MUSCLE CRAMPS

MUSCLE CRAMPS Defined as an involuntarily and forcibly

contracted muscle that does not relax. This causes a visible or palpable hardening of the involved muscle.

Sometimes called charley horses in North America

Very unpleasant, often painful, sensations caused by contraction or over shortening of muscles

Cramps are extremely common. Almost everyone (one estimate is about 95%) experiences a cramp at some time in their life.

Cramps are common in adults and become increasingly frequent with aging. However, children also experience cramps.

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 goes away.

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 may also be a symptom/complication of pregnancy, kidney disease, thyroid disease, hypokalemia or hypocalcemia in conditions such as: restless legs syndrome, varicose veins, and multiple sclerosis.

CAUSES

There are six basic causes of cramping: hyperflexion; Hypoxiaexposure to large changes in temperature dehydration low blood salt or low blood calcium.

Cramps can be caused by cold, overexertion or low calcium level in blood, especially for adolescents where they need calcium for both blood and bone maturing. Illness or poisoning can also cause cramps, particularly in the stomach, which is referred to as colic if it fits particular characteristics.

IATROGENIC CAUSES Statins are known to cause myalgia and cramps

among other side effects. Additional factors increasing probability for these adverse side effects are physical exercise, age, female gender, history of cramps and hypothyroidism.

Up to 80% of athletes using statins suffer significant muscular adverse effects including cramps, the rate appears to be approximately 10-25% in typical population using statins.

In some cases these adverse effects will disappear after switching to a different statin, however they should not be ignored if they persist as they can, in rare cases, develop into a more serious problem. Coenzyme Q10 supplementation can be helpful to avoid some statin related adverse effects but currently there is not enough evidence to prove effectiveness in avoiding myopathy or myalgia.

TYPES OF CRAMPS

SMOOTH MUSCLE CRAMPS Smooth muscle contractions lie at the

heart of the cramping pain of internal organs.

These include the intestine, uterus, ureter, and various others.

MENSTRUAL CRAMPS “Dysmenorrhea” Menstruation is also highly likely to cause

cramps of varying severity in the abdomen that may radiate to the lower back and thighs.

Menstrual cramps can be treated with ibuprofen, acetaminophen, stretching exercises, or the application of heat through such means as warm baths or heating pads. Menstrual cramps that do not respond to self-treatment can be a symptom of endometriosis or other health problems.

SKELETAL MUSCLE CRAMPS Skeletal muscles are muscles that can

be voluntarily controlled. Of the skeletal muscles, those which cramp the most often are the calves, thighs, and arches of the foot. These cramps are seemingly associated with strenuous activity and can be intensely painful.

Cramps are categorized according to their different causes and the muscle groups they affect.

Skeletal muscle cramps can be categorized into four major types: "true" cramps, tetany, contractures, dystonic cramps

"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:InjuryVigorous activityRest crampsDehydrationBody fluid shifts Low blood calcium, magnesium Low potassium

TETANY

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.

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. 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.

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. The constant spasms are caused by a depletion of ATP, an energy chemical within the cell. This prevents muscle fiber relaxation. The nerves are inactive in this form of muscle spasm.

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

DYSTONIC CRAMPS

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.

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 while resting.

Only a few fibers of a muscle may be activated. The duration of nocturnal leg cramps is highly variable with cramps sometimes only lasting a few seconds and other times several minutes. Soreness in the muscles may remain for some time after the cramp ends.

These cramps are more common in older people but may happen to anyone. They can happen quite frequently in teenagers and in some people while they are exercising at night. Nocturnal leg cramps can be very painful, especially if the person is dehydrated. Usually, putting some pressure on the affected leg by walking some distance will make the cramp go away.

The precise cause of these cramps is unclear. Potential contributing factors are believed to include dehydration, low levels of certain minerals, and the reduced blood flow through the muscles attendant in prolonged sitting or lying down. Less common causes include more serious conditions or the use of drugs.

Nocturnal leg cramps may be relieved by stretching the affected leg straight out and pointing the toes upward. People report that quickly standing up and walking a few steps may also shorten the duration of a cramp.

Nocturnal leg cramps are considered to be 'normal' during the late stages of pregnancy. They can however vary in intensity from mild to incredibly painful. Also, the standard R.I.C.E. treatment may be used.

CAN MEDICATIONS

CAUSE MUSCLE CRAMPS?

CAN VITAMIN DEFICIENCIES

CAUSE MUSCLE CRAMPS?

CAN POOR CIRCULATION

CAUSE MUSCLE CRAMPS?

WHAT ARE THE SYMPTOMS OF

COMMON MUSCLE

CRAMPS? HOW ARE THEY

DIAGNOSED?

SUMMARY 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.

RESTLESS LEG SYNDROME

RESTLESS LEG SYNDROME common cause of painful legs leg pain of restless leg syndrome typically

eases with motion of the legs and becomes more noticeable at rest

features worsening of symptoms during the early evening or later at night

night time worsening of symptoms in persons with restless legs syndrome frequency leads to insomnia.

Restless leg syndrome usually begins slowly. Over time, the legs become more affected. Less frequently, restless leg syndrome can affect the arms.

CAUSE unknown in most patients However, restless leg syndrome has been

associated with pregnancy, obesity, smoking, iron deficiency and anemia, nerve disease, polyneuropathy other hormone disease, such as diabetes, and kidney failure Some drugs and medications have been associated with restless leg syndrome including caffeine, alcohol, H2-histamine blockers

Occasionally, restless legs run in families. Recent studies have shown that restless leg syndrome appears to become more common with age.

TREATMENT a search for iron deficiency by blood testing to reveal

underlying iron deficiency anemia. Reduction or elimination of caffeine and alcohol can be very helpful. Stopping smoking can also diminish symptoms. Getting better sleep and exercise can help some persons affected by restless legs.

Medications used to treat restless leg syndrome include carbidopa-levodopa, opioids (such as propoxyphene) or tramadol (Ultram) for intermittent symptoms, carbamazepine, clonazepam, diazepam, triazolam, temazepam, baclofen, bromocriptine, and clonidine. Also, recently, gabapentin (Neurontin) has been found helpful. The FDA has now approved ropinirole (Requip) and pramipexole (Mirapex) for the treatment of restless leg syndrome. Other treatments that have been helpful for some patients include avoiding caffeine, warm/cold baths, electric nerve stimulation, oral magnesium, and acupuncture.

TREATMENT &

PREVENTION

TREATMENT

Cramps usually go away on their own without seeing a doctor.

Stop doing whatever activity triggered the cramp.

Gently stretch and massage the cramping muscle, holding it in stretched position until the cramp stops.

Apply heat to tense/tight muscles, or cold to sore/tender muscles.

Applying a soft massage on the cramped muscle

Drug• Quinine- for non-pregnant• Several other drugs have been

suggested as possible treatments including diltiazem, verapamil, and naftidrofuryl.

PRECAUTIONS Excessive heat or cold to sore muscles

may bring on cramps. Pounding on a cramped muscle can

increase soreness Trying to put weight on a cramp too

soon can cause another cramp, or even a temporary loss of ability to use that muscle.

PREVENTION

Avoid dehydration. Drink plenty of liquids every day. Fluids help your muscles contract and relax and keep muscle cells hydrated and less irritable. Drink fluids before any exercise activity. During the activity, replenish fluids at regular intervals, and continue drinking water or other fluids after you're finished.

Stretch your muscles. Stretch before and after you use any muscle for an extended period. If you tend to have leg cramps at night, stretch before bedtime.

Developing cramps may be reduced by eating a healthy diet with appropriate levels of minerals, and getting regular exercise to build up energy reserves in muscle. Avoiding exercising in extreme heat helps prevent heat cramps

MANAGEMENT Non-drug• Passive stretching and massage

of the affected muscle will help ease the pain of an acute attack.

• It is thought that regular stretching of the calf muscles throughout the day may help to prevent acute attacks. Some people recommend stretching 3 times daily while others advocated stretching before going to bed.

• Using a pillow to raise the feet through the night, or raising the foot of the bed may help to prevent attacks in some people.