Article by Shane Armfield
What is a Cramp?
A cramp is defined as a spontaneous or involuntary electrical activity of a large number of skeletal muscle fibres that quickly develops into a painful,
sustained contraction (muscle spasm).
Cramps can be divided into two categories:
- Exercise-Associated Muscle Cramps (EAMC)
- Nocturnal Cramps
As their names suggest, EAMC occur during/post exercise and nocturnal cramps occur, by definition, at nighttime. If the contraction is severe enough it
can cause you to enter a state of functional disability or, if nocturnal, sleep disturbance.
What Causes a Cramp?
Although similar in presentation, the cause of both EAMC and nocturnal cramps differ.
Unfortunately, the exact cause of a cramp is not fully understood but there are a number of hypothesis for both EAMC and nocturnal cramps as outlined below.
What Causes Exercise-Associated Muscle Cramps (EAMC)?
Potential causes of EAMC include:
- Overuse that fatigues the affected muscle and reduces fibre lengthening between contractions.
- Altered neuromuscular control .
- Dehydration and altered electrolyte imbalance secondary to extensive sweating. This may be the primary cause or contribute to causing your cramps.
- Incomplete recovery from a previous episode of cramping.
- If resting muscle length is short, the muscle can be predisposed to cramping. This can be exacerbated by a fatigued muscle.
- Electrolyte loss through sweating during exercise can cause the onset of EAMC.
What Causes Nocturnal Cramps?
Potential causes of Nocturnal Cramps include:
- Dehydration from chronic insufficient fluid intake or aberrant drinking behaviour with voluntary dehydration - drinking too many glasses of wine!
- Electrolyte imbalances (low magnesium, calcium or potassium etc.) .
- Short resting muscle length.
- Poor blood circulation.
Other Causes of Cramps
Leg cramps that occur during daily activities and also during the nighttime should be investigated in a bit more detail to rule out the following medical
- Peripheral vascular disease.
- Uremia - raised levels of urea and other nitrogenous waste in the blood .
- Thyroid dysfunction.
- Alpha motor neuron disorders.
Medications that Cause Cramps
Finally, some medications can induce cramping such as, but not limited to: diuretics, calcium channel blockers - such as nifedipine, long-acting ß2-agonists,
steroids, lithium, statins, cimetidine.
NOTE: if you are concerned that your medication may be causing cramps please consult your doctor or pharmacist.
What to do When You Cramp
If you experience a cramp, the quickest way to relieve it is to stretch it out - i.e. if you get a cramp in your calf, stretch your calf by pulling your
toes towards your knee. There is some evidence showing that drinking a highly salty drink (e.g. pickle juice) can relieve a cramp. Finally, it sounds
simple but move out of the position that caused you to cramp.
If cramps are a regular occurrence for you, see one of our physiotherapists for a stretching routine that will ease the cramp when it comes on but also
prevent it from occurring.
How to Prevent a Cramp
Taking the aforementioned causes of cramps into account, steps can be taken to prevent the onset of a cramp:
- Drink plenty of water - 2L a day should suffice, and decreased coffee and/or alcohol consumption.
- Stretch regularly - particularly your calves, hamstrings, gluteals, quadriceps.
- Magnesium supplementation or if you know you are low in other electrolytes, take the respective electrolyte supplementation accordingly. We recommend
you do this through your doctor or pharmacists guidance.
- Warm up thoroughly and stay hydrated BEFORE and throughout your exercise - water or a sports drink is useful in this instance.
Treatment for Cramps
The first and foremost priority of treatment for cramps is identifying the root cause of your cramps. Whether this be tight muscles, over-exercising or
a cause that requires further investigation. Our physiotherapists are experienced in finding out what it is that is causing your cramps and will point
you in the right direction.
Depending on what our physiotherapists find, treatment may involve:
- Lengthening of hypertonic muscles.
- Restoring joint range of motion.
- Strengthening weak muscles.
- Lifestyle modifications:
- Fluid intake.
- Reducing coffee / alcohol intake.
- Vitamin / electrolyte balancing.
- Modifying current exercise regimes.
Investigating the Cause of Your Cramps
At PhysioWorks, we work closely with our dietitians and we would often refer our patients to them if we believe the cause of your cramps is from a diet
/ lifestyle origin.
It is always helpful to seek the advice of your doctor regarding repeated episodes of cramps. They may organise further assessment eg ultrasound, MRI,
blood tests etc.
If you have any further question please ask your physiotherapist.
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Common Cramp Treatment Options
Early Injury Treatment
Avoid the HARM Factors
Soft Tissue Injury? What are the Healing Phases?
What to do after a Muscle Strain or Ligament Sprain?
Acupuncture and Dry Needling
Sub-Acute Soft Tissue Injury Treatment
Active Foot Posture Correction Exercises
Balance Enhancement Exercises
Proprioception & Balance Exercises
Agility & Sport-Specific Exercises
Soft Tissue Massage
Brace or Support
Electrotherapy & Local Modalities
Supportive Taping & Strapping
FAQs about Cramps
Common Physiotherapy Treatment Techniques
What is Pain?
Physiotherapy & Exercise
When Should Diagnostic Tests Be Performed?
Massage Styles and their Benefits
How Does Kinesiology Tape Reduce Swelling?
What Causes Post-Exercise Muscular Pain?
Barefoot Running: Your MUST READ Guide to the Pro's and Con's.
Heat Packs. Why does heat feel so good?
How Can You Prevent a Future Leg Injury?
How Much Treatment Will You Need?
Post-Run Soreness: Should You Be Concerned?
Sports Injury? What to do? When?
What are the Common Massage Therapy Techniques?
What are the Early Warning Signs of an Injury?
What is a TENS Machine?
What is Chronic Pain?
What is Nerve Pain?
What is Sports Physiotherapy?
What's the Benefit of Stretching Exercises?
When Can You Return to Sport?
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Helpful Products for Cramps
Achilles Tendon Rupture
Achilles Tendonitis / Tendinitis
Anterior Ankle Impingement
Calf Muscle Tear
DOMS - Delayed Onset Muscle Soreness
High Ankle Sprain
Muscle Strain (Muscle Pain)
Pes Planus - Flat Feet
Posterior Ankle Impingement
Restless Leg Syndrome