Why leg muscles cramp and what to do?

Many people are familiar with the condition when an involuntary contraction of the leg muscles occurs, which makes it impossible to change its position, take a step, and also causes severe acute pain. A popular method is also known to get oneself out of this situation - to prick with a pin. Even if this stops the spasm, it does not remove the question of why this is happening and what lies behind it.

Muscle cramp means episodic, involuntary, painful muscle contraction. Muscle spasm is a more comprehensive term that refers to any involuntary muscle contraction. [1]

Causes of the leg cramps

Muscle cramps sometimes occur in healthy people, but can be a manifestation of problems that lie in the pathologies of various organs and systems. [2]Most often this is due to:

• metabolic disorders, including calcium (metabolic theory);
• violation of the concentration of electrolytes in serum (theory of electrolytes);
• prolonged uncomfortable position of the legs, for example, in a dream;
• muscle cramps associated with exercise;
• pregnancy
• diseases of the endocrine system (diabetes mellitus, hypothyroidism, etc.);
• vascular pathology, varicose veins;
• neurological disorders;
• intoxication of the body (poisoning, malfunction of the kidneys);
• dehydration (dehydration theory);
• extreme environmental conditions of heat or cold (environmental theory);
• hypertensive crisis. 

Diseases and conditions accompanied by leg cramps

Below are some of the most common diseases.

Nocturnal leg cramps

Nighttime leg cramps affect approximately 37% of America’s population over 60. The syndrome is also known as leg cramps associated with sleep. The calf muscles are most often spasmodic. Night cramps reduce the quality of sleep and the quality of life of patients. The diagnosis is relatively simple: cramps and night pains in the legs, which can disappear with stretching of the involved muscles. As a conservative treatment, deep massage or stretching is used. Medication is currently not effective.[3]

Leg cramps in pregnant women

Muscle cramps in women during pregnancy are very common, about 50%; especially in the last 3 months and at night.

The exact cause of this disorder is not fully understood. This may be due to changes in neuromuscular function, excessive weight gain, compression of peripheral nerves, insufficient blood flow to the muscles and increased work of the muscles of the lower extremities.  

Cramping during pregnancy is not associated with fetal growth problems. There seems to be a connection between nightly fits of leg cramps and snoring in some pregnant women. This can lead to fetal growth problems (delays) and premature birth.

Currently, there is no adequate treatment to reduce the incidence of seizures.

Fasciculosis Seizure Syndrome

Fasciculation Convulsion Syndrome (CFS) is a peripheral syndrome associated with increased excitability of the peripheral nervous system. This situation leads to the presence of unwanted muscle cramps and / or fasciculations. Some patients may experience other symptoms, such as numbness and a burning sensation typical of neuropathy. 

End stage renal failure

People with chronic renal failure who undergo dialysis often suffer from muscle spasms of the lower extremities, up to 50%. Seizures may occur during dialysis or at home. Cramping in patients of this type is associated with depression, poor quality of life, and sleep disturbances. The etiology of seizures in patients on hemodialysis is not clear.

One possible reason is the presence of polyneuropathy, typical in these situations, with morphological and functional changes in peripheral nerve fibers. A kidney transplant significantly reduces the risk of developing seizures.

Amyotrophic lateral sclerosis

About 95% of patients with amyotrophic lateral sclerosis (ALS) report seizures. The frequency and intensity of seizures are not related to the severity of the disease. The causes of these seizures are not known, but they are probably related to the increased excitability of neurons. Mexiletine and quinine sulfate are the drugs that reduce seizures in these patients, and the latter have serious contraindications.

Cirrhosis of the liver

Muscle cramps in this category of patients are common and common (88%). With the electromyogram, the activation of the involuntary potential action of the motor units was quite high - more than 150 Hz. The behavior of the peripheral nervous system is not associated with nervous degeneration. The cause of the seizures remains unclear. The presence of seizures varies depending on the muscle area: cervical (9%), thigh (43%), lower leg (70%), toe (50%), abdominal muscles (12%) and fingers (74%). There is no direct relationship between age or specific causes that lead to cirrhosis (alcohol, infection, etc.). It is known that there is no single cause or specific treatment methods to avoid the occurrence of seizures in patients with cirrhosis.

Anti-myelin-associated glycoprotein antibody (anti-MAG) neuropathy

About 60% of patients have cramps, especially in the lower extremities. Most episodes occur at night or during exercise. To date, there is no explanation of how cramps occur with this pathology, and there is no therapeutic strategy.

Diabetes

In people with diabetes, seizures are associated with the presence of neuropathy with increased excitability of the peripheral nerves. Type I diabetes has a lower percentage of seizures (about 60%) compared with type II diabetes (about 80%). In type II diabetes, nephropathy is another factor in the occurrence of seizures. Another likely cause of seizures is associated with a change in peripheral vascularization that causes episodes of ischemia and seizures. 

Fibromyalgia

According to the US National Rheumatic Disease Databank, seizures are one of ten concomitant diseases affecting patients. One of the most likely causes is hyper-excitation of the peripheral nervous system. According to recent studies, the presence of seizures and peripheral neurological changes is directly related to the severity of the disease and is inversely related to the quality of life.

Risk factors

Spasms contribute to both large physical exertion, in which the same muscle groups are involved, and a sedentary lifestyle, wearing high-heeled shoes.

A serious risk factor is a deficiency of vitamins and macronutrients, mainly calcium, magnesium, vitamin D. Taking certain medications, such as diuretics, entails leaching of potassium from the body, an imbalance between it and calcium, which also leads to involuntary muscle contraction.

An important role in the appearance of seizures is played by the predisposition to hereditary-monetary disease of the nervous system.

Pathogenesis

Ordinary muscle cramps are characterized by a painfully hard, palpable contraction with a sudden onset, sometimes preceding or accompanied by short twitches, which usually involve one muscle at a time.

The mechanism of muscle cramps is complex and ambiguous. By their nature, they can contract rhythmically, followed by shocks (clonic) and prolonged, causing the muscles to harden in one position for several minutes (tonic), sometimes they are mixed.

It is believed that the former are triggered due to excessive excitation of the cells of the cerebral cortex, the latter - of the subcortical structures.

In their distribution, muscle contractions are local, exciting one, or generalized, when many muscles are involved, in nature.

While leg cramps are quite common in older people and almost never occur in healthy, athletic people, they often appear in certain clinical conditions. The mechanism of this relatively familiar symptom remains unclear, although popular theories suggest that the intramuscular nerve branches for some reason turn out to be overexcited.

In the pathogenesis of the disease, a convulsive reaction, convulsive syndrome and epileptic disease are distinguished. An example of the first can be muscle contractions caused by high fever in children, or insulin shock, alcohol poisoning in adults.

Convulsive syndrome is provoked by the development of pathology of the nervous system, a decrease in the threshold of convulsive readiness of the brain.

In the occurrence of epilepsy, heredity plays the main role, for this type of seizure, the provoking factors are not decisive.

Epidemiology

According to statistics, about 75% of all people know firsthand what convulsions are. There are frequent cases of muscle contractions in children with increased excitability of the nervous system. Cramping occurs more often in women (56%) than in men (40%). [4]

The age of older people in France suffering from seizures is between 65 and 69 years.

There is no connection between sex and spasms. About 80% of the affected muscle area is caviar.

Nighttime leg cramps affect about 6% of the US population, whose condition appears to be related to heart problems and depression.

The prevalence of seizures in pregnant women in China affects the calf area, with a percentage of 32.9%. During the first trimester - it is 11.6%, the second trimester - 28.2%, and the last trimester - 50.2%. Pregnant Indian women most often experience cramps in the third trimester, especially in the lower leg (64.6%). 

A multicenter American study found that patients with COPD suffer from 46% of muscle cramps, which appears to be the main cause of pain in this patient population.

Another multicenter American study found that 74% of seizures occur in athletes and in high-temperature environments.

In Australia, 32% of children with Charcot-Marie-Tooth disease type 1A suffer from seizures. The phenomenon intensifies with age. [5]

Symptoms

Dwelling on the symptoms of muscle cramps, we take as a basis a convulsive reaction, and not a more complex manifestation of muscle contraction. This is a condition that is short-lived, and although it gives us some inconvenience, it does not affect the quality of life too much.

The first signs of seizures can be observed visually, noticing a slight twitching of a separate section of muscles independent of our will and desire. Another type of sensation boils down to the expression "reduced leg" - a painful and somewhat longer state. Their localization is different, but most often complaints relate to:

• cramps of the calf muscles of the legs - affects mainly athletes with their heavy loads, frequent injuries, training regimen. After a spasm of the calf muscle, the leg may hurt for a long time, which requires the intervention of a doctor and treatment;
• leg muscle cramps at night - a prolonged static position of a limb in a dream leads to a slowdown in blood circulation, rare manifestations do not cause concern, frequent ones require examination;
• legs and cramps hurt - symptoms of varicose veins. Pain, burning, swelling occur mainly at the end of the day or after exercise. Symptoms require examination and treatment, because the disease is dangerous by the formation of blood clots;
• muscle cramps in the arms and legs - may indicate a lack of a number of vitamins and minerals in the body, excessive enthusiasm for coffee, smoking, causing vasospasm;
• cramps of the thigh muscles - a very painful condition, a spasm is able to fetter the front and back of the thigh, the muscles turn into stone. It can provoke a prolonged strong load on the legs;
• cramps of the toes and calf muscles - can occur due to wearing tight shoes, hypothermia of the feet, poor blood circulation in the limbs;
• leg muscle cramps during pregnancy - such manifestations almost always accompany the period of bearing a child and are explained by a lack of calcium, potassium, magnesium, vitamin B6 in the body of a woman, because the need for them increases for the formation and development of the fetus. This contributes to toxicosis, accompanied by frequent vomiting, with vomit is lost part of the necessary useful components.

Diagnostics of the leg cramps

The most reasonable for frequent convulsions is to contact a therapist who will conduct the initial diagnosis and, if indicated, will refer to a narrow specialist.

Palpation is the first study: a strong tension is felt at hand, which can cover the entire muscle region or localized node.

Among the necessary studies are a clinical blood test that gives an idea of the general condition of the body (whether there is inflammation, anemia, etc.), blood sugar levels for diabetes mellitus, a biochemical blood test to assess liver and kidney function, a general urine test and Nechiporenk (kidney function).

Instrumental diagnostics may include head MRI, brain electroencephalography, vascular ultrasound, dopplerography of veins with suspected venous insufficiency, x-ray examination.

Electromyography is another study that can be done to understand the type of motor unit discharge and diagnose neurological pathology. Echocardiography can evaluate morphological abnormalities that can cause seizures. [6], [7]

Differential diagnosis

A differential assessment is carried out between all possible causes of uncontrolled muscle contractions, from true muscle cramps to electromyographic muscle contractures (for example, Brody's disease) and cramps associated with dystrophinopathies. In addition, they distinguish between true muscle cramps and muscle stiffness and muscle twitching. [8]

Treatment of the leg cramps

With leg cramps, you first need to learn how to remove them. How to do it? First aid consists in gently rubbing, massaging the hardened muscle, patting it, since with severe cramps the muscle can remain painful for several days.

Cramping can be stopped by passively stretching the muscle or activating its antagonist. To do this, stand on a cold floor, straighten up and try to raise your toes up. Another way is to take the leg back, put it on the thumb, pressing with the weight of the body. You can also pull the sock towards you while lying down.

A 2010 study suggests that taking small amounts of pickled juice relieves muscle cramps within 35 seconds after ingestion. The rapid inhibition of electrically induced spasms reflects a neuro-mediated reflex that occurs in the oropharyngeal region and inhibits the triggering of alpha motor neurons in muscle spasm. [9]

Assuming that there is a link between dehydration-electrolyte imbalance and muscle cramps associated with exercise (EAMC), the National Association of Sports Trainers recommends athletes prone to muscle cramps to add 0.3 to 0.7 g / l salt to their drinks, to prevent muscle cramps. [10]

Stretch marks, quinine and beta-blockers have a high level of evidence (level 2 or 3) in support of their use, based on studies of drugs with the participation of people [11]and other studies. [12]If the athlete does not have the underlying disease, then the most common treatment for EAMC is sprain.[13]

The treatment of seizures is carried out in parallel with the therapy of the underlying disease. So, with varicose veins, a comprehensive approach is used, including systemic medication (with drugs aimed at combating the development mechanism of pathology), local (ointments, gels to improve blood circulation) treatment, a diet to reduce body weight if necessary, increase physical activity with the exception of power types sports and hard work.

Medication

The treatment regimen is built depending on the nature of the seizures, the time of their occurrence (night or day), age, weight, and only a doctor can develop it. The main anticonvulsants include phenobarbital, benzonal, diphenin, chloracan can be used.

Quinine sulfate is an effective medicine for cramps in the legs, but the side effect profile limits its use. Other membrane stabilizing drugs are probably equally effective in treating this condition. [14]

Phenobarbital - tablets, reduce the excitation of the central nervous system, have a hypnotic effect. As a rule, the minimum dose is prescribed. For children under 6 months, it is 5 mg once, 6-12 months - 10 mg, 1-2 years old - 20 mg, 3-4 years old - 30 mg, 5-6 years old - 40 mg, 7-9 years old - 50 mg, 10-14 years old 75 mg Children older and adults from 50 to 200 mg. Frequency of admission 2 times a day. Among the adverse reactions, dizziness, nausea, vomiting, decreased blood pressure, skin rashes are possible. The drug is contraindicated in the 1st trimester of pregnancy, while breastfeeding, diabetes mellitus, severe liver and kidney diseases, alcohol and drug addiction. [15]

Benzonal - the dose is determined by the doctor individually. For children 3-6 years old, it can be 50 mg once, 7-10 years old 50-100 mg, 11-14 years old - 100 mg, adults -150-200 mg. They begin treatment with one dose per day, after 2-3 days increasing to three times. Do not prescribe a remedy for asthma, anemia, hyperthyroidism, diabetes, kidney, liver, heart failure, pregnant and lactating, children under 3 years. The use of benzonal can cause an allergic reaction, an asthmatic attack, constipation, diarrhea, addiction to the drug.

Frequent convulsive attacks make it necessary to prescribe other drugs at the same time: calcium gluconate, papaverine, belladone extract, tranquilizers (thioridazine, diazepam).

Quinine reduces the frequency of idiopathic leg cramps compared to placebo. Adding theophylline to quinine can reduce the incidence of nocturnal leg cramps compared to quinine alone.

There is no evidence whether analgesics, antiepileptic drugs, magnesium salts, vitamin E, stretching exercises or compression stockings reduce spasms. There is no evidence that seizures reduce calcium salts, sodium chloride, or multivitamins and mineral supplements. [16]

To reduce the tone of peripheral muscles, muscle relaxants, [17]for example, dantrolene, antispasmodics, are effective, in particular, in the treatment of nonspecific back pain.

With varicose veins, phlebotropic preparations are prescribed: venotonics, phleboprotectors (detralex, venoruton, aescusan). [18]

Detralex - tablets reduce the extensibility of veins, improve lymphatic drainage, blood microcirculation. Take 1 pc. Morning and evening with food. Children are not recommended for admission. Caution is prescribed for pregnant women. If necessary, it is best to interrupt while breastfeeding. Detralex may cause an allergy. Of the side effects, the most common skin rashes, edema, headache, malaise, nausea, and diarrhea.

From leg cramps in the muscles, ointments can be used, which, due to their warming or cooling effect, rubbing movements, relieve the condition. Among such actovegin, venozole, troxevasin, heparin, diclofenac.

Venozole - a cream that activates venous outflow, relieves a feeling of heaviness in the legs, and enhances blood circulation. Contraindicated in children under 12 years of age, pregnant, during lactation. It is applied by massaging movements to the surface of the lower extremities 2 times a day. The course of treatment is from a month to three.

Vitamins from cramps in the muscles of the legs

Since one of the causes of seizures is a lack of certain minerals and vitamins in the body, care must be taken to ensure that the diet includes more calcium and potassium. It is necessary to put emphasis in the menu on legumes, cottage cheese, hard cheeses, liver, raisins, apples, dried apricots.

Periodically, it is worth taking multivitamin complexes or, as prescribed by a doctor, preparations of magnesium, calcium, vitamin D, which helps to assimilate the latter. However, in a 2017 study, it was proved that Vitamin D does not affect pain in muscle cramps. [19]

Folic acid (vitamin B9) is effective against leg muscle cramps. During an attack, it is recommended to chew 2 tablets at once, and then take another week or two.

Short-term vitamin E treatment is safe and effective in reducing muscle spasms. [20]

Physiotherapeutic treatment

One of the common physiotherapeutic methods is physiotherapy, massage. [21]Even without using a special complex, you need to walk daily at home or at work on toes, heels, the inside and outside of the foot. Unbeknownst to others under the table, you can take off your shoes, move your fingers, pull them towards yourself and away from you. It will not be superfluous to squat, bend the leg at the knee and pull the heel to the buttock.

Useful foot baths with a change in water temperature, their hydromassage.

When pathology is detected, the use of phono- and electrophoresis, electro- and shock-wave therapy is possible. [22]

Alternative treatment

Alternative recipes describe how to relieve muscle cramps:

• a pinch of onion husks is poured with a glass of boiling water and infused for 20 minutes. Drink infusion daily at night;
• several weeks in a row eat a tablespoon of honey in the morning on an empty stomach, washed down with a glass of kefir;
• two tablespoons of raisins are steamed overnight with 250 ml of hot water, they drink it the next day, you also need to eat berries.

Herbal treatment

Of the variety of medicinal herbs, tansy, fern roots are used to reduce convulsive manifestations. Their infusion is added to the water when taking a bath. I also drink tea from a drugstore chamomile, it relaxes, soothes. [23]An alcohol tincture is prepared from yarrow and thyme for rubbing the feet, and from a mixture of celandine juice and petroleum jelly - an ointment that is rubbed for 2 weeks.

Homeopathy

There is some evidence that homeopathic treatment is more effective than placebo; however, the strength of this evidence is low due to the low methodological quality of the tests. [24]

Cramping convulsive pains, muscle soreness after an attack relieves Colocynthis cucumis - the fruits of the plant are ordinary colocyntes from the pumpkin family.

There is a series of anti-seizure drugs manufactured by Hyland's Leg Cramps in tablets, ointments. Tablets can be taken from 12 years old, 2 pieces at a time every 4 hours.

The same manufacturer owns Magnesia phosphorica 6X, a muscle relaxant. You can give children 2 balls three times a day. For prevention, 2 pieces are enough twice. For adults, the dose is 4 tablets. During an attack, you can absorb under the tongue up to 8 pieces every 15 minutes.

Venoflebin - anticonvulsant granules. At a time, take 8 pieces before meals with four-hour intervals, absorbing under the tongue before eating. May cause side effects in the form of allergic manifestations.

Surgery

Some conditions that cause leg cramps may require surgery. This refers to possible injuries or, for example, varicose veins, in which resort to phlebectomy - the removal of its dilated areas.

Complications and consequences

Cramps and spasms of the leg muscles are often the precursors of a particular disease, so the possible consequences are associated with specific diagnoses. Sometimes the complications provoked by the attack are fraught with disability.

Prevention

Preventive measures include the organization of proper nutrition, an adequate drinking regimen, periodic massage courses, physical education for the legs. Prevention in healthy people may include proper muscle warming before exercise and adequate hydration. For various pathologies, also characterized by the appearance of seizures, there are no generally accepted recommendations regarding the pharmacological approach. [25]

Forecast

Muscle cramps are not life threatening, but they can indicate a wide range of systemic disorders. In many cases, eliminating the underlying cause can lead to the resolution of muscle cramps. Most muscle cramps go away on their own, and therefore treatment is not required. Patients with ongoing muscle cramps in their legs should be referred to an appropriate specialist to determine the cause and treatment. The patient should also be informed that, despite the presence of a huge number of drugs, their effectiveness is low and unpredictable. (Level V)  [26],  [27], [28]

The prognosis of muscle cramps is directly dependent on the causes that caused them, the person’s age, nature of the course, timeliness and effectiveness of treatment. Those caused by organic damage to the nervous system tend to progress and increase. An unsuccessful outcome is characteristic of generalized convulsive epileptic seizures. In less complex cases, therapeutic support provides long-term remission.