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Calf cramps: causes and treatment

by Josephine Andrews
Published: Last Updated on 189 views

Calf cramps occur when muscles or parts of muscles in the calf suddenly and painfully contract without influencing them consciously. This can happen during sports, for example, but also during sleep. Occasional muscle cramps in the calf are usually harmless. However, if the cramps occur more frequently, they can be a sign of a disease. Read everything you need to know about calf cramps here!

quick overview

  • Description : Calf cramps are sudden, brief, involuntary, and painful contractions of a muscle part, whole muscle, or muscle group in the calf.
  • Causes : mostly unknown or harmless (e.g. severe muscle tension during sports, severe loss of water and salt through sweating, etc.). Less frequently, calf cramps are signs of an illness (e.g. hypofunction of the thyroid , diabetes, kidney failure, varicose veins ) or side effects of medication.
  • Treatment : depending on the cause and need, e.g. replacement of missing fluid or electrolytes, treatment of underlying diseases
  • What helps against cramps in acute cases? Stretching , gentle massage, heat treatments
  • Prevention : e.g. regular training, gentle stretching (before exercising and going to bed), drinking enough, eating a magnesium-rich diet, taking magnesium supplements if necessary, avoiding nicotine, caffeine and stimulants such as ephedrine

Calf cramps: description

Calf cramps are spasms in the calf muscles. In such a muscle spasm, part of a muscle, an entire muscle, or a group of muscles suddenly, involuntarily, and painfully contracts. The affected musculature is palpably hardened and unable to move. Muscle cramps only last for a short time (seconds to minutes) and then go away on their own.

Muscle cramps usually occur in the legs and here preferably in the calves. Calf cramps are therefore the most common and probably the most well-known form of muscle cramps.

Muscle cramps are to be distinguished from muscle spasms, i.e. painless cramps in the muscles. Also to be distinguished are fasciculations – visible, irregular and involuntary twitching of muscle fiber bundles without movement effect (e.g. twitching eyelid ). They are not painful, but often uncomfortable.

Convulsions: frequency

Calf cramps and other muscle cramps occur especially at night and are not uncommon. Almost everyone has a muscle cramp from time to time. More than 90 percent of young adults report isolated cramps. Muscle cramps become more common with age: 33 to 50 percent of people over the age of 65 have a cramp regularly (at least once a week).

The increased susceptibility to muscle cramps in old age can be explained by generally shortened muscles. In addition, older people tend to drink too little – this can throw the water and mineral balance out of balance and thus promote cramps (e.g. in the legs).

Calf cramps: causes

Basically, calf cramps and other muscle cramps are divided into three categories depending on how they develop:

  1. Paraphysiological cramps : Occasional cramps during pregnancy and after physical exertion, which are usually caused by a disturbance in the electrolyte and water balance – for example as a result of heavy sweating.
  2. Idiopathic convulsions : They occur for no apparent reason and no cause can be identified. Leg cramps at night are common.
  3. Symptomatic spasms : They are accompanying symptoms of illnesses, such as disturbances in the nervous system, muscles or metabolism. Medication can also cause muscle cramps (such as calf cramps) as a side effect.

Calf cramps mostly harmless

An occasional cramp in the calf is generally not a cause for concern – it is usually an idiopathic or paraphysiological cramp. The latter can be triggered, for example, by a lack of fluid intake, sweaty sport or a common gastrointestinal flu with severe vomiting and diarrhea. Strong muscle tension (e.g. during sports) can also result in calf cramps.

More rarely, calf cramps are the symptom of a serious illness (e.g. hormonal or metabolic diseases, vascular diseases, kidney diseases) or a side effect of medication.

Below is more detailed information on possible causes of calf and other muscle cramps.

Disorders of the electrolyte and water balance

dehydration

Calf cramps or muscle cramps are often triggered by dehydration, i.e. dehydration of the body. The result is an imbalance in the mineral balance that can trigger muscle cramps.

For example, dehydration can result from severe diarrhea , severe vomiting or excessive sweating and lack of fluid intake. Sometimes the cause is a serious illness such as diabetes insipidus (a hormonal disease with extremely high urine output) or the chronic inflammatory bowel disease Crohn’s disease. Likewise, diuretics (drugs that drain water) can cause the body to lose a lot of water, causing muscle cramps (in the leg or elsewhere).

magnesium deficiency

A magnesium deficiency (hypomagnesemia) can also cause calf cramps or muscle cramps. An undersupply of the mineral can be caused by an unbalanced diet or diet, diabetes mellitus, alcoholism or intestinal and kidney diseases. A deficiency often develops during pregnancy as well – there is then an increased need for magnesium.

Leg cramps and other muscle spasms associated with other magnesium deficiency symptoms (such as confusion, weakness, fatigue, headaches and cold feet) are collectively referred to as magnesium deficiency syndrome.

Other electrolyte disorders

Potassium deficiency (hypokalemia) and calcium deficiency (hypocalcemia) are also possible causes of muscle cramps:

potassium deficiency can be caused, for example, by severe diarrhea, taking certain medications, magnesium deficiency or diseases of the adrenal glands (see below). An undersupply of calcium can be caused by magnesium or vitamin D deficiency , disorders of the parathyroid gland or kidneys (see below) or certain medications.

Hormonal and metabolic disorders

Various hormonal and metabolic disorders can cause symptomatic muscle cramps when they upset water and electrolyte balance. Examples:

  • Underactive thyroid : The most common signs of underactive thyroid (hypothyroidism) include poor performance and concentration , rapid fatigue and memory disorders. In addition, the muscles tend to cramp.
  • Underactive parathyroid glands (hypoparathyroidism) : It causes a calcium deficiency that makes muscles over-excitable. Among other things, this can trigger muscle cramps and, in severe cases, even tetany (rigid, persistent cramps) in the hands and feet.
  • Diabetes mellitus : The first symptoms are increased urination and a strong feeling of thirst. Muscle cramps (such as calf cramps) can initially be caused by electrolyte imbalances, later they can be the result of diabetic nerve damage (polyneuropathy).
  • Adrenal Cortical Disorders : The adrenal gland secretes hormones that are essential for the regulation of water and mineral balance. Diseases of this organ can therefore manifest themselves with muscle cramps, among other things.
  • Kidney Diseases : The kidneys play the central role in regulating fluid balance. Kidney weakness or even kidney failure can therefore trigger cramps, among other things.

Musculoskeletal Disorders

Occasionally, symptomatic muscle spasms are the result of muscle diseases (myopathies). These rare disorders can be congenital or acquired and are typically associated with muscle weakness. Sometimes there is also cramping muscle pain.

Structural disorders are also possible triggers for muscle cramps . For example, flat feet can lead to foot cramps due to the uneven load on the foot muscles. A genu recurvatum – an abnormally hyperextensible knee joint – sometimes results in muscle cramps in the leg.

nerve diseases

Neurological disorders and diseases that can be associated with symptomatic muscle spasms include:

  • Motor neuron diseases : These are diseases in which nerve cells that stimulate muscle movement are progressively destroyed. The most common form is amyotrophic lateral sclerosis . Its symptoms include muscle weakness, muscle wasting and muscle cramps.
  • Peripheral neuropathies : These are disorders in which peripheral nerves are damaged (such as nerves in the legs), which can cause muscle spasms. The disorders can affect just one or a few nerves, but sometimes many. In the latter case one speaks of polyneuropathy. It is often caused by diabetes mellitus or alcoholism.
  • Radiculopathies : These are diseases of the nerve roots (in the area of ​​the spine ), triggered, for example, by a herniated disc. For example, nerves that control the leg muscles can be affected, which can result in muscle cramps (such as calf cramps).

vascular diseases

Varicose veins ( varicose veins ) are extensions of superficial veins that are caused by venous insufficiency . They form particularly often on the legs and are visible here as blue, thick, nodular blood vessels . Legs feel heavy and tense. In addition, nocturnal calf cramps occur frequently.

drugs and stimulants

There are a number of medications that can cause muscle spasms. These include:

  • certain high blood pressure medicines: angiotensin II receptor blockers (AT1 antagonists) and some beta-blockers
  • bronchodilators used to treat asthma , e.g. salbutamol
  • Cisplatin and vincristine (cancer drugs)
  • lovastatin (medicine against high blood fat levels)
  • Diuretics (water tablets)
  • Donepezil (medicine for Alzheimer’s )
  • Tolcapone (Anti- Parkinson’s Drug )
  • contraceptive pill (“anti-baby pill”)
  • Pyrazinamide (anti- tuberculosis medicine )
  • raloxifene (used to prevent and treat osteoporosis )
  • teriparatide (used to treat osteoporosis)

Various stimulants (such as amphetamines, cocaine, caffeine, nicotine, ephedrine, and pseudoephedrine) can also cause muscle spasms.

Leg cramps: treatment and first aid

Treatment for leg cramps (and other muscle spasms) depends on the cause. Some examples:

Disturbances in the electrolyte and water balance can often be compensated for if the person affected drinks more and eats a balanced diet. This is especially true if the disorder is not caused by an illness, but is caused by heavy sweating during sport. If there is a severe imbalance in the water-salt balance (e.g. as a result of severe vomiting and diarrhea), special electrolyte solutions can be useful. They contain the most important mineral salts in an optimal composition and can quickly and effectively compensate for water and salt loss.

If a medical condition is causing the cramps in the calf or other muscles (via water-salt imbalance or otherwise), it is important to treat them appropriately. For example, in the case of hypothyroidism , the doctor prescribes a hormone preparation to replace the missing thyroid hormones. If the parathyroid gland is underactive (hypoparathyroidism), those affected receive vitamin D and calcium. This compensates for the lack of calcium and can help against muscle cramps.

If cramps are a side effect of the medication , the doctor will prescribe an alternative preparation if possible.

Historically, quinine was given to treat muscle spasms (such as leg cramps). Due to the side effects (such as vomiting, blurred vision, ringing in the ears, headaches), however, it is not recommended today. Mexiletine (a remedy for cardiac arrhythmias ) would also be effective against cramps . But it also has many side effects (nausea, vomiting, shaking = tremor and seizures).

First aid for acute muscle spasms

>> stretch

In acute cases (e.g. muscle cramps during sport or night cramps in the calves) it usually helps to stretch the aching, cramping muscle – this can often end the cramp.

For example, if you have a calf cramp while standing, pull the toes of the affected leg towards your nose (possibly with the help of your hand ) while at the same time pressing your heel into the floor. The whole thing also works while lying down – pull your toes towards your shinbone and at the same time push your heel away. This stretch of the calf muscles also stretches the hamstrings, so this exercise will also help if you have a hamstring cramp .

On the other hand, if you have a front thigh cramp , here’s how to stretch: Stand up straight, grab the foot of the offending leg, and pull it toward your butt until you feel the stretch in the front of your thigh. If this one-legged stand is too shaky for you, you can use your other hand to hold on to the wall or a chair.

>> Soft massage

In addition to stretching, gentle massaging can also help with muscle cramps, preferably with a warm, damp towel. This loosens the cramped muscles and increases the local blood circulation. This allows the muscle to relax better.

>> heat

Warm wraps and hot baths also have a relaxing effect on cramped muscles – or you can put a hot -water bottle on the aching muscles.

By the way: Conventional painkillers such as acetylsalicylic acid (ASA) or paracetamol do not help against muscle cramps.

Calf cramps: when to see a doctor?

Leg cramps and other muscle cramps that only occur occasionally are usually harmless. But be sure to go to the doctor if the painful cramps

  • occur more frequently
  • disturb night’s sleep or daily routine,
  • not go away on its own or with stretching and gentle massage and/or
  • be accompanied by other symptoms such as nausea, numbness, tingling or restricted movement.

Your first point of contact in such cases is your general practitioner. He or she can refer you to a specialist if necessary.

Calf Cramps: Examinations & Diagnosis

In order to uncover the cause of calf cramps (or muscle cramps in general), a detailed discussion between you and the doctor to collect the medical history (anamnesis) is first necessary. Examples of frequently asked questions are:

  • Where do the cramps occur?
  • When and how often do you have the cramps?
  • Approximately how long does a single cramp last?
  • Are there specific situations or events that might trigger your seizures?
  • Do you have any other symptoms (e.g. muscle weakness, numbness, diarrhea, sensitivity to cold, weight gain , etc.)?
  • What about your alcohol consumption?
  • Do you use any medication? If yes, which?
  • Do you have any pre-existing conditions?

Physical and neurological examination

A physical exam gives the doctor clues about your general health. He can feel under the muscles and joints and test the muscle reflexes. He also pays attention to abnormalities that may indicate the cause of the muscle cramps (e.g. dry skin and mucous membranes and standing skin folds in the case of dehydration or a swollen face, dull hair and hair loss in the case of hypothyroidism).

neurological examination may also be useful. The examination methods often used to clarify muscle cramps include:

  • Measurement of electrical muscle activity (electromyography): This can be used to check whether there is a muscle disease or nerve disorder.
  • Measurement of nerve conductivity ( electroneurography ): This allows the doctor to test the functionality of peripheral nerves and identify any nerve damage.

Further investigations

For example, blood tests can show a lack or excess of electrolytes such as magnesium, calcium or sodium . The kidney values ​​provide information about possible diseases of the organ. A disturbed thyroid function, which causes muscle cramps, can be recognized by corresponding hormone changes in the blood.

Sometimes imaging procedures are also necessary to get to the bottom of cramps and their possible causes. Ultrasound , for example, can be used to assess the condition of the kidneys and thyroid gland. Doppler sonography (a special form of ultrasound) is used to clarify varicose veins more precisely. If nerve root damage (radiculopathy) is suspected, for example due to a herniated disc, computed tomography (CT) or magnetic resonance imaging (magnetic resonance imaging, MRI) can bring clarity.

In some cases, a muscle biopsy is also necessary to confirm or rule out a (suspected) cause of muscle spasms. This is necessary, for example, in amyotrophic lateral sclerosis.

differentiation of other disorders

What the doctor must note during his examinations: A distinction must be made between systemic muscle cramps and painful muscle contractions of other origins as well as symptoms that resemble muscle cramps. These include, for example:

  • Dystonia : These are involuntary muscle contractions that generally last longer than normal muscle spasms and often affect other muscles – such as the muscles of the vocal cords (spasmodic dysphonia ), the eyelids ( blepharospasm ), the muscles of the neck ( torticollis ), or the muscles of the hands (“writer’s cramp”) . Sometimes dystonias occur in the context of diseases such as Parkinson’s or Huntington ‘s disease .
  • Tetany : The term refers to continuous or periodic spasms of muscles throughout the body. So these spasms are much more widespread and longer lasting than normal muscle spasms. In addition, they are often accompanied by repeated short muscle twitches. Tetany can be triggered, for example , by rickets , chronic kidney failure , inflammation of the pancreas , craniocerebral trauma and vomiting. Sometimes the cause of tetany remains unknown (idiopathic tetany).
  • Lockjaw ( tetanus ): This is an infectious disease with certain bacteria, the toxins of which trigger strong, persistent muscle spasms, for example in the face (mouth gag, “devil’s grin”) and on the back. If left untreated, tetanus leads to death.
  • Stiff Man Syndrome (Stiff Person Syndrome): This is a rare neurological disorder characterized by slowly increasing muscle stiffness in the trunk and limbs and spasms that are painful and shooting.
  • Strychnine poisoning : The highly toxic substance was formerly used as a stimulant (analeptic) and rat poison. Typical symptoms of poisoning are stretch cramps, i.e. long-lasting, rigid (tonic) spasms, especially of the extensor muscles. Death usually occurs from respiratory paralysis.
  • Muscular ischemia : Patients with ” smoker ‘s leg ” (peripheral arterial occlusive disease, PAOD) can experience calf pain during physical exertion because the calf muscles are not supplied with enough blood (reduced blood flow = ischemia). This may feel like a leg cramp, but it isn’t (not a muscle contraction!).
  • Illusory muscle spasm : This is what medical professionals call when someone feels a muscle spasm but there is no muscle contraction or muscular ischemia.

Calf cramps: prevention

The following tips can usually be used to prevent occasional calf cramps (and other muscle cramps), such as those caused by exercise or a lack of fluids and electrolytes:

  • regular exercise : Regular exercise coupled with stretching exercises (see below) helps keep muscles well vascularized and healthy. This can prevent cramps. However, make sure that you train appropriately – if you overdo it, you will develop calf cramps and other skeletal muscle cramps.
  • gentle stretching : Gentle stretching before exercise and before bed makes muscles and tendons more flexible. This reduces the likelihood that they will contract involuntarily (during or after exercise or during sleep).
  • no exercise after eating : You should not exercise immediately after eating.
  • drink enough : Anyone who drinks enough (non-alcoholic!) prevents disturbances in the water-salt balance and thus muscle cramps. This is particularly important if you sweat heavily, for example during sports. You can compensate for the loss of water and salt with isotonic drinks (e.g. an apple juice spritzer with a pinch of salt or a non-alcoholic beer). Passionate athletes also like to use special sports drinks.
  • Refrain from caffeine and nicotine
  • Avoiding stimulants : If possible, you should also avoid stimulants such as ephedrine and pseudoephedrine (e.g. found in cold relievers).
  • Magnesium : So far there is no scientific evidence that taking a magnesium supplement can prevent calf cramps (or muscle cramps). In the right dosage, however, taking it can at least not do any harm. In any case, you should ensure you eat a diet rich in magnesium (e.g. bananas, nuts, whole grain products).
  • Correct footwear : Sometimes incorrect footwear (e.g. high-heeled pumps) or a foot deformity such as splayfoot or flat feet is the reason for muscle cramps (e.g. foot cramps or calf cramps). Then the right shoes and, if necessary, insoles will help.

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