diagnosis

Muscle cramps are usually harmless and don’t require medical attention. However, you should see a doctor if your muscle cramps are severe, don’t improve with stretching, or persist for a long time. This could be a sign of an underlying medical condition.

To learn the cause of muscle cramps, your doctor will perform a physical examination. They may ask you questions, such as:

* How often do your muscle cramps occur?
* Which muscles are affected?
* Do you take any medications?
* Do you drink alcohol?
* What are your exercise habits?
* How much liquid do you drink on a daily basis?

You may also need a blood test to check the levels of potassium and calcium in your blood, as well as your kidney and thyroid function. You may also take a pregnancy test.

Your doctor may order an electromyography (EMG). This is a test that measures muscle activity and checks for muscle abnormalities. An MRI may also be a helpful test. It’s an imaging tool that creates a picture of your spinal cord.

On occasion, a myelogram, or myelography, another imaging study, might be helpful.

Let your doctor know if you’re experiencing weakness, pain, or a loss of sensation. These symptoms can be signs of a nerve disorder.

Details

A cramp is a sudden, involuntary, painful skeletal muscle contraction or overshortening associated with electrical activity; while generally temporary and non-damaging, they can cause significant pain and a paralysis-like immobility of the affected muscle. A cramp usually goes away on its own over a period of several seconds or (sometimes) minutes. Cramps are common and tend to occur at rest, usually at night (nocturnal leg cramps). They are also often associated with pregnancy, physical exercise or overexertion, and age (common in older adults); in such cases, cramps are called idiopathic, because there is no underlying pathology. In addition to those benign conditions cramps are also associated with many pathological conditions.

Cramp definition is narrower than the definition of muscle spasm: spasms include any involuntary abnormal muscle contractions, while cramps are sustained and painful. True cramps can be distinguished from other cramp-like conditions. Cramps are different from muscle contracture, which is also painful and involuntary, but which is electrically silent. The main distinguishing features of cramps from dystonia are suddenness with acute onset of pain, involvement of only one muscle and spontaneous resolution of cramps or their resolution after stretching the affected muscle. Restless leg syndrome is not considered the same as muscle cramps and should not be confused with rest cramps.

Causes

Skeletal muscle cramps may be caused by muscle fatigue or a lack of electrolytes such as sodium (a condition called hyponatremia), potassium (called hypokalemia), or magnesium (called hypomagnesemia). Some skeletal muscle cramps do not have a known cause. Motor neuron disorders (e.g., amyotrophic lateral sclerosis), metabolic disorders (e.g., liver failure), some medications (e.g., diuretics and inhaled beta‐agonists), and haemodialysis may also cause muscle cramps.

Causes of cramping include hyperflexion, hypoxia, exposure to large changes in temperature, dehydration, or low blood salt. Muscle cramps can also be a symptom or complication of pregnancy; kidney disease; thyroid disease; hypokalemia, hypomagnesemia, or hypocalcaemia (as conditions); restless legs syndrome; varicose veins; and multiple sclerosis.

As early as 1965, researchers observed that leg cramps and restless legs syndrome can result from excess insulin, sometimes called hyperinsulinemia.

Skeletal muscle cramps

Under normal circumstances, skeletal muscles can be voluntarily controlled. Skeletal muscles that cramp the most often are the calves, thighs, and arches of the foot, and in North America are sometimes called a "Charley horse" or a "corky". Such cramping is associated with strenuous physical activity and can be intensely painful; however, they can even occur while inactive and relaxed. Around 40% of people who experience skeletal cramps are likely to endure extreme muscle pain, and may be unable to use the entire limb that contains the "locked-up" muscle group. It may take up to a week for the muscle to return to a pain-free state, depending on the person's fitness level, age, and several other factors.

Nocturnal leg cramps

Nocturnal leg cramps are involuntary muscle contractions that occur in the calves, soles of the feet, or other muscles in the body during the night or (less commonly) while resting. The duration of nocturnal leg cramps is variable, with cramps lasting anywhere from a few seconds to several minutes. Muscle soreness may remain after the cramp itself ends. These cramps are more common in older people. They happen quite frequently in teenagers and in some people while exercising at night. Besides being painful, a nocturnal leg cramp can cause much distress and anxiety. The precise cause of these cramps is unclear. Potential contributing factors include dehydration, low levels of certain minerals (magnesium, potassium, calcium, and sodium, although the evidence has been mixed), and reduced blood flow through muscles attendant in prolonged sitting or lying down. Nocturnal leg cramps (almost exclusively calf cramps) are considered "normal" during the late stages of pregnancy. They can, however, vary in intensity from mild to extremely painful.

A lactic acid buildup around muscles can trigger cramps; however, they happen during anaerobic respiration when a person is exercising or engaging in an activity where the heartbeat rises. Medical conditions associated with leg cramps are cardiovascular disease, hemodialysis, cirrhosis, pregnancy, and lumbar canal stenosis. Differential diagnoses include restless legs syndrome, claudication, myositis, and peripheral neuropathy. All of them can be differentiated through careful history and physical examination.

Gentle stretching and massage, putting some pressure on the affected leg by walking or standing, or taking a warm bath or shower may help to end the cramp. If the cramp is in the calf muscle, dorsiflexing the foot (lifting the toes back toward the shins) will stretch the muscle and provide almost immediate relief. There is limited evidence supporting the use of magnesium, calcium channel blockers, carisoprodol, and vitamin B12.

Quinine is no longer recommended for treatment of nocturnal leg cramps due to potential fatal hypersensitivity reactions and thrombocytopenia. Arrhythmias, cinchonism, and hemolytic uremic syndrome can also occur at higher dosages.

Cramps caused by treatments

Various medications may cause nocturnal leg cramps:

* Diuretics, especially potassium sparing
* Intravenous (IV) iron sucrose
* Conjugated estrogens
* Teriparatide
* Naproxen
* Raloxifene
* Long acting adrenergic beta-agonists (LABAs)
* Hydroxymethylglutaryl-coenzyme A reductase inhibitors (HMG-CoA inhibitors or statins)

Statins may sometimes cause myalgia and cramps among other possible side effects. Raloxifene (Evista) is a medication associated with a high incidence of leg cramps. Additional factors, which increase the probability for these side effects, are physical exercise, age, history of cramps, and hypothyroidism. Up to 80% of athletes using statins experience significant adverse muscular effects, including cramps; the rate appears to be approximately 10–25% in a typical statin-using population. In some cases, adverse effects disappear after switching to a different statin; however, they should not be ignored if they persist, as they can, in rare cases, develop into more serious problems. Coenzyme Q10 supplementation can be helpful to avoid some statin-related adverse effects, but currently there is not enough evidence to prove the effectiveness in avoiding myopathy or myalgia.

Treatment

Stretching, massage, and drinking plenty of liquids may be helpful in treating simple muscle cramps.

Medication

The antimalarial drug quinine is a traditional treatment that may be slightly effective for reducing the number of cramps, the intensity of cramps, and the number of days a person experiences cramps. Quinine has not been shown to reduce the duration (length) of a muscle cramp. Quinine treatment may lead to haematologic and cardiac toxicity. Due to its low effectiveness and negative side effects, its use as a medication for treating muscle cramps is not recommended by the FDA.

Magnesium is commonly used to treat muscle cramps. Moderate quality evidence indicates that magnesium is not effective for treating or preventing cramps in older adults. It is not known if magnesium helps cramps due to pregnancy, liver cirrhosis, other medical conditions, or exercising. Oral magnesium treatment does not appear to have significant major side effects, however, it may be associated with diarrhea and nausea in 11–37% of people who use this medicine.

With exertional heat cramps due to electrolyte abnormalities (primarily potassium loss and not calcium, magnesium, and sodium), appropriate fluids and sufficient potassium improves symptoms. Vitamin B complex, naftidrofuryl, lidocaine, and calcium channel blockers may be effective for muscle cramps.

Prevention

/Adequate conditioning, stretching, mental preparation, hydration, and electrolyte balance are likely helpful in preventing muscle cramps.

Additional Information

Cramp is a painful, involuntary, and sustained contraction of muscle, most common in the limbs but also affecting certain internal organs. Examples of cramping include menstrual cramps and spasms of the circular muscles of the bowel (irritable colon), blood vessels (vasospasm), and pylorus of the stomach (pylorospasm; the pylorus is the opening from the stomach to the intestine).

Cramps of the muscles of the extremities may occur in a variety of circumstances. Overexertion in cold water is responsible for swimmer’s cramp of the legs or stomach, and the accompanying severe pain and temporary paralysis may lead to drowning unless the individual is rescued immediately. Severe cramp in the calf of a leg can awaken people from a sound sleep. The origin may be overstretching or strain of the affected muscle on the previous day, unconscious tensing of the muscle during sleep, or, especially in older individuals, poor circulation. Toe cramps are usually less painful than leg cramps.

Menstrual cramps, which involve contractions of the uterine muscle, occur before or during menstruation and may last from several hours to a day. They occur most commonly in younger women who have not had children. Heat cramps in the muscles of the extremities or abdomen stem from loss of salt after periods of profuse perspiration. Overexertion in a hot environment usually is responsible for this condition.

Professional or occupational cramp is a functional spasm affecting certain muscles that are used constantly in a daily occupation. At first there is a gradually increasing difficulty, or clumsiness, in making the movements required for the work at hand. Writers, for example, cannot move the pen or pencil with freedom, and the typist loses his dexterity in finding the right key on the keyboard. Painters, pianists, and tailors and seamstresses are other candidates for occupational cramp. Cramping usually fails to occur when the same muscles are employed in tasks not associated with the occupation, suggesting a psychological basis for the disorder. Indeed, there are many neurological, reflex, and psychological causes for muscle cramps.

Cramps are particularly bothersome in victims of Parkinson’s disease and Huntington’s chorea. Tetany (q.v.) is a severe form of cramping that is noticed first in muscles located in the extremities.

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#1 2025-01-23 17:39:39

Cramps

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