Muscle Cramps - Oren Zarif

Cramps are painful, whether it's a quad muscle seizing up playing pickleball or a calf spasm at night. They are very common, especially during exercise and in the elderly.

If cramps persist, see your provider. They can give you advice and recommend a treatment. They may want to do a physical exam and/or order blood tests or MRI exams to look for a medical condition that can cause cramps.

Causes

Muscles are bundles of fibers that alternately contract and expand to produce movement. A cramp is a sudden, involuntary contraction (tightening) of one of these muscles that does not relax. Cramps can affect any muscle under your voluntary control — including those in your feet, hands, arms, belly, and ribcage. Doctors aren't sure what causes most muscle cramps. They often happen after exercise or when you're working hard and losing body fluids. Some people are more prone to cramps than others, such as infants, the elderly, and athletes. People with certain medical conditions are also more likely to get cramps, such as rheumatoid arthritis or Parkinson's disease.

During intense exercise, you can lose body fluids through sweat, and this can lead to dehydration, which may cause cramping. Cramps can also occur during long periods of standing or when you hold a position for an extended period of time, such as driving or sitting in a chair. Pregnancy and older age can also cause muscle cramps.

If you have a condition that makes you more prone to cramps, then you should seek treatment for that condition. In addition, you can help prevent cramps by stretching your muscles before exercise and drinking plenty of liquids during workouts and in hot weather. You can also try a magnesium or potassium supplement. Some people get cramps when they take certain medications, so talk to your provider before trying any new medication.

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It's important to distinguish muscle cramps from other types of spasms, such as dystonia or tetany. Dystonias are continuous spasms of many muscles and last much longer than muscle cramps. Tetany is a more serious disorder that is associated with a range of symptoms, including weakness and tingling in the extremities or trunk.

It's also important to know that it can be difficult to tell the difference between muscle cramps and twitching. While twitching can feel like a cramp, it doesn't involve the formation of a tight muscle. You can usually stop twitching by gently rubbing the area. Then you can apply heat, use an ice pack, or take an over-the-counter pain reliever.

Symptoms

Cramps are a common symptom in healthy people, and can also occur as a consequence of many neuromuscular disorders. Taking a history of these painful spasms is a useful diagnostic tool in both characterizing the complaint and uncovering clues that might disclose its etiology. The history should focus on identifying the location, quality, duration, precipitating and relieving maneuvers, course and associated features of the cramping.

The most common type of muscle cramp is a sudden tightening of a leg muscle, usually in the calf. It is usually painful and lasts only seconds to minutes. A twitch of the skin may precede the cramp.

A cramp can happen as a result of exercise that causes the muscles to overwork and deplete their oxygen supply. This can lead to spinal neural reflexes, which then cause the muscle to tighten and spasm. It can also occur due to excessive sweating, which leads to loss of the body’s salts and minerals (particularly potassium). It is more common in athletes or people who work out hard in hot environments. It can also occur during pregnancy or with some illnesses and medicines.

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Muscle cramps can also be caused by other conditions that affect the nervous system or blood flow, and can cause weakness, numbness and paresthesias in addition to pain. These include nerve and muscle disorders like Bell’s palsy, multiple sclerosis or Tourette’s syndrome. They can also be a side effect of certain medications including antipsychotics and calcium channel blockers.

It is possible to prevent cramping by including stretching exercises before and after exercise, making sure to drink plenty of fluids during sports or exertion and eating foods that are rich in potassium. It is also advisable to warm up and cool down properly, and avoid exercising in extreme heat. If a cramp is a regular occurrence, or if it is severe or lasts more than a few minutes, see a doctor as it might be a sign of an illness or medication. In these cases, non-steroidal anti-inflammatory medication can help. The doctor might also prescribe a muscle relaxant or analgesic.

Treatment

Many cramps resolve on their own, and the medical evaluation of a cramp usually involves no further than a careful history and physical examination. Physicians ask about the duration, frequency and location of the cramp, apparent triggers, and any associated symptoms such as weakness, numbness or paresthesias (abnormal feelings) in the affected area. They also ask whether episodes of myoglobinuria occur, a sign of muscle fiber breakdown that causes urine to turn dark (cola colored).

If the diagnosis is unclear, the patient may undergo a neurological examination and muscle testing, including the assessment of reflexes and the sensations at the skin's surface. Doctors may also perform blood tests to check the levels of calcium, magnesium, potassium and phosphorus, since these nutrients are important for normal muscle activity. Electromyography can reveal the presence of a nerve problem or an electrical disturbance in the muscle that results in cramping.

Stretching often relieves a cramp, especially in the legs. When a calf cramp occurs, the patient can hold on to a chair or other object for support and gently stretch the leg by pulling the foot and toes up toward the buttock. A foot or hand cramp can be eased by walking on tiptoes or by wrapping a bandage, necktie or belt around the ankle and flexing the foot and toes.

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Some medicines, especially the anticholinergics donepezil (Aricept), neostigmine (Prostigmine) and terbutaline (Brethine and others), as well as the statins used to reduce cholesterol such as lovastatin (Mevacor) and atorvastatin (Crestor), can cause muscle cramps. It is also possible to develop cramps from long-term use of nifedipine (Procardia and other brands) for angina or high blood pressure.

Quinine sulphate was once widely used to treat muscle cramps but the Food and Drug Administration warns against its use. Other medications used to treat cramps include the muscle relaxants cyclobenzaprine (Flexeril), orphenadrine (Norflex) and baclofen (Lioresal). In addition, calcium channels blockers such as carisoprodol (Orudis) can be helpful, as can the painkiller acetaminophen (Tylenol). Some multivitamin supplements, including vitamin B-12 and magnesium, may also help. A simple dietary regimen of whole grains, fruit, vegetables and lean meats is helpful to prevent cramping.

Prevention

In many cases, cramps are a result of overuse or dehydration. The best way to prevent cramps is to drink plenty of fluids. It is especially important to drink water during and after exercise or any strenuous activity, especially if you sweat a lot. Salt tablets or sports drinks that replenish lost electrolytes may also help to prevent cramps.

Stretching your muscles before and after exercise can also help to prevent cramps. Stretching your leg muscles before going to bed at night can also help prevent cramps in the legs while you sleep. You should avoid drinking alcohol or caffeine, as these can contribute to cramping. If you have a condition that causes a lack of blood flow to the legs, such as peripheral vascular disease (an umbrella term for several slow, progressive circulatory diseases that cause narrowing or blockage in the arteries, veins and lymphatic vessels), you are more likely to get leg cramps than other people.

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If a cramp is severe, a doctor can usually prescribe a medication to ease the spasm. This can include over-the-counter anti-inflammatory medications such as acetaminophen and muscle relaxants. If the cramp is not relieved by these medicines, it may be a sign of an underlying problem and you should see your physician.

Muscle cramps are not usually a cause for concern, but anyone who experiences frequent, painful leg or foot cramps should see their health care provider to identify an underlying medical issue. This could be as simple as a deficiency of calcium, potassium or magnesium. Or it could be as serious as a spinal cord problem that can lead to nerve pain.

The symptoms of muscle cramps can range from a mild tic or twitch to agonizing pain. Cramps are often a result of a muscle that is overused or injured, but they can also be caused by dehydration, exercise in hot weather, poor posture and sitting or standing for long periods of time. They can also be caused by the buildup of lactic acid, which is produced when a muscle is overused.