Paging Dr. Frischer - Muscle cramps

Muscle cramps! You may have heard a cramp referred to as a charley horse or a muscle spasm. I discuss them with my patients frequently, and you have likely experienced them. The thigh, calf, and arch of the foot are the muscles most prone to cramping. The most common type of muscle cramp is known as the “true” muscle cramp, and this is what I’ll address here. True muscle cramps involve part or all of a single muscle, or a group of muscles that generally act together. When we use a muscle, fibers contract and relax. A cramp is caused by hyper-excitability of the nerves that stimulate those fibers.

Cramps may have a number of triggers, including:

• Injury.
• Muscle fatigue, brought on by sports and vigorous activities.
• Lack of activity due to sitting or lying for an extended period of time, often at night. Movements that shorten the muscle may trigger a cramp, but the reason isn’t clear.
• Dehydration. This, naturally, occurs more often in warm weather. Diuretics can lead to dehydration. The shifting of body fluids can be another trigger; this can result from cirrhosis of the liver, dialysis, or kidney failure.
• Low blood calcium, magnesium, and potassium. Calcium and magnesium levels drop during pregnancy, when taking diuretics, from hyperventilating, excessive vomiting, poor nutrition, or when the body is low in vitamin D.
• Medications. A number of medications can lead to cramps, as can withdrawal from certain addictive medications.
• Vitamin B1, B5, or B6 deficiency.

What does a muscle cramp feel like? Very much like what it is: an involuntarily and forcibly contracted muscle that does not relax. The muscle will bulge, feel hard, and be tender to the touch. It might be a mild twitch, or be excruciatingly painful. It might last for a few seconds, 15 minutes or longer, and might even recur multiple times until it finally resolves. There may be soreness and swelling in the muscle which could persist for several days after the cramp. Diagnosing a muscle cramp is straightforward; there are no special tests to run.

Stretching the muscle will stop most cramps. If, for example, the cramp is in the foot or leg, then standing up and walking can stretch the muscle. Some will go away if you lie down and pull the toes toward the head. For hand cramps, pressing the hand on a wall with the fingers facing down will stretch the cramping finger flexor muscles. Gently massaging a muscle will often help, or applying heat from a heating pad or hot bath. If the cause is fluid loss, then drinking fluids and replacing electrolytes will help. Short-term treatments with muscle relaxants and even Botox have been used with some success. Typically, however, a cramp will end before a medication has a chance to kick in.

It is interesting that for many years, those with frequent muscle cramps were prescribed quinine. Quinine does decrease the excitability of the muscles. The FDA, however, banned it in 1994 due to very serious potential side effects. It is still found today in some tonic waters, but the quantity of quinine in tonic water is strictly regulated, and is far too low to have any curative benefits.

Muscle cramps are inevitable for all of us. The best approach to avoiding them is to identify and address the underlying problem. Here are a few suggestions:

• Stretch before and after exercise, and include an adequate warm up and cool down. Stretch before bed to help prevent night cramps.
• Hydrate well before, during and after exercise. Your urine should be light yellow in color.
• Replace your electrolytes, especially sodium and potassium. There is a huge variety of drinks and gels on the market; not to mention real foods that are high in sodium and potassium.
• Avoid excessive fatigue, and avoid a sudden increase in your exercise level.
• Limit or avoid drinks with alcohol or caffeine. These can be dehydrating.
• Be sure to have an adequate amount of calcium and magnesium in your diet, especially during pregnancy. Some favor vitamin E supplements to help prevent muscle cramps, although studies do not appear to support this. Vitamin D deficiency is common as we get older, and this can lead to poor calcium absorption.

Remember that while muscle cramps can be a real pain, they don’t normally cause lasting damage. Nonetheless, see your doctor if you have persistent or severe muscle cramps.

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: Feb. 26, 2015 - Volume 13 - Issue 46