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Horrible Muscle Cramps Causes, Cramping Prevention, Treatment ..

Muscle cramps facts

A muscle cramp is an involuntarily and forcibly contracted muscle that does not relax.
Almost everyone experiences a muscle cramp at some time in their life.
There are a variety of types and causes of muscle cramps.
Numerous medicines can cause muscle cramps.
Most muscle cramps can be stopped if the muscle can be stretched.
Muscle cramps can often be prevented by measures such as adequate nutrition and hydration, attention to safety when exercising, and attention to ergonomic factors.

What are muscle cramps?

A muscle cramp is an involuntarily and forcibly contracted muscle that does not relax. When we use the muscles that can be controlled voluntarily, such as those of our arms and legs, they alternately contract and relax as we move our limbs. Muscles that support our head, neck, and trunk contract similarly in a synchronized fashion to maintain our posture. A muscle (or even a few fibers of a muscle) that involuntarily (without consciously willing it) contracts is in a "spasm." If the spasm is forceful and sustained, it becomes a cramp. Muscle cramps often cause a visible or palpable hardening of the involved muscle.
Muscle cramps can last anywhere from a few seconds to a quarter of an hour or occasionally longer. It is not uncommon for a cramp to recur multiple times until it finally resolves. The cramp may involve a part of a muscle, the entire muscle, or several muscles that usually act together, such as those that flex adjacent fingers. Some cramps involve the simultaneous contraction of muscles that ordinarily move body parts in opposite directions.
Muscle cramps are extremely common. Almost everyone (one estimate is about 95%) experiences a cramp at some time in their life. Muscle cramps are common in adults and become increasingly frequent with aging. However, children also experience cramps of muscles.
Any of the muscles that are under our voluntary control (skeletal muscles) can cramp. Cramps of the extremities, especially the legs and feet, and most particularly the calf (the classic "charley horse"), are very common. Involuntary muscles of the various organs (uterus, blood vessel wall, bowels, bile and urine passages, bronchial tree, etc.) are also subject to cramps. Cramps of the involuntary muscles will not be further considered in this review. This article focuses on cramps of skeletal muscle.

What are the types and causes of muscle cramps?

Skeletal muscle cramps can be categorized into four major types. These include "true" cramps, tetany, contractures, and dystonic cramps. Cramps are categorized according to their different causes and the muscle groups they affect.

True cramps

True cramps involve part or all of a single muscle or a group of muscles that generally act together, such as the muscles that flex several adjacent fingers. Most authorities agree that true cramps are caused by hyperexcitability of the nerves that stimulate the muscles. They are overwhelmingly the most common type of skeletal muscle cramps. True cramps can occur in a variety of circumstances as follows.

Injury: Persistent muscle spasm may occur as a protective mechanism following an injury, such as a broken bone. In this instance, the spasm tends to minimize movement and stabilize the area of injury. Injury of the muscle alone may cause the muscle to spasm.

Vigorous activity: True cramps are commonly associated with the vigorous use of muscles and muscle fatigue (in sports or with unaccustomed activities). Such cramps may come during the activity or later, sometimes many hours later. Likewise, muscle fatigue from sitting or lying for an extended period in an awkward position or any repetitive use can cause cramps. Older adults are at risk for cramps when performing vigorous or strenuous physical activities.

Rest cramps: Cramps at rest are very common, especially in older adults, but may be experienced at any age, including childhood. Rest cramps often occur during the night. While not life threatening, night cramps (commonly known as nocturnal cramps) can be painful, disruptive of sleep, and they can recur frequently (that is, many times a night, and/or many nights each week). The actual cause of night cramps is unknown. Sometimes, such cramps are initiated by making a movement that shortens the muscle. An example is pointing the toe down while lying in bed, which shortens the calf muscle, a common site of muscle cramps.

Dehydration: Sports and other vigorous activities can cause excessive fluid loss from perspiration. This kind of dehydration increases the likelihood of true cramps. These cramps are more likely to occur in warm weather and can be an early sign of heat stroke. Chronic volume depletion of body fluids from diuretics (medicine that promote urination) and poor fluid intake may act similarly to predispose to cramps, especially in older people. Sodium depletion has also been associated with cramps. Loss of sodium, the most abundant chemical constituent of body fluids outside the cell, is usually a function of dehydration.

Body fluid shifts: True cramps also may be experienced in other conditions that feature an unusual distribution of body fluids. An example is cirrhosis of the liver, which leads to the accumulation of fluid in the abdominal cavity (ascites). Similarly, cramps are a relatively frequent complication of the rapid body fluid changes that occur during dialysis for kidney failure.

Low blood calcium, magnesium: Low blood levels of either calcium or magnesium directly increase the excitability of both the nerve endings and the muscles they stimulate. This may be a predisposing factor for the spontaneous true cramps experienced by many older adults, as well as for those that are commonly noted during pregnancy. Low levels of calcium and magnesium are common in pregnant women unless these minerals are supplemented in the diet. Cramps are seen in any circumstance that decreases the availability of calcium or magnesium in body fluids, such as taking diuretics, hyperventilation (overbreathing), excessive vomiting, inadequate calcium and/or magnesium in the diet, inadequate calcium absorption due to vitamin D deficiency, poor function of the parathyroid glands (tiny glands in the neck that regulate calcium balance), and other conditions.

Low potassium: Low potassium blood levels occasionally cause muscle cramps, although it is more common for low potassium to be associated with muscle weakness.

Tetany

In tetany, all of the nerve cells in the body are activated, which then stimulate the muscles. This reaction causes spasms or cramps throughout the body. The name tetany is derived from the effect of the tetanus toxin on the nerves. However, the name is now commonly applied to muscle cramping from other conditions, such as low blood levels of calcium and magnesium. Low calcium and low magnesium, which increase the activity of nerve tissue nonspecifically, also can produce tetanic cramps. Often, such cramps are accompanied by evidence of hyperactivity of other nerve functions in addition to muscle stimulation. For instance, low blood calcium not only causes spasm of the muscles of the hands and wrists, but it can also cause a sensation of numbness and tingling around the mouth and other areas.

Sometimes, tetanic cramps are indistinguishable from true cramps. The accompanying changes of sensation or other nerve functions that occurs with tetany may not be apparent because the cramp pain is masking or distracting from it.

Contractures

Contractures result when the muscles are unable to relax for an even more extended period than a common muscle cramp. The constant spasms are caused by a depletion of adenosine triphosphate (ATP), an energy chemical within the cell. This prevents muscle fiber relaxation. The nerves are inactive in this form of muscle spasm.

Contractures can result from inherited (for example, McArdle's disease, which is a defect of the breakdown of glycogen to sugar within the muscle cell) or from acquired conditions (for example, hyperthyroid myopathy, which is a muscle disease that is associated with an overactive thyroid). Cramps of this category are uncommon.

Dystonic cramps

The final category is dystonic cramps, in which muscles that are not needed for the intended movement are stimulated to contract. Muscles that are affected by this type of cramping include those that ordinarily work in the opposite direction of the intended movement, and/or others that exaggerate the movement. Some dystonic cramps usually affect small groups of muscles (eyelids, jaws, neck, larynx, etc.). The hands and arms may be affected during the performance of repetitive activities such as those associated with handwriting (writer's cramp), typing, playing certain musical instruments, and many others. Each of these repetitive activities may also produce true cramps from muscle fatigue. Dystonic cramps are not as common as true cramps.

Do all muscle cramps fit into the above categories?

No. Not all cramps are readily categorized in the preceding manner since these categories best apply to cramps that make up an individual's major muscle problem. Many cramps are a relatively minor part of nerve and muscle diseases; other muscle symptoms are usually more prominent in these diseases. Some examples include amyotrophic lateral sclerosis (Lou Gehrig's disease) with weakness and muscle wasting; radiculopathy (spinal nerve irritation or compression from various causes) with pain, distortion or loss of sensation, and/or weakness; diseases of the peripheral nerves, such as diabetic neuropathy, with distorted and diminished sensation and weakness; and a number of primarily dystonic muscle diseases.

Can medications cause muscle cramps?

Numerous medicines can cause cramps. Potent diuretic medications, such as furosemide (Lasix), or the vigorous removal of body fluids, even with less potent diuretics, can induce cramps by depleting body fluid and sodium. Simultaneously, diuretics often cause the loss of potassium, calcium, and magnesium, which can also cause cramps.

Medications such as donepezil (Aricept, used for Alzheimer's disease) and neostigmine (Prostigmine and others, used for myasthenia gravis) as well as raloxifene (Evista, used to prevent osteoporosis in postmenopausal women) have caused cramps. Tolcapone (Tasmar, used for Parkinson's disease) reportedly causes muscle cramps in at least 10% of patients. True cramps have been reported with nifedipine (Procardia and others, used for angina, high blood pressure and other conditions) and the asthma drugs terbutaline (Brethine) and albuterol (Proventil, Ventolin, and others). Some medicines used to lower cholesterol, such as lovastatin (Mevacor), can also lead to cramps.

Cramps are sometimes noted in addicted individuals during withdrawal from medications and substances that have sedative effects, including alcohol, barbiturates and other sedatives, anti-anxiety agents such as benzodiazepines (for example, diazepam [Valium] and alprazolam [Xanax]), narcotics, and other drugs.

Can vitamin deficiencies cause muscle cramps?

Several vitamin deficiency states may directly or indirectly lead to muscle cramps. These include deficiencies of thiamine (B1), pantothenic acid (B5), and pyridoxine (B6). The precise role of deficiency of these vitamins in causing cramps is unknown.

Can poor circulation cause muscle cramps?

Poor circulation to the legs, which results in inadequate oxygen to the muscle tissue, can cause severe pain in the muscle (sometimes known as claudication pain or intermittent claudication) that occurs with walking or exercise. This commonly occurs in the calf muscles. While the pain feels virtually identical to that of a severely cramped muscle, the pain does not seem to be a result of the actual muscle cramping. This pain may be due to accumulation of lactic acid and other chemicals in the muscle tissues. It's important to see your doctor if you have pain like this.

What are the symptoms of common muscle cramps? How muscle cramps diagnosed?

Characteristically, a cramp is painful, often severely so. Usually, the sufferer must stop whatever activity is under way and seek relief from the cramp; the person is unable to use the affected muscle while it is cramping. Severe cramps may be associated with soreness and swelling, which can occasionally persist up to several days after the cramp has subsided. At the time of cramping, the knotted muscle will bulge, feel very firm, and may be tender.
There are no special tests for cramps. Nevertheless, the diagnosis of muscle cramps is relatively easy. Most people know what cramps are and when they have one. If present during a cramp, the doctor, or any other bystander, can feel the tense, firm bulge of the cramped muscle.

What is the treatment of skeletal muscle cramps?

Most cramps can be stopped if the muscle can be stretched. For many cramps of the feet and legs, this stretching can often be accomplished by standing up and walking around. For a calf muscle cramp, the person can stand about 2 to 2.5 feet from a wall (possibly farther for a tall person) and lean into the wall to place the forearms against the wall with the knees and back straight and the heels in contact with the floor. (It is best to learn this maneuver at a time when you don't have the cramp.) Another technique involves flexing the ankle by pulling the toes up toward the head while still lying in bed with the leg as straight as possible. For writer's cramp (contractures in the hand), pressing the hand on a wall with the fingers facing down will stretch the cramping finger flexor muscles.

Gently massaging the muscle will often help it to relax, as will applying warmth from a heating pad or hot soak. If the cramp is associated with fluid loss, as is often the case with vigorous physical activity, fluid and electrolyte (especially sodium and potassium) replacement is essential. Medicines generally are not needed to treat an ordinary cramp that is active since most cramps subside spontaneously before enough medicine would be absorbed to even have an effect.

Muscle relaxant medications may be used over the short-term in certain situations to relax muscle cramps due to an injury or other temporary event. These medications include cyclobenzaprine (Flexeril), orphenadrine (Norflex), and baclofen (Lioresal).

In recent years, injections of therapeutic doses of botulism toxin (Botox) have been used successfully for some dystonic muscle disorders that are localized to a limited group of muscles. A good response may last several months or more, and the injection may then be repeated.

The treatment of cramps that are associated with specific medical conditions generally focuses on treating the underlying condition. Sometimes, additional medications specifically for cramps are prescribed with certain of these conditions.

Of course, if cramps are severe, frequent, persistent, respond poorly to simple treatments, or are not associated with an obvious cause, then the patient and the doctor need to consider the possibility that more intensive treatment is indicated or that the cramps are a manifestation of another disease. As described above, the possibilities are extremely varied and include problems with circulation, nerves, metabolism, hormones, medications, and nutrition. It is uncommon for muscle cramps to occur as the result of a medical condition without other obvious signs that the medical condition is present.

Cramps are inevitable, but if possible, it would be best to prevent them.

How can muscle cramps be prevented?

Activity: Authorities recommend stretching before and after exercise or sports, along with an adequate warm-up and cooldown, to prevent cramps that are caused by vigorous physical activity. Good hydration before, during, and after the activity is important, especially if the duration exceeds one hour, and replacement of lost electrolytes (especially sodium and potassium, which are major components of perspiration) can also be helpful. Excessive fatigue, especially in warm weather, should be avoided.

How much should I drink?

Hydration guidelines should be individualized for each person. The goal is to prevent excessive weight loss (>2% of body weight). You should weigh yourself before and after exercise to see how much fluid you lose through sweat. One liter of water weighs 2.25 pounds. Depending on the amount of exercise, temperature and humidity, body weight, and other factors, you can lose anywhere from approximately .4 to 1.8 liters per hour.

Pre-exercise hydration (if needed):

1. 0.5 liters per hour for a 180-pound person several hours (three to four hours) prior to exercise. 2. Consuming beverages with sodium and/or small amounts of salted snacks or sodium-containing foods at meals will help to stimulate thirst and retain the consumed fluids. During exercise:

there is inadequate access to meals or meals are not eaten,
physical activity exceeds four hours in duration,
during the initial days of hot weather.

Under these conditions, adding modest amounts of salt (0.3 g/L to 0.7 g/L) can offset salt loss in sweat and minimize medical events associated with electrolyte imbalances (for example, muscle cramps, hyponatremia).
Post-exercise:

1. Drink approximately 0.5 liters of water for every pound of body weight lost. 2. Consuming beverages and snacks with sodium will help expedite rapid and complete recovery by stimulating thirst and fluid retention. Pregnancy: Supplemental calcium and magnesium have each been shown to help prevent cramps associated with pregnancy. An adequate intake of both of these minerals during pregnancy is important for this and other reasons, but supervision by a qualified health care professional is essential.

Dystonic cramps: Cramps that are induced by repetitive non-vigorous activities can sometimes be prevented or minimized by careful attention to ergonomic factors such as wrist supports, avoiding high heels, adjusting chair position, activity breaks, and using comfortable positions and equipment while performing the activity. Learning to avoid excessive tension while executing problem activities can help. However, cramps can remain very troublesome for activities that are difficult to modify, such as playing a musical instrument.

Rest cramps: Night cramps and other rest cramps can often be prevented by regular stretching exercises, particularly if done before going to bed. Even the simple calf-stretching maneuver (described in the first paragraph of the section on treatment), if held for 10 to 15 seconds and repeated two or three times just before going to bed, can be a great help in preventing nocturnal cramps. The maneuver can be repeated each time you get up to go to the bathroom during the night and also once or twice during the day. If nocturnal leg cramps are severe and recurrent, a foot board can be used to simulate walking even while recumbent and may prevent awkward positioning of the feet during sleep. Ask your doctor about this remedy.

Another important aspect of prevention of night cramps is adequate calcium and magnesium. Blood levels may not be sensitive enough to accurately reflect what is happening at the tissue surfaces where the hyperexcitability of the nerve occurs. Calcium intake of at least 1 gram daily is reasonable, and 1.5 grams may be appropriate, particularly for women with or at risk for osteoporosis. An extra dose of calcium at bedtime may help prevent cramps.

Supplemental magnesium may be very beneficial for some, particularly if the person has a magnesium deficiency. However, added magnesium can be very hazardous for people who have difficulty eliminating magnesium, as happens with kidney insufficiency. The vigorous use of diuretics usually increases magnesium loss, and high levels of calcium intake (and therefore of calcium excretion) tend to increase magnesium excretion. Magnesium is present in many foods (greens, grains, meat and fish, bananas, apricots, nuts, and soybeans) and some laxatives and antacids, but a supplemental dose of 50-100 milligrams of magnesium daily may be appropriate. Splitting the dose and taking a portion several times during the day minimizes the tendency to diarrhea that magnesium can cause.

Vitamin E has also been said to help minimize cramp occurrence. Scientific studies documenting this effect are lacking, but anecdotal reports are common. Since vitamin E is thought to have other beneficial health effects and is not toxic in usual doses, taking 400 units of vitamin E daily is approved, recognizing that documentation on its effect on cramps is lacking.