Article by John Miller

What is a Cramp?

cramp is defined as a spontaneous or involuntary electrical activity of many skeletal muscle fibres that quickly develops into a painful, sustained contraction (muscle spasm).

Cramps can be divided into two categories:

  1. Exercise-Associated Muscle Cramps (EAMC)
  2. Nocturnal Cramps

As their names suggest, EAMC occurs 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 several hypotheses for both EAMC and nocturnal cramps, as outlined below.

What Causes Exercise-Associated Muscle Cramps (EAMC)?

Potential causes of EAMC include:

  • Overuse 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. A fatigued muscle can exacerbate this.
  • Electrolyte loss through sweating during exercise can cause the onset of EAMC.
  • Pregnancy.

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.
  • Pregnancy.

Other Causes of Cramps

Leg cramps that occur during daily activities and also during the night time should be investigated in a bit more detail to rule out the following medical conditions:

  • Peripheral vascular disease.
  • Uremia – raised levels of urea and other nitrogenous waste in the blood.
  • Diabetes.
  • 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.

Your trusted healthcare practitioner should investigate persisting muscular cramps.

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. Some evidence shows that drinking a highly salty drink (e.g. pickle juice) can relieve a cramp. Finally, it sounds simple but moves 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 and prevent it from occurring.

How to Prevent a Cramp

Taking the causes mentioned above of cramps into account, you can prevent the onset of a cramp:

  • Drink plenty of water – 2L a day should suffice, and decreased coffee and 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 helpful 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 is tight muscles, over-exercising, or a reason that requires further investigation, our experienced physiotherapists can assist in investigating what is causing your cramps and pointing 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 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, e.g. ultrasound, MRI, blood tests etc.

If you have any further questions, please ask your physiotherapist.

Muscle Pain Injuries

Myalgia, or muscle pain, can have many sources. Here are some of the more common sources of muscle pain. Would you please click the links for more information?

Neck & Back Muscle Injuries

Lower Limb Muscle Injuries

Upper Limb Muscle Injuries

Haematoma-Related Myalgia

Fatigue-Related Myalgia

Systemic Causes of Myalgia

More Information: Myalgia

Article by John Miller

Muscle Strain Treatment

Muscle strain treatment will vary depending upon an accurate diagnosis from your health professional. The severity of your muscle strain, and what function or loads your injured muscle will need to cope with, will impact the length of your healing and rehabilitation process.

Until you’ve been accurately diagnosed with a muscle strain, use the following guidelines:

  • Ice and a compression bandage.
  • Elevate the injured region if it is swollen.
  • If it’s painful to walk you should be using crutches.
  • Cease or reduce your exercise or activity level to where you feel no pain.

Muscle strain can take anywhere from a few days to several weeks to rehabilitate successfully. Please seek the advice of your physiotherapist, doctor or your health care practitioner who specialises in muscle injuries eg massage therapist, to guide your treatment.

Common Treatments for Muscle Strain

The following options are available to your physiotherapist to assist the rehabilitation of your muscle strain. Please seek their professional advice prior to self-managing your injury to avoid aggravating your muscle strain. These are general guidelines only and should not be treated as individual treatment advice.

Acute Muscle Strain Treatment

Subacute Muscle Strain Treatment

Later Stage Muscle Strain Treatment Options

Other Factors to Consider

General Information


Massage Techniques