Have you ever experienced that painful, involuntary cramp in the calf or leg or feet? It is the muscle cramp or spasm or charley horse that has put you in discomfort. Though muscle spasms can occur in any muscle in the body, they often hit the leg.
“They occur without any apparent cause. Leg muscles (i.e., calf, feet and thighs) are the commonly affected areas. If the leg cramp happens at night when you’re at rest or asleep, it is known as ‘nocturnal leg cramp’. However, one can have cramps or spasms in the muscles of the hand, arm and abdomen as well,” Dr Bishwaranjan Das, physiotherapist, Kasturba Medical College Hospital, Mangaluru, tells Happiest Health.
Dr Akash Hosthota, orthopaedic spine surgeon from Bengaluru, says the shoulders and nape of the neck can also be affected.
A 2005 study by neuroscientist Timothy M Miller and neurologist Robert B Layzer from the University of California outlined the significant clinical features of muscle cramps. The study was published in Muscle & Nerve.
Muscle cramps are:
- sudden, painful, involuntary contraction of muscles
- usually affect one muscle or part of a muscle
- originate from peripheral nerves due to mild loss or damage to lower motor neurons
- marked by trivial movements and forceful contraction of the shortened muscle
“These involuntary contractions usually last for about 10-15 seconds,” Dr Das says.
A muscle cramp with no apparent cause (such as charley horse) can happen during periods of inactivity, activity or post activity. They are often treated as a temporary and trivial issue.
Physiology of charley horse
The exact pathology behind muscle cramp remains a grey area. “Muscle cramps occur when the muscles are overexcited (i.e., prolonged contraction without break),” says Dr Das.
Miller and Layzer conducted an electromyogram (EMG) reading to analyse these involuntary muscle contractions and found out that:
- cramps stimulate repetitive firing of motor unit at high rates (up to 150 per second)
- there is a gradual increase in the number and frequency of motor units fired
- the firing subsides gradually with an irregular firing pattern toward the end
Work environment and the geographical condition play a crucial role in stimulating charley horse. “Electrolyte disturbance and dehydration — especially in a hot, humid environment — commonly stimulate muscle cramps. This is prevalent during sports and rigorous activities,” Dr Hosthota says.
Additionally, Dr Das lists out a host of factors which could lead to painful muscle contractions:
- Reduced blood supply to the muscle
- Altered hormonal levels
- Involuntary nerve discharges
- Inadequate stretching
- High-intensity exercise training
- Muscle fatigue
- Improper sitting habits and work ergonomics
Dr Hosthota says on an average he gets at least two to three patients who complain of muscle cramps every day. “There is always a significant surge in the number of people complaining about muscle cramps during the beginning of every new year. This is because a lot of them start their fitness regime at that time as a part of their new year resolution,” he says.
Dr Das indicates that two-thirds of the time muscle cramps happen during activity or post activity.
Moreover, everyone can be affected by charley horse. “Whether you are old, young, leading a sedentary life, desk job holder, manual labourer or sportsperson, you may develop a cramp. It can happen while walking, changing position, exercising or during sleep,” says Dr Das.
Cramps in women
Menstruating women and pregnant women often suffer from muscle cramps, specifically nocturnal cramps. “The incidence of pregnant women developing nocturnal muscle cramps is high. At least 25-30 per cent women develop these cramps during their third trimester,” says Dr Hosthota.
Dr Das says altered hormonal level and/or excessive bleeding could be the causes for these cramps.
“Although the cause of cramps is not clearly known, it is believed to affect the nerves,” says Bengaluru-based naturopath Dr Swathi (who uses just her first name). “The contraction (excitability) of muscle fibres indicates sodium and calcium depletion in the body. Menstruation is marked by lower estrogen levels and blood loss. While estrogen affects the calcium levels, the blood loss affects sodium levels.”
Cramps in elderly
In ‘A general population survey of rest cramps’, a paper published in Age and Aging in 1994, researchers JR Naylor and JB Young from St Luke’s Hospital, Bradford, England, said rest cramps are prevalent among hundreds of elderly patients.
According to their survey:
- 37 per cent of the elderly suffered from infrequent rest cramps
- 40 per cent elderly suffered from cramps more than three times per week
- 21 per cent elderly experienced painful and distressing cramps
- For most of them, the affected area was the lower limbs muscle group
How to relieve a cramped muscle
Muscle contraction can be reversed by stretching. However, Dr Hosthota says cramps can become a serious concern if they are:
- progressive and there is no relief with stretch and rest
- frequent and disrupt your sleep (nocturnal cramps)
- coexist with swelling and redness at the affected site
Miller and Layzer claim frequent and painful cramps can be a comorbid condition for the following medical conditions and may demand immediate professional help:
- lower motor neuron disorder known as amyotrophic lateral sclerosis (ALS)
- metabolic disorders including pregnancy, uraemia, cirrhosis, hypothyroidism, hypoadrenalism
- acute extracellular volume depletion such as patients undergoing haemodialysis, diarrhoea, vomiting, diuretic therapy and the like
Preventing development of charley horse
“Adequate liquid intake based on your living environment and work pattern, maintenance of proper posture and fitness throughout the day, intermittent breaks and stretches during long hours of work and adequate muscle rest can prevent incidences and frequency of charley horse,” Dr Das says.
Ayurveda, yoga and naturopathy too suggest numerous preventive measures. Dr Swathi, who has also been an independent yoga practitioner, says yoga, when practised regularly, can help establish a healthier lifestyle. She suggests a host of remedies for muscle cramps:
- Stretch: Stretches play a cardinal role in charley horse. They will improve the heart pumping and blood circulation. Stretches are anaerobic. Anaerobic exercises are slow and not strenuous; one perspires lesser during these stretches. This reduces chances of dehydration and heals cramps too
- Breathe: Pranayama (breathing exercises) can help release muscle tension and improve contractions
- Bend: Bending the knee while in a supine position (pawanamuktasana) is also helpful. This relieves pressure on the lower back. In turn it releases the strained nerves at the lumbar level. But do note that these exercises should be done under supervision.
- Neutral arm and foot bath: For the elderly, pregnant women and those who have limited movement or flexibility, keeping legs and hands dipped in warm neutral water (arm and foot bath) also improves the blood circulation and provides relief. Even though the body is at rest and there is no exercise, you can reduce the chances of muscle cramps.
- Eat right: Eating right can help reduce muscle cramps. Ayurveda recommends freshly cooked, warm, nourishing and strength-building foods that are rich in protein and fat. Your meals should include cooked grains, butter, eggs, root vegetables (such as beets, parsnips, turnips, ginger, radishes, fennel), fresh yoghurt, soups and stews. Cold and frozen food, as well as raw fruits and vegetables should be avoided. “In naturopathy, those who suffer from cramps are encouraged to eat mineral-rich foods such as fruits,” Dr Swathi says. “The rationale is to reverse the depletion of electrolytes (salts and minerals like sodium, potassium, magnesium and calcium in the body as well as water).”
- Oil massage: Ayurveda also recommends oil massages for pain relief. These oils are generally warmed through double-boiling method, and gently massaged on the cramped area. These massages improve your blood circulation and relaxes the muscles. Please note, the oils should be warm but not hot. The massage should be gentle and not forced. “Warm massages or hot packs not only help reverse muscle contraction through thermos-regulation, but regular use of the same could prevent muscle cramps too,” says Dr Swathi.
(Inputs by Vishnupriya B)