Muscle cramps

A muscle cramp is a sudden and involuntary contraction of one or more of your muscles. If you’ve ever been awakened in the night or stopped in your tracks by a sudden charley horse, you know that muscle cramps can cause severe pain. Though generally harmless, muscle cramps can make it temporarily impossible to use the affected muscle.

Long periods of exercise or physical labor, particularly in hot weather, can lead to muscle cramps. Some medications and certain medical conditions also may cause muscle cramps. You usually can treat muscle cramps at home with self-care measures

Symptoms

Most muscle cramps develop in the leg muscles, particularly in the calf. Besides the sudden, sharp pain, you might also feel or see a hard lump of muscle tissue beneath your skin.

When to see a doctor

Muscle cramps usually disappear on their own and are rarely serious enough to require medical care. However, see your doctor if your cramps:

• Cause severe discomfort
• Are associated with leg swelling, redness or skin changes
• Are associated with muscle weakness
• Happen frequently
• Don’t improve with self-care
• Aren’t associated with an obvious cause, such as strenuous exercise

Causes

Overuse of a muscle, dehydration, muscle strain or simply holding a position for a prolonged period can cause a muscle cramp. In many cases, however, the cause isn’t known.

Although most muscle cramps are harmless, some may be related to an underlying medical condition, such as:

• Inadequate blood supply. Narrowing of the arteries that deliver blood to your legs (arteriosclerosis of the extremities) can produce cramp-like pain in your legs and feet while you’re exercising. These cramps usually go away soon after you stop exercising.
• Nerve compression.Compression of nerves in your spine (lumbar stenosis) also can produce cramp-like pain in your legs. The pain usually worsens the longer you walk. Walking in a slightly flexed position — such as you would use when pushing a shopping cart ahead of you — may improve or delay the onset of your symptoms.
• Mineral depletion. Too little potassium, calcium or magnesium in your diet can contribute to leg cramps. Diuretics — medications often prescribed for high blood pressure — also can deplete these minerals.

Risk factors

Factors that might increase your risk of muscle cramps include:

• Age. Older people lose muscle mass, so the remaining muscle can get overstressed more easily.
• Dehydration. Athletes who become fatigued and dehydrated while participating in warm-weather sports frequently develop muscle cramps.
• Pregnancy. Muscle cramps also are common during pregnancy.
• Medical conditions. You might be at higher risk of muscle cramps if you have diabetes, or nerve, liver or thyroid disorders.Muscle cramps are when a muscle gets tight (contracts) without you trying to tighten it, and it does not relax. Cramps may involve all or part of one or more muscles.·         Back of the lower leg/calf·         Front of the thigh (quadriceps)
• ·         Back of the thigh (hamstrings)
• The most commonly involved muscle groups are:

Back of the lower leg/calf

Back of the thigh (hamstrings)

Front of the thigh (quadriceps)

Cramps in the feet, hands, arms, abdomen, and along the rib cage are also very common.

Muscle cramps are common and may be stopped by stretching the muscle. The cramping muscle may feel hard or bulging.

Considerations

Muscle cramps are different than muscle twitches, which are covered in a separate article.

Causes

Muscle cramps are common and often occur when a muscle is overused or injured. Working out when you have not had enough fluids (dehydration) or when you have low levels of minerals such as potassium or calcium can also make you more likely to have a muscle spasm.

Muscle cramps can occur while you play tennis or golf, bowl, swim, or do any other exercise.

They can also be triggered by:

• Alcoholism
• Hypothyroidism (underactive thyroid)
• Kidney failure
• Medications
• Menstruation
• Pregnancy

Home Care

If you have a muscle cramp, stop your activity and try stretching and massaging the muscle.

Heat will relax the muscle when the spasm begins, but ice may be helpful when the pain has improved.

If the muscle is still sore, nonsteroidal anti-inflammatory medications can help with pain. If the muscle cramps are severe, your health care provider can prescribe other medicines.

The most common cause of muscle cramps during sports activity is not getting enough fluids. Often, drinking water will ease the cramping. However, water alone does not always help. Salt tablets or sports drinks, which also replenish lost minerals, can be helpful.

Other tips for relieving muscle cramps:

• Change your workouts so that you are exercising within your ability.
• Drink plenty of fluids while exercising and increase your potassium intake (orange juice and bananas are great sources of potassium).
• Stretch to improve flexibility.

When to Contact a Medical Professional

Call your provider if your muscle cramps:

• Are severe
• Do not go away with simple stretching
• Keep coming back
• Last a long time

What to Expect at Your Office Visit

Your provider will examine you and ask questions about your symptoms and medical history, such as:

• When did the spasms first begin?
• How long do they last?
• How often do you experience muscle spasms?
• What muscles are affected?
• Is the cramp always in the same location?
• Are you pregnant?
• Have you been vomiting, had diarrhea, excessive sweating, excessive urine volume, or any other possible cause of dehydration?
• What medicines do you take?
• Have you been exercising heavily?
• Have you been drinking alcohol heavily?

Blood tests may be done to check for the following:

• Calcium, potassium, or magnesium metabolism
• Kidney function
• Thyroid function

Pain medicines may be prescribed.§  A muscle cramp is an involuntarily and forcibly contracted muscle that does not relax.

You can usually treat muscle cramps with self-care measures. Your doctor can show you stretching exercises that can help you reduce your chances of getting muscle cramps. Making sure you stay well-hydrated also can help. For recurrent cramps that disturb your sleep, your doctor might prescribe a medication to relax your muscles.

Alternative medicine

Some suggest taking vitamin B complex supplements to help manage leg cramps. However, more research is needed to confirm this benefit.

Treating leg cramps 

If the cause of your leg cramps is known, it may be possible to treat the underlying cause.

For example, secondary leg cramps that are related to liver disease are caused by high levels of toxins in the blood which trigger muscles spasms. Therefore, muscle relaxants can be used to help prevent your muscles from going into spasm.

If the cause of your legs cramps is unknown (primary idiopathic leg cramps), a combination of exercise and painkilling medication is usually recommended.

Exercises

Most cases of leg cramps can be treated with exercises. There are two types of exercise that you can do:

• exercises you do during an episode of cramping to relieve the pain and stop the cramping
• exercises you do during the day to reduce how often you get leg cramps

The two types of exercises are explained below. 

Exercises during cramps

During an episode of leg cramp, stretch and massage the affected muscle.

For example, if the cramp is in your calf muscle:

• Straighten your leg and lift your foot upwards, bending it at the ankle so that your toes point towards your shin.
• Walk around on your heels for a few minutes.

Exercises to prevent cramps

To reduce your risk of getting leg cramps in the future, you should do exercises to stretch the affected muscles three times a day.

For example, if your calf muscles are affected by cramps, the following exercise should be beneficial:

• stand about a metre away from a wall
• lean forward with your arms outstretched to touch the wall while keeping the soles of your feet flat on the floor
• hold this position for five seconds before releasing
• repeat the exercise for five minutes

For the best results, you should repeat this exercise three times a day, including one session just before you go to bed. Here’s an alternative calf stretch.

If you find these exercises useful you can carry on doing them for as long as you are able to.

Painkillers

If you have leg pain that persists after an episode of cramping, an over-the-counter painkiller, such as paracetamol or ibuprofen may help reduce the pain.

Quinine

Quinine was originally designed as a medication to treat malaria. Subsequent research has found that it can also be moderately effective in reducing the frequency of leg cramps.

However, there is a small chance that quinine may cause unpleasant side effects including:

• tinnitus (ringing in your ears)
• impaired hearing
• headache 
• nausea (feeling sick)
• disturbed vision
• confusion
• hot flushes

Thrombocytopenia is a rarer but more serious complication of quinine. It occurs when the number of platelets in your blood falls to a dangerously low level. Platelets help the blood to clot which means people with thrombocytopenia are at increased risk of excessive bleeding such as:

• nosebleeds 
• bleeding gums
• bleeding inside the eye
• bleeding inside the skull or digestive system (both of which can be fatal)

There have been a number of reported cases of people dying from thrombocytopenia after taking quinine to prevent leg cramps.

Never take more than your recommended dose of quinine. An overdose of quinine can result in permanent blindness and death.

Due to these small but potential risks, your GP will only prescribe quinine if there is evidence that the potential benefit of treatment outweighs the risks.

It is recommended that quinine is only prescribed when:

• you have tried the exercise techniques discussed above and they haven’t helped prevent your leg cramps
• you have frequent leg cramps which affect your quality of life

In these circumstances, you may be prescribed a four-week course of quinine. After this time, if you have not gained any benefit, the treatment will be withdrawn.

If you experience any of the side effects listed above, stop taking quinine immediately and contact your GP. 

Treatment plan

Your treatment for leg cramps will be closely monitored and regularly reviewed. For example:

• You may be asked to keep a “sleep and cramp” diary to record how often you get leg cramps.
• It is likely that your GP will review your initial treatment after three months.
• If your condition improves, your GP may reassess your treatment needs every three-to-six months.

• Treating a Muscle Cramp

  Stretching

  Relax the cramping muscle. Stop any activity that may have induced the cramp and lightly stretch the muscle, gently holding the stretch. You may even massage the muscle while or after you stretch, and maybe apply a heating pad as described below, to the area after stretching. “My first recommendation for patients coming in with leg cramps is magnesium,” says Sarah Thompson, a doula and acupuncturist at Sacred Vessel Acupuncture. Magnesium has been suggested for treating pregnant women’s muscle cramps, but more studies are needed. Talk to your doctor before taking any supplements if you’re pregnant. Read More: 10 Foods High in Magnesium »Many professionals like personal trainers, coaches, and physical therapists also recommend magnesium on the outside of your body, in the form of Epsom salts. This old-school remedy can be applied to a wet cloth and pressed onto a cramped muscle, or you can add some to a hot bath for a soak. 

  Hydration

  Another possible way to stop leg cramps is to hydrate. It might take a little longer to address your pain, but once you have had water or a sports drink with electrolytes, you could prevent another cramp.“If you are experiencing leg cramps, the best thing that you can do is walk around,” says certified personal trainer Henry Halse. “This will send the signal that your muscle needs to contract and then relax. Think of it as hitting the reset button on the muscle.” If all else fails, and you continue to have regular muscle cramps, Halse advises getting regular massages, which is a nice idea whether you have muscle cramps or not. 

Get Moving

“If you are experiencing leg cramps, the best thing that you can do is walk around,” says certified personal trainer Henry Halse. “This will send the signal that your muscle needs to contract and then relax. Think of it as hitting the reset button on the muscle.” If all else fails, and you continue to have regular muscle cramps, Halse advises getting regular massages, which is a nice idea whether you have muscle cramps or not.