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
Ø There are six basic causes of cramping:
Øhyperflexion;
ØHypoxia
Øexposure to large changes in temperature
Ødehydration
Ølow blood salt
Øor 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
 Skeletalmuscles 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:
 Injury
 Vigorous activity
 Rest cramps
 Dehydration
 Body 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
&
Preventio
n
 Treatment
 Cramps usually go away on their own
without seeing a doctor.

 Stopdoing whatever activity triggered

the cramp.

 Gentlystretch and massage the

cramping muscle, holding it in stretched
position until the cramp stops.
 Applyheat to tense/tight muscles, or cold to
sore/tender muscles.

 Applying a soft massage on the cramped

muscle
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
 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.