Cramps

Definition
• Cramp usually means a spasmodic,
painful, involuntary, contraction of
skeletal muscle.

• A muscle (or even a few fibers of a muscle) that

involuntarily (without consciously willing it) contracts is
called a "spasm."

• Sometimes it is also defined as an

involuntarily and forcibly contracted
muscle that does not relax.
• This transient, involuntary episode of pain, is
usually sustained for minutes and even up to 10
minutes, and whole muscles or muscle groups go
into spasm.

• There is a visible or palpable hardening of the

involved muscle

• Most often cramps involve the calf muscle, thigh

muscle, and small muscles of the foot.
Epidemiology
• Cramps are extremely common. Almost
everyone (one estimate is about 95%)
experiences a cramp at some time in their
life.
• The prevalence increases with age.
– About 1/3 of people over age 60, and half
those over 80 complain of cramps.
Types
Paraphysiological Cramps
• occur in healthy people in response to a
physiological stimulus.

• Common during vigorous activity.

• They are thought to be the result of hydro-

electrolyte imbalance following repeated and
chronic use of the same muscle group producing
increased excitation of the neuromuscular nerve
endings
• Also common to pregnancy, particularly the third
trimester.

• may also occur in healthy individuals as a result

of a sustained posture over a prolonged period of
time.
Symptomatic cramps
Drugs causing cramps
• In a study of 70 patients in general practice who
were prescribed quinine for cramps, 37 (53%)
were also taking drugs known to cause cramps.
Implicated drugs include:
• Salbutamol and terbutaline
• Raloxifene
• Opiate withdrawal
• Diuretics cause electrolyte loss
• Nifedipine
• Phenothiazines
• Penicillamine
• Nicotinic acid
Idiopathic cramps
• this represents the largest group of causes of
cramps

• Familial forms exist which appear to have an

autosomal dominant mode of transmission.
What are the symptoms of
common muscle cramps? How are
they diagnosed?
• Characteristically, a cramp is painful, often
severely so. Usually, the sufferer must stop
whatever activity is under way and seek relief
from the cramp; the person is unable to use the
affected muscle while it is cramping. Severe
cramps may be associated with soreness and
swelling, which can occasionally persist up to
several days after the cramp has subsided. At the
time of cramping, the knotted muscle will bulge,
feel very firm, and may be tender.
• There are no special tests for cramps. Most
people know what cramps are and when they
have one. If present during a cramp, the doctor,
or any other bystander, can feel the tense, firm
bulge of the cramped muscle.
 Management
• Non-drug
• Passive stretching and
massage of the affected
muscle will help ease the pain
of an acute attack.
• It is thought that regular
stretching of the calf muscles
throughout the day may help
to prevent acute attacks.
Some people recommend
stretching 3 times daily while
others advocated stretching
before going to bed.
• Using a pillow to raise the
feet through the night, or
raising the foot of the bed
may help to prevent attacks
• Hydration

• One enthusiastic nonscientific recommendation

has been to firmly pinch the tissues above the lip,
just under the nose, and hold the pinch until the
cramp stops (said to be within 15 minutes.) Of
course, why this might be effective is uncertain,
and no scientific study of this technique has been
reported.
• Drug
• Quinine- for non-pregnant
• Several other drugs have been suggested as
possible treatments including diltiazem,
verapamil, and naftidrofuryl.