Dealing with Cramps

Treatment and prevention of cramps

Almost everyone has experienced cramps in their life but most people do not understand why they happen or how to prevent them.                                  

Cramps are involuntary contractions of the muscle fibres of a muscle, or group of muscles.  They can last anything from a few seconds to fifteen minutes.  Almost anywhere can be affected, organs, intestines even blood vessel walls, but most commonly affected are skeletal muscle especially in the legs, especially calves.  Everyone has an increased chance of cramps with age.

There are no medicines for cramps since they come and go quickly and there are many different reasons for them.

What causes cramps?

True cramps are the most common type of cramp they are the result  of excitable nerves to part or entire muscles.  All of the following can bring on cramps:

  • Vigorous activity can bring on cramp during or after due to fatigue.  Inactivity in an awkward position may result in the same.
  • Injury can cause protective guarding to stabilise an area and minimise movement.
  • Dehydration due to hot weather, high levels of training, bikram yoga.  Bear in mind that this is likely to be associated with heat exhaustion. 
  • Low blood calcium and magnesium.  This can be brought on during pregnancy, through hyperventilation, vomiting lack of vitamin D and problems with the parathyroid, which regulates calcium levels. 
    (Note that low potassium causes weak muscles rather than cramping).
  • Rest Cramps occur mainly at night especially in the calves as we point toes under bedding, but the cause is still unknown.

What can you do to prevent them?

  • Stretch before and after activity and before bed at night.
  • Warm up and cool down properly.
  • Maintain good hydration throughout the day with electrolytes.
  • Massage the affected are to relieve tension and soreness.
  • Apply a cold pad if there is any swelling.
  • Avoid alcohol tea and coffee.
  • Seek medical attention if persistent, since numerous medications and certain vitamin deficiencies can cause cramps.

What do you see?

  • There is no test for cramps.
  • Most people will know and are stopped in tracks with anxiety and pain.
  • Muscle can be tender and firm. 
  • Inflammation and pain can continue for days afterwards.

What do you do?

  • Reassure.
  • Stretch the muscle to relieve, especially calve, hand & forearm muscles.
  • Manage any unconsciousness with a safe airway position

Special considerations

Low levels of carbon dioxide, most commonly caused by hyperventilation (over breathing), can cause tetany by altering the albumin binding of calcium such that the ionised (physiologically influencing) fraction of calcium is reduced.  So if someone over breathes it possible that they can reduce the amount of calcium available causing their feet and hands to spasm.

If the spasms have been bought on through hyperventilation the casualty must be reassured and encourage to slow their breathing rate down in order to correct the carbon dioxide imbalance that has built up through over breathing.

Other types of cramps

1) Tetany

In tetany, all of the nerve cells in the body are activated, which then stimulate the muscles. This reaction causes spasms or cramps throughout the body. 

Sometimes, tetanic cramps are indistinguishable from "true" cramps. The accompanying changes of sensation or other nerve functions that occurs with tetany may not be apparent because the cramp pain is masking or distracting from it.

The muscle cramps caused by the disease tetanus are due to a blocking of the inhibition to the neurons that supply muscles and are not classified as tetany.

The most common cause of tetany is lack of calcium. Low ionic calcium can be hidden in blood tests.  Symptoms could be an arm cramp, while numbness and tingling occurs around the mouth or other areas of the body.  The ability to swallow may also be impaired as the larynx goes into spasm.  Tetany is sometimes impossible to tell from true cramps since tingling can be masked by pain and anxiety.

An excess of phosphate (high phosphate-to-calcium ratio) can also trigger the spasms. As well as the under function of the parathyroid gland and it is possible that low levels of carbon dioxide, most commonly caused by hyperventilation,  causes tetany by altering the albumin binding of calcium such that the ionised (physiologically influencing) fraction of calcium is reduced.

Signs 

  •  Hyperreflexia - overactive neurological reflexes.
  • Carpopedal spasm - spasms of the hands and feet.
  • Cramps.
  • Laryngospasm - spasm of the larynx, the voice box.

2) Dystonic cramps – are when the opposite muscle groups to that needed contract.  Examples include the jaw eyelids and larynx.

3) Contractures – muscles can't relax due to lack of ATP.  This can occur with no muscle activity be inherited or acquired.

Reference:
http://www.medicinenet.com/muscle_cramps/article.htm
http://www.medterms.com/script/main/art.asp?articlekey=13312
http://en.wikipedia.org/wiki/Tetany_(medical_sign)