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Cramps are unpleasant, often painful sensations caused by contraction or over shortening of muscles. Cramps can be caused by cold, overexertion, or a low calcium level in the blood (especially for adolescents, who need calcium for both blood and bone maturation). However, the most common reasons are low sodium and potassium levels in the blood, accompanied by excessive dehydration. Illness or poisoning can also cause cramps, particularly in the stomach, which is referred to as colic if it fits certain characteristics. This will often happen when you are dehydrated.
There are numerous causes of cramping: hyperflexion, hypoxia, exposure to large changes in temperature, dehydration, low blood salt, or low blood calcium. Muscle cramps may also be a symptom or complication of pregnancy, kidney disease, thyroid disease, hypokalemia, or hypocalcemia (as conditions), restless-leg syndrome, varicose veins, and multiple sclerosis.
Electrolyte disturbance may cause cramping and tetany of muscles, particularly hypokalaemia (a low level of potassium) and hypocalcaemia (a low level of calcium). This disturbance arises as the body loses large amounts of interstitial fluid through sweat. This interstitial fluid comprises mostly water and table salt (sodium chloride). The loss of osmotically active particles outside of muscle cells leads to a disturbance of the osmotic balance and swelling of muscle cells, as these contain more osmotically active particles. This causes the calcium pump between the muscle lumen and sarcoplasmic reticulum to short circuit; the calcium ions remain bound to the troponin, and the muscle contraction is continued. This may occur when the lactic acid is high in the cells.
As early as 1965, it was observed that leg cramps and restless-leg syndrome can be a result of excess insulin, sometimes called hyperinsulinemia. Hypoglycemia & reactive hypoglycemia are also known to be associated with excess insulin , and avoidance of low blood glucose concentration may help to avoid cramps.
Skeletal muscles work as antagonistic pairs, the contraction of one skeletal muscle requires the relaxation of the opposing muscle in the pair. Cramps can occur when muscles are unable to relax properly due to the myosin fibres not detaching fully from the actin filaments. In skeletal muscle, both ATP (energy) and magnesium must attach to the myosin fibres in order for them to disassociate from the muscle and allow relaxation — the absence of either of these in sufficient quantities means that the myosin remains attached to actin. An attempt to force a muscle cramped in this way to extend (by contracting the opposing muscle) can tear muscle tissue and make the pain worse.
Statins are known to cause myalgia and cramps among other possible adverse reactions or side effects, including substantially lowering blood glucose concentration. Additional factors, which increase the probability for these adverse side effects, are physical exercise, age, female gender, history of cramps, and hypothyroidism. Up to 80% of athletes using statins suffer significant muscular adverse effects, including cramps; the rate appears to be approximately 10-25% in a typical population using statins. In some cases, these adverse effects will disappear after switching to a different statin; however, they should not be ignored if they persist, as they can, in rare cases, develop into more serious problems. Coenzyme Q10 supplementation can be helpful to avoid some statin-related adverse effects, but currently there is not enough evidence to prove the effectiveness in avoiding myopathy or myalgia.
Muscle cramps can be treated by applying a soft massage on the cramped muscle, stretching hands above the head, inhaling deeply through the mouth, stretching the muscle, and applying heat or cold. Heat improves superficial blood circulation and makes muscles more flexible, so some people find heat to be soothing for muscle cramps. Application of excessive heat or cold to sore muscles may bring on cramps, even though this just contradicts the former. Pounding on a cramped muscle can increase soreness. Trying to put weight on a cramp too soon can cause another cramp or even a temporary loss of ability to use that muscle. For leg cramps, the quickest treatment involves bending over and grabbing the end of the toes, fully straightening out the leg; the cramp will eventually dissipate.
In the case of inadequate oxygenation, excess lactic acid, produced by anaerobic respiration, builds up and stresses the muscle. Cramps from poor oxygenation will not be improved by rapid deep breathing, as the oxygen-transporting hemoglobin in the blood is always (nearly) completely saturated with oxygen in healthy individuals. The poor oxygenation is rather a result of the heart’s inability to transport oxygenated blood fast enough to the over-exercised muscles. The maximum heart rate and the amount of capillaries supplying the unconditioned muscles are among the limiting factors (the latter can be improved by exercising the muscle over time).
Cramps from lack of water and salt can be treated by drinking water and increasing salt intake, respectively.
There is no scientific evidence to support the widely held claim by the sports-nutrition industry that the intake of specially composed electrolyte drinks has any advantage over intake of plain table salt (via drink or food) and water to counter these electrolyte disturbances and muscle cramps in people with a well-functioning renal system.
Eating foods high in potassium can help prevent muscle cramps.
In the case of cramps caused by varicose veins, treatment of the affected veins with sclerotherapy, endovenous laser, or surgery usually provides relief.
Quinine has been prescribed for the treatment of leg cramps. However, due to the drug’s risks, the United States Food and Drug Administration has declared that it should not be used to prevent or treat leg cramps.
Calcium and magnesium replacement are also an effective remedy for exercise induced muscle cramps. Antacids containing calcium carbonate and magnesium carbonate immediately release salts that replace regional calcium and magnesium deficiency due to sweating and muscle activity.
Smooth muscle contractions lie at the heart of the cramping (or colicky) pain of internal organs. These include the intestine, uterus, ureter (in kidney stone pain), and various others.
Menstruation is also highly likely to cause cramps of varying severity in the abdomen that may radiate to the lower back and thighs. Menstrual cramps can be treated with ibuprofen, acetaminophen (paracetamol), stretching exercises, or the application of heat through such means as warm baths or heating pads. Menstrual cramps that do not respond to self treatment may be symptomatic of endometriosis or other health problems.
Skeletal muscles are muscles that can be voluntarily controlled. Of the skeletal muscles, those which cramp the most often are the calves, thighs, and arches of the foot. These cramps are seemingly associated with strenuous activity and can be intensely painful.
Note: The idea of holding ones upper lip as a remedy for various leg cramps is purely fiction. There is no scientific proof of this or any evidence proving its plausibility.
Nocturnal leg cramps are involuntary muscle contractions that occur in the calves, soles of the feet, or other muscles in the body during the night or (less commonly) while resting. Only a few fibers of a muscle may be activated. The duration of nocturnal leg cramps is highly variable with cramps sometimes only lasting a few seconds and other times several minutes. Soreness in the muscles may remain for some time after the cramp ends. These cramps are erroneously believed to be more common in older people but may happen to anyone. They can happen quite frequently in teenagers and in some people while they are exercising at night. Nocturnal leg cramps can be very painful, especially if the person is dehydrated. Usually, putting some pressure on the affected leg by walking some distance will make the cramp go away.
The precise cause of these cramps is unclear. Potential contributing factors are believed to include dehydration, low levels of certain minerals (magnesium, potassium, calcium, and sodium), and the reduced blood flow through the muscles attendant in prolonged sitting or lying down. Less common causes include more serious conditions or the use of drugs.
Nocturnal leg cramps may sometimes be relieved by stretching the affected leg and pointing the toes upward. Quickly standing up and walking a few steps may also shorten the duration of a cramp.
Nocturnal leg cramps (almost exclusively calf cramps) are considered to be ‘normal’ during the late stages of pregnancy. They can, however, vary in intensity from mild to incredibly painful.
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