Muscle Cramps & Spasms

One of the many things to “go wrong” as we age is the unwanted and often painful involuntary contraction of muscles in our legs and sometimes other areas. The medical definition of this is the contraction of a muscle or muscle group that is unintentional. If the contraction is sustained for more than several seconds it moves from being a muscle in spasm to a muscle cramp. In other words the process begins as a muscle spasm which is a tightening of the muscle and if it persists it becomes a cramp. Neither of these conditions is voluntary, meaning we did not intentionally tighten the muscle as we might when lifting a weight.

Symptoms

It is easy to self-diagnose muscle spasms and cramps. The most important sign is intense pain caused by the extreme tightening of the muscle. The pain is localized at the site of the muscle. There may be tenderness on touching the muscle with ones hands. There always is the sensation of a tense or tight muscle that feels very hard compared to other relaxed muscles. The spasm may last only a few seconds or up to 15 minutes. The longer the cramp lasts the more likely the muscle will be sore for a prolonged period after the acute pain has subsided. The cramps can and often do impair function, for example, writer’s cramp occurs in muscles of the hand making it impossible to write. Or, there can be cramps in leg muscles that make walking or running difficult. The most common site of a cramp as we age is in the calf.

Risks & Causes

Cramps occur commonly, it is estimated that 60 percent of adults have cramps from time to time. The frequency increases as we age. Women suffer more than men with nighttime cramps. In addition to age, there are a number of risk factors that often are associated with muscle cramping. These include medications, dehydration, electrolyte imbalance, certain diseases, and exercise. Medications that are known to produce cramps include drugs to treat the following conditions:

• Hypertension (e.g., furosemide or Lasix).
• Heart disease (e.g., nifedipine).
• Cholesterol (e.g., any of the “statins”).
• Parkinson’s disease (e.g., tolcapone).
• Alzheimer’s disease (e.g., donepezil).

There are a host of other drugs that also are reported to cause cramps and if you start taking a new medicine and start having more cramps, call your physician to report this. 

Cramps are associated with physical exertion. Even the best conditioned athletes can be brought to their knees and removed from competition because of cramps. The intense use of the muscles and the dehydration that occurs with perspiration together create the risk of cramping. The loss of electrolytes like sodium, potassium, and calcium with perspiration will lead to cramping of muscles. 

Dehydration for any reason predisposes one to cramping. For example, if one does not drink six to eight glasses of water or equivalent fluid per day, dehydration can occur. If any of the liquids one does consume have caffeine in them, then the fluid is likely to be excreted in the form of urine since caffeine is a diuretic. As we age, there is a tendency to become less well hydrated. 

Some of the diseases associated with cramping include alcoholism, hypothyroidism, myopathies, renal disease with dialysis, and excessive sweating. Pain in muscles that is not true cramping can occur with walking if there is claudication, which is a circulatory disorder causing inadequate blood supply to the muscles used in walking.

Treatment 

The treatment for a cramp is what we in medicine term “supportive.” That means stopping what one is doing that could have precipitated the cramp. Walk around – “walk if off” if possible. Next, is to massage the muscle areas attempting to relax the muscle. Drink fluids with some electrolytes like Gatorade. Take a warm shower or bath. Some recommend either heat or cold applied to the affected muscle. If the pain persists after the muscle has relaxed, over the counter analgesics (acetaminophen, ibuprofen, or naproxen) may be used to combat the residual soreness.

Proper stretching before and after exercise is key to preventing cramps related to exercise. Calf stretching is particularly important before or after exercise. The other important preventive measure is to hydrate before, during, and after the exercise. It is wise to use a diluted electrolyte solution like Gatorade in this prevention strategy. Always exercise in moderation and build up to increased amounts. 

As for nighttime cramps, the best prevention is to stay well hydrated, avoid alcohol or caffeine before bedtime, eat a balanced diet that has the recommended dietary requirements for vitamins and minerals. Foods rich in calcium, potassium, and  magnesium are essential. Gently stretch muscles that have caused cramps before going to bed. Avoid assuming positions of the body that seem to cause cramping at night or during the day. Do not smoke.

Muscle spasms and cramping are increasingly common as we age. They generally are a benign problem that is self-limited and often preventable. If cramping increases despite good efforts at prevention, consult with your physician.