Joanna had a problem. It wasn’t really a crippling one, but, when it occurred, she was in significant pain. The pain always developed suddenly, without warning, and any activity she was participating in had to stop. This wasn’t a disabling problem, but, In a way, when the cramping in her calf struck, she was essentially crippled.

Joanna had a problem, and it was putting a “cramp” in her style. (Sorry, but I really wanted to use the cliche.) She did a little research and found this is a common problem, but apparently there are many causes for the sudden, sharp pain that developed in her calf. This large muscle group is one of the most common sites for cramps. But her cramps were never associated with exercise, which is a separate and distinct type.

Muscle cramps are extremely common, and almost everyone experiences a cramp at some time in their life. They are frequently experienced by adults, becoming more so as we age, but children can also experience them. Any of the muscles that are under our voluntary control (skeletal muscles) can cramp. This affliction generally is noted in the extremities, especially the legs and feet (including nocturnal leg cramps), and, as mentioned, most particularly the calf (the classic “charley horse”).

Joanna’s research revealed the existence of several different types. Many participating in some demanding athletic activity will develop muscle cramps, especially when the sport is of greater duration. You see this often in soccer, where there is no stoppage of play. True cramps involve part or all of a single muscle, or a group of muscles, that act together.

For example, the muscles that flex several adjacent fingers, or, very commonly, the leg muscles. Such cramps may come during the activity or later, sometimes many hours later. Older adults are at risk for cramps when performing vigorous or strenuous physical activities, since they likely are not conditioned for these demands.

Most authorities agree that true cramps are caused by hyperexcitability of the nerves that stimulate the muscles. They are overwhelmingly the most common type of skeletal muscle cramps.

True cramping can also be the result of an injury, where the muscle spasm is a protective mechanism. It is an attempt by the muscle to minimize movement, such as when there is a broken bone, and the body wants to stabilize the area. Injury of the muscle alone may cause the muscle to spasm, as well.

Rest muscle cramps often occur at night. While not life threatening, night cramps can be painful, disruptive of sleep, and can recur many times a night, or many nights each week. The actual cause of night cramps is unknown, although numerous theories exist. Sometimes, such cramps are initiated by making a movement that shortens the muscle. An example is pointing the toe down while lying in bed, which shortens the calf muscle of the leg.

Sports and other vigorous activities, including activities of endurance athletes, can cause excessive fluid loss from perspiration, and may be associated with sodium depletion. Loss of sodium, the most abundant chemical constituent of body fluids outside the cell, is usually a function of dehydration.

These cramps are more likely to occur in warm weather and can be an early sign of heat stroke. Chronic volume depletion of body fluids from medicine that promote urination, as well as poor fluid intake, can both lead to dehydration and may predispose a person to cramps, especially the elderly.

Another cause may be low blood levels of either calcium or magnesium. Inadequate amounts of these substances can directly increase the excitability of both the nerve endings and the muscles they stimulate (a common predisposing factor for the cramps experienced by older individuals). Low levels of calcium and magnesium are common in pregnant women, and should be supplemented in the diet.

There are many other reasons for cramps to develop. Numerous medicines can cause cramps. Potent diuretic medications, such as furosemide, aka Lasix, can induce cramps by depleting body fluid and sodium. Simultaneously, diuretics often cause the loss of potassium, calcium, and magnesium, which can also cause cramps.

Returning to our protagonist, Joanna found the cramp could be stopped by stretching her calf muscles out. Her technique, developed out of necessity due to the severity of the pain, involved flexing the ankle by pulling the toes up toward the head while still lying in bed.

This is most effective if the knee is kept as straight as possible. For many cramps of the feet and legs, stretching can be accomplished by standing up and walking around. For a calf muscle cramp, an Achilles stretch, also called a runner’s stretch, can be beneficial at easing the cramp.

Other techniques for reducing the pain of muscle cramps include gently massaging the muscle to help it relax, as well as applying warmth from a heating pad or hot soak. If the cramp is associated with fluid loss due to vigorous physical activity, electrolyte replacement is essential, along with the obvious one, water. Medicines are not generally used since most cramps subside spontaneously before enough medicine would be absorbed to even have an effect.

Joanna reduced greatly the occurrence of her cramps with magnesium supplements, although added magnesium can be very hazardous for people who have difficulty eliminating it (as with renal disease or kidney insufficiency). The use of diuretics can increase magnesium loss, while high levels of calcium intake tends to increase magnesium excretion. Magnesium is present in many foods, including greens, fish, bananas, nuts, and soybeans, but a supplemental dose of 50-100 milligrams of magnesium daily may be appropriate.

Determining the exact cause of night cramps can be difficult. The best prevention involves stretching regularly, adequate fluid intake, appropriate calcium and vitamin D intake, supplemental vitamin E, and possibly supplemental magnesium. The situation is different if you are a participant in demanding athletic activities, but for many older people, night cramps are a painful and recurrent condition.

If some of the simple measures listed above do not minimize your muscle cramping, it may be time to see your physician, since this is a condition you don’t want to live with. And recurrent cramps may be a symptom of something else. As mentioned, a solution can be hard to find. The pain of muscle cramping may not last forever, but in the midst of one, you want only one thing, for it to end!

Editor’s note: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.