Joint, Ligament and Muscle Disorders

Cramps or Charley Horse

Description

A cramp is an involuntary, forcibly contracted muscle that does not relax, resulting in sudden and intense pain. Cramps can affect any muscle under your voluntary control (skeletal muscle), and can involve part or all of a muscle, or several muscles in a group. The most commonly affected muscle groups are: the back of the lower leg/calf (gastrocnemius), the back of the thigh (hamstrings), and the front of the thigh (quadriceps). Muscles that span two joints are most prone to cramping, and cramps in the feet, hands, arms, abdomen, and along the rib cage are also very common.

Nearly everyone experiences a muscle cramp during their life. They may occur while you are playing tennis or golf, bowling, swimming, or exercising. The slightest movement that shortens a muscle could trigger a cramp, and they can also be experienced while sitting, walking or even sleeping. Some people are more predisposed to muscle cramps than others, and may have them regularly with any physical exertion.

Although most muscle cramps are benign, they can sometimes indicate a serious medical condition. See your doctor if cramps are severe, happen frequently, respond poorly to simple treatments, or are not related to obvious causes like strenuous exercise. You could have problems with circulation, nerves, metabolism, hormones, medications, or nutrition. Muscle cramps may be a part of many conditions that range from minor to severe, such as Lou Gehrig's disease (amyotrophic lateral sclerosis), spinal nerve irritation or compression (radiculopathy), hardening of the arteries, narrowing of the spinal canal (stenosis), thyroid disease, chronic infections, and cirrhosis of the liver.

Symptoms

Muscle cramps range in intensity from a slight tic to agonizing pain. A cramping muscle may feel hard to the touch and/or appear visibly distorted or twitch beneath the skin. A cramp can last a few seconds to 15 minutes or longer and can recur multiple times before going away.

Causes

Muscle cramps are very common among endurance athletes (i.e., marathon runners and triathletes) and older people who perform strenuous physical activities. Athletes are more likely to get cramps in the preseason when the body is not conditioned and therefore more subject to fatigue. Cramps often develop near the end of intense or prolonged exercise, or four to six hours later.

Those at greatest risk for cramps, and other ailments related to excess heat, include infants and young children, people over age 65, and those who are ill, overweight, overexert during work or exercise, or take drugs or certain medications. Older people are more susceptible to muscle cramps due to normal muscle loss (atrophy) that begins in the mid-40s and accelerates with inactivity. As you age, your muscles cannot work as hard or as quickly as they used to. The body also loses some of its sense of thirst and its ability to sense and respond to changes in temperature.

Although the exact cause of muscle cramps is unknown (idiopathic), some researchers believe inadequate stretching and muscle fatigue leads to abnormalities in mechanisms that control muscle contraction. Other factors may also be involved, including poor conditioning, exercising or working in intense heat, dehydration and depletion of salt and minerals (electrolytes).

• Stretching and muscle fatigue—Muscles are bundles of fibers that contract and expand to produce movement. A regular program of stretching lengthens muscle fibers so they can contract and tighten more vigorously when you exercise. When your body is poorly conditioned, you are more likely to experience muscle fatigue, which can alter spinal neural reflex activity. Overexertion depletes a muscle's oxygen supply, leading to build up of waste product and spasm. When a cramp begins, the spinal cord stimulates the muscle to keep contracting.
• Heat, dehydration, and electrolyte depletion—Muscle cramps are more likely when you exercise in hot weather because sweat drains your body's fluids, salt and minerals (i.e., potassium, magnesium and calcium). Loss of these nutrients may also cause a muscle to spasm.

Diagnosis

During your appointment, tell your doctor about your medical history including details about allergies, illnesses, injuries, surgeries and medications. Be prepared to answer questions, such as: How long have you experienced cramps? Is there a family history of the problem? Do your cramps occur only after exercise, or do they happen while at rest? Does stretching relieve the cramps? Do you have muscle weakness or other symptoms? Routine blood tests may help your physician to rule out certain diseases.

Treatment

Cramps usually go away on their own without seeing a doctor. First, stop doing whatever activity triggered the cramp. Then gently stretch and massage the cramping muscle, holding it in stretched position until the cramp stops. Apply heat to muscles that are tense or tight muscles, and apply cold to muscles that feel sore or tender. Be sure you are adequately hydrated.

Prevention

To avoid future cramps, work toward better overall fitness. Do regular flexibility exercises before and after you work out to stretch muscle groups most prone to cramping.