Everyone knows the situation. You're sleeping and suddenly your calf cramps. You grab your leg and stay in that painful position. But after a short time the stabbing pain is over. Why do these muscle cramps occur in the first place and how do you get them under control?
In our article we address the most frequently asked questions about muscle cramps and inform you about the most important facts. In the last part you will of course get the best tips and tricks to take with you. This will get rid of your calf cramps as quickly as possible, or better yet, you will get them much less often.
the essentials in brief
- A muscle spasm is a painful tightening of a muscle or group of muscles. The cramping happens completely unconsciously and normally only lasts for a short time.
- Muscle cramps are particularly common during sports, during pregnancy, in older people, but also during periods of rest. Triggers can be a lack of fluids and electrolytes, alcohol or medication consumption. Serious damage to the nervous and metabolic systems can also trigger spasms.
- In order to get rid of or prevent cramps, stretching exercises, sufficient fluid intake and exercise have proven to be particularly effective. The gherkin water drink is new but effective. For long-lasting muscle spasms, quinine, cannabinoids, and anti-epilepsy drugs are helpful.
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Definition: What is a muscle spasm?
A muscle spasm is an unconscious, painful tightening of a muscle or muscle group. The hardening of the muscle is clearly palpable and harmless in most cases. Because the usual muscle spasm lasts only a few seconds or minutes and resolves itself.
Muscle cramps are common during exercise and usually go away quickly. (Image source: pixabay / composita)
Muscle cramps usually occur in the skeletal muscles, which are also called striated muscles. These can usually be consciously tightened and relaxed. When a muscle cramps, the muscle contracts unconsciously and does not relax again for a certain period of time, as would normally be the case.
Background: What you should know about muscle cramps
Before we explain to you what is helpful for muscle cramps, we would like to go into the most important facts. We have therefore compiled the most frequently asked questions on this topic and answered them in detail.
What happens when you have a muscle spasm?
The contraction is not triggered directly by the muscle, but by the nerve that is connected to the muscle. The nerve, in turn, receives signals from the brain, which flow in the form of electrical impulses through the spinal cord to the nerve cells.
The nerve endings thus have an essential function in signal transmission. And it is precisely at this transition point that the cramp occurs. Because during a cramp, the nerve cells send uncontrolled impulses to the muscle without the brain giving the command to do so.
Normally, a nerve discharges at a rate of between 12 and 30 Hz per second. In the case of a cramp, the value goes up to 300 Hz. We then perceive this flood of impulses as a painful cramp.
Are there different types of muscle cramps?
Muscle cramps can be divided into three categories based on their influences or causes:
| kind | Description |
|---|---|
| paraphysiological convulsions | Paraphysiological convulsions are the most common. Literally, the term means: triggered by external causes. This means that in a healthy person and under certain circumstances, a cramp develops. The cause can be overexertion during sport, pregnancy, etc. |
| Symptomatic cramps | In symptomatic spasms, a neurological or intrinsic disease is the trigger of the spasms. Damage to the nervous system, disturbances in the metabolism, the heart and other organs can be possible causes. |
| Idiopathic convulsions | Idiopathic means "idios" = own and "pathos" = suffering. In medicine, this term is used when no specific cause for the seizures can be found based on the patient's medical history. |
In the following, further important terms are discussed for better understanding and differentiation:
- Dystonia The term "dystonia" is used when there is a prolonged contraction in contrast to the usual muscle spasm. This contraction leads to a movement disorder or misalignment of individual body parts. In the case of dystonia, the problem is not due to the nerve-muscle transmission, but to a malfunction in the brain. They are therefore assigned to the symptomatic cramps. Dystonia can be mild or severe, affecting the whole body.
- Seizure If not just a muscle but the whole body cramps, then this is referred to as a "seizure". Possible causes can be fever, epilepsy, drug or alcohol withdrawal.
- Epilepsy One speaks of "epilepsy" when epileptic seizures occur repeatedly. An "epileptic seizure", on the other hand, only occurs once. In both cases, groups of neurons in the brain suddenly malfunction, leading to seizures.
- Restless Legs Syndrome The "Restless Legs Syndrome", RLS for short, has similar symptoms. However, it is not a question of muscle spasms, but of a neurological disorder. Those affected complain of restless legs and a strong urge to move, which worsens in phases of rest, i.e. in the evening and at night. One suspects, among other things, iron deficiency in the brain as the cause of the dysfunction.(1,2)
Where and when can muscle cramps particularly occur?
Legs and feet are particularly often affected by cramps. Of all the muscle groups, they are subjected to the most stress and can sometimes withstand high loads. This is why muscle cramps are common in sports.
However, they can also occur at rest during sleep. Each of us has already experienced the well-known calf cramps in bed. Elderly people and pregnant women are also particularly often plagued by unpleasant cramps.
What are the possible causes of muscle cramps?
In many cases, the cause of cramps is unclear. There are various explanatory models, but they are more hypotheses than scientific facts. When a neurological disease is ruled out, finding the cause can be difficult.
It is relatively unclear why the nerve behaves in the muscle in this way. However, what you can largely determine is that muscle cramps often occur with heavy exertion. This is especially the case with sports activities.
When you exercise, you lose water and minerals. Therefore, make sure you drink enough fluids - preferably with water containing minerals. (Image Source: Pexels / Andrea Piacquadio)
A lack of electrolytes and increased fluid loss can also trigger cramps. The body loses fluid and electrolytes such as sodium, potassium, calcium and magnesium through sweating. These are important for the communication of the nerves and muscles and can possibly trigger a muscle cramp if there is a deficiency.
Other contributing factors to muscle cramps can be excessive alcohol consumption and medication. (3)
As already indicated, however, serious diseases can also be behind the muscle contractions. If the cramps occur frequently and last for a long time, you should see a doctor. He will examine you for possible neurological diseases and metabolic disorders such as diabetes mellitus or an underactive thyroid gland.
You should also ensure adequate exercise and a healthy diet. Poor blood circulation means that the muscles are poorly supplied. Fat deposits in the vessels, but also smoking, diabetes and high blood pressure mean that oxygen and nutrients can no longer reach the muscles properly.
What medications cause muscle cramps?
Medications such as antidepressants, psychotropics, asthma medications and those that affect the nervous system can trigger muscle spasms. The following list is only an excerpt. In any case, you should discuss side effects and interactions with your doctor.
| drug | clinical picture |
|---|---|
| lithium | in manic-depressive and bipolar disorder |
| donepezil | dementia |
| Levodopa/Carbidopa | Parkinson's, Restless Leg Syndrome |
| diuretics | diuretic and hypotensive |
| cholinesterase inhibitors | Alzheimer |
| Ramipril | high blood pressure, heart failure |
| ciclosporin | is an immunosuppressant, in transplantation, rheumatoid arthritis |
| tamoxifen | breast cancer |
Can muscle cramps be dangerous and when do I need to see a doctor?
If you experience muscle cramps more frequently, you should have the cause clarified by a doctor. A specialist will scan your joints and muscles. After that, he will do a blood test and check for possible hormonal imbalances.
If the cramps continue to occur frequently, this can also indicate damage to the nervous system such as multiple sclerosis, epilepsy, etc. The doctor will therefore carry out further examinations using antibody tests, muscle biopsies, etc.
Muscle cramps: The best tips & tricks for treatment and prevention
There are a variety of methods to prevent common spasms or treat them in acute cases. In the following, we will go into detail about known and unknown methods and explain which ones are helpful.
Lots of drinking
Fluid needs vary from person to person. A different amount of liquid is required depending on body weight, size, age and exercise. Athletes in particular lose a lot of fluid and minerals through sweating, which can lead to muscle cramps.
Did you know that adults should drink 1ml of water per 1kcal per day? For young adults (19-25 years) who have a daily energy intake of 2,500 kcal, this works out to 2.5 liters per day.
When it comes to mineral water, athletes should therefore make sure that they do not drink low-sodium water, but mineral water with a lot of sodium, magnesium, potassium and calcium. In general, all unsweetened drinks, such as teas and infused water, are ideal for boosting drinking behavior.
Nourishment
A balanced, healthy diet is important for all processes in your body to function optimally. If your diet is quite one-sided and rather unhealthy, then you should consider changing your diet. Foods such as whole grains, bananas, nuts, seeds and mineral water contain many valuable minerals that have a beneficial effect on the nervous system.
In particular, nuts contain magnesium, potassium, folic acid, iron and also B vitamins, which are important for the brain and nerve cells. In addition to vitamin B6 and magnesium, bananas contain a particularly large amount of potassium, which is important for the heart, muscles and nerves.
magnesium
For common muscle cramps, prescription magnesium supplements are often the first choice. However, studies have so far not found any significant effect on the influence and frequency of cramps compared to the placebo groups. (4,5,6)
The effectiveness of magnesium for muscle cramps has not yet been proven.
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When it comes to prophylaxis, i.e. the prevention of cramps, the information is somewhat unclear. In older adults, magnesium supplementation seems insignificant to prevent cramps. (4) Another study explains that a magnesium deficiency has a negative effect on muscle contraction. (5)
The German Society for Neurology (DGN) summarizes in its guidelines that although the effect has not been sufficiently proven, the intake of magnesium should be attempted in moderation due to the favorable side effects. (15)
Studies have shown that magnesium can be effective against cramps in pregnant women. The use of magnesium therefore makes sense in this group of people, but further studies are needed to consolidate these results. (5)
stretching exercises and movement
A simple method that has proven itself in the therapy of muscle cramps is stretching exercises. In an acute case, you should stretch the cramped muscle or tense the antagonist, i.e. the opposing muscle. Athletes are particularly prone to muscle cramps. With them, warm-up phases and stretching are particularly advisable.
Few people know that stretching exercises also help prevent cramps.
If you regularly suffer from nocturnal calf cramps, it helps if you do stretching exercises before going to bed to prevent it. You can do this exercise while lunging or lying in bed by grasping your foot and gently but constantly pulling. Elderly people find it difficult to get on their feet, which is why they can help themselves with a sling made of rope, a scarf or a cloth.
Fascia rollers are also very effective. You lie down on a mat on the floor and position the roller under your lower leg. Then you let the roll slowly and with pressure slide up to the thigh.
You should also make sure that you exercise regularly. Because exercise ensures that the tissue is well supplied with blood, which can prevent muscle cramps.
massages
Massages have always proven to be effective for muscle cramps. Above all, massaging trigger points is very effective for loosening hardened areas. The treatment with a sports masseur is certainly not completely painless, but you can also do the massage yourself at home.
Sit on your couch, your bed or even better in the warm bathtub. Muscles tend to relax better in warm water. Now feel the muscle for hardening (trigger points) and massage the area with pressure and in circular movements until the pain subsides.
contrast showers
The positive effect of exercise on a healthy circulatory system and good blood circulation has already been mentioned. Contrast showers or baths have a similar effect. They stimulate the circulation and thus promote better blood circulation in the muscles.
Caution: The difference in temperature should not be too great for the contrast shower.
With a contrast shower, you start as usual with a normal, warm shower. Then switch to cool water for a minute and gently shower your legs and arms. Then work your way carefully towards the center of the body and towards the face. Repeat this change twice: warm - cold - warm - cold. Older people and those with cardiac insufficiency should refrain from alternating showers in order not to put additional strain on the circulatory system.
Warm packs
Another good alternative to counteract tension and cramps are warm compresses and packs. While the heat won't make the cramp go away, it will help soften the tissue. With a subsequent stretching or massage, cramps can be better relieved. A warm bath has the same effect and can provide relief just as well.
cucumber water
The positive effect of cucumber water, more precisely the vinegar water from pickled cucumbers, is very surprising. An American study found that the duration of the cramps in the study participants was reduced by almost half, namely to 85 seconds.
Surprising but true: the vinegar water in the pickles can shorten the duration of the seizure. (Image Source: pixabay / Photo Mix)
The study recommends taking one milliliter of cucumber water per kilogram of body weight. It is assumed that the dose plays a minor role. Because the body cannot absorb the cucumber water in the specified time. The leaders of the study suspect that the sour taste of the water slows down the activity of the impulse-giving nerve cells. As a result, this has an antispasmodic effect. (7.8)
homeopathy
In homeopathy, the following remedies are recommended for muscle cramps:
| Medium | Description |
|---|---|
| cuprum metallicum | Kuper, the most important anticonvulsant in homeopathy |
| Magnesium phosphoricum | muscle cramps |
| Valerina officinalis | real valerian, calming, for spasms all over the body |
| Schuessler salt Magnesium phosphoricum D6 | dissolved in warm water as hot 7 |
treatment with medication
Treatment with medication comes into play when the muscle cramps occur frequently and limit the patient's movement and everyday life. If the cramps are tormenting you, then you should discuss further therapies with the specialist. The following information represents an excerpt of the possibilities.
quinine
The muscle-relaxing properties of quinine have been known in medicine since the end of the 19th century. Even then, quinine sulfate was used to treat malaria. Studies also show the positive effect on permanent muscle cramps. (9,10)However, quinine can also cause rare but serious side effects, which is why you should urgently discuss the use of quinine with your doctor. Typically, ringing in the ears (tinnitus) and visual disturbances can occur.
Did you know that tonic water and bitter lemon drinks contain quinine? The typical bitter-tasting substance is obtained from the bark of the cinchona tree. The soft drinks contain relatively little quinine at 30 - 50 mg / liter. However, pregnant women and people with previous illnesses should avoid quinine-containing drinks due to possible side effects.
In very rare cases, it can also lead to a blood clotting disorder, anemia or kidney damage, which can be life-threatening. In the case of a previous cardiac insufficiency, the use of quinine should be carefully considered. Quinine sulphate as a medicine is administered by the doctor when hypersensitivity to quinine can be ruled out and the usual methods have had little success.
cannabinoids
Cannabis is a very controversial product and falls under the Narcotics Act in many countries. Nevertheless, the positive effect of cannabinoids on improving muscle cramps (caused by multiple sclerosis) has been demonstrated in several studies. (11,12,13,14)
In a meta-analysis that was co-financed, the Swiss Federal Office of Public Health came to the conclusion that cannabinoids reduce the over-excitability of nerve cells. They therefore have a muscle-relaxing, anti-spastic effect. (11)
Cannabinoids have muscle relaxant properties and are relatively well tolerated by patients. (Image source: pixabay / Julia Teichmann)
The drug Nabiximol contains tetrahydrocannabinol (THC) and cannabidiol (CBD). The THC has a muscle relaxant and psychoactive effect. CBD, on the other hand, has analgesic, antispasmodic, neuroprotective, anxiolytic and has no psychoactive effects. Rather, CBD weakens the addictive and psychoactive potential of THC. (11)
The drug is available in an oily or alcoholic suspension and is prescribed when previous forms of therapy have not worked.
The side effects, including the potential for dependence, are generally classified as low. However, the ability to drive and cognitive abilities may be restricted. (11)
botulinum toxin
The botulinum toxin is a neurotoxin and is only used in certain areas of the body (focal dystonia). The drug is injected directly into the affected muscle. This inhibits the transmission from the nerve to the muscle and paralyzes the muscle. Since the body breaks down the agent, botulinum toxin must be injected every 10 to 12 weeks.
Drugs for epilepsy
As mentioned, idiopathic muscle cramps cannot be traced back to any specific cause. If the muscle spasms are persistent and severely debilitating, anti-epileptic drugs are often used as well.
deep brain stimulation
Deep brain stimulation is used for severe dystonia. It is a minimally invasive neurosurgical precision procedure. The finest electrodes are implanted in the patient in order to normalize malfunctions in the brain. The surgeons intervene, so to speak, in the disturbed control circuit of the brain, which improves the symptoms of the muscle spasms.
Conclusion
When you have seizures, there are a variety of ways to get rid of them. In the case of an acute seizure, it helps if you stretch the affected muscle. The heat softens the muscle and you can massage and stretch the affected area better. If that doesn't help, try a small sip of pickle water.
To prevent seizures, make sure you drink enough fluids and eat a healthy diet. The effect of magnesium on seizures has not yet been proven. Nevertheless, a balanced mineral content is important to guarantee the supply of muscles and nerves. If you have frequent and long-lasting cramps, you should see a doctor. He or she will explain to you about possible forms of therapy and their side effects.
itemizations
- Wurzinger B, König P. Iron deficiency, fatigue and restless legs syndrome. Vienna Med Wochenschr. 2016;166(13-14):447-452. doi:10.1007/s10354-016-0497-3
- Trotti LM, Becker LA. Iron for the treatment of restless legs syndrome. Cochrane Database Syst Rev. 2019;1(1):CD007834. Published 2019 Jan 4. doi:10.1002/14651858.CD007834.pub3
- Delacour C, Chambe J, Lefebvre F, et al. Association Between Alcohol Consumption and Nocturnal Leg Cramps in Patients Over 60 Years Old: A Case-Control Study. Ann Fam Med. 2018;16(4):296-301. doi:10.1370/afm.2238
- Garrison SR, Allan GM, Sekhon RK, Musini VM, Khan KM. Magnesium for skeletal muscle cramps. Cochrane Database Syst Rev. 2012;2012(9):CD009402. Published 2012 Sep 12. doi:10.1002/14651858.CD009402.pub2
- Sebo P, Cerutti B, Haller DM. Effect of magnesium therapy on nocturnal leg cramps: a systematic review of randomized controlled trials with meta-analysis using simulations. family practice 2014;31(1):7-19. doi:10.1093/fampra/cmt065
- Roguin Maor N, Alperin M, Shturman E, et al. Effect of Magnesium Oxide Supplementation on Nocturnal Leg Cramps: A Randomized Clinical Trial. JAMA Intern Med. 2017;177(5):617-623. doi:10.1001/jamainternmed.2016.9261
- Peikert J, Miller KC, Albrecht J, Tucker J, Deal J. Pre-exercise ingestion of pickle juice, hypertonic saline, or water and aerobic performance and thermoregulation. J Athl Train. 2014;49(2):204-209. doi:10.4085/1062-6050-49.2.11
- Miller KC, Mack GW, Knight KL, et al. Reflex inhibition of electrically induced muscle cramps in hypohydrated humans. Med Sci Sports Exerc. 2010;42(5):953-961. doi:10.1249/MSS.0b013e3181c0647e
- Diener HC, Dethlefsen U, Dethlefsen-Gruber S, Verbeek P. Effectiveness of quinine in treating muscle cramps: a double-blind, placebo-controlled, parallel-group, multicenter trial. Int J Clin Pract. 2002;56(4):243-246.
- El-Tawil S, Al Musa T, Valli H, et al. Quinine for muscle cramps. Cochrane Database Syst Rev. 2015;(4):CD005044. Published 2015 Apr 5. doi:10.1002/14651858.CD005044.pub3
- Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis [published correction appears in JAMA. 2015 Aug 4;314(5):520] [published correction appears in JAMA. 2015 Aug 25;314(8):837] [published correction appears in JAMA. 2015 Dec 1;314(21):2308] [published correction appears in JAMA. 2016 Apr 12;315(14):1522]. JAMA. 2015;313(24):2456-2473. doi:10.1001/jama.2015.6358
- Pryce G, Baker D. Endocannabinoids in Multiple Sclerosis and Amyotrophic Lateral Sclerosis. Handb Exp Pharmacol. 2015;231:213-231. doi:10.1007/978-3-319-20825-1_7
- Novotna A, Mares J, Ratcliffe S, et al. A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex(®) ), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis. Eur J Neurol. 2011;18(9):1122-1131. doi:10.1111/j.1468-1331.2010.03328.x
- Flachenecker P, Henze T, Zettl UK. Long-term effectiveness and safety of nabiximols (tetrahydrocannabinol/cannabidiol oromucosal spray) in clinical practice. your neurol. 2014;72(1-2):95-102. doi:10.1159/000360285
- Guidelines crampi/muscle spasm
