Materiały źródłowe

• #1 Muscle Cramps – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499895/

  Muscle cramps result in continuous, involuntary, painful, and localized contraction of an entire muscle group, individual single muscle, or select muscle fibers. […] The specific etiology is not well understood and possible causes depend on the physiological or pathological situation in which the cramps appear. […] A cramp is almost never a local effect but involves the whole body system, such as somatic and emotional. […] The pathophysiology of muscle cramps is not always clear and depends on the patient’s pathological condition. […] Despite the depletion of electrolytes during treatment in patients with dialysis, there is no direct relationship between the presence of cramps and dialysis. […] The etiology of the cramp depends on the situation in which it occurs. […] The first is related to the concept of dehydration and electrolyte imbalance, while the second, most recent theory is linked to a transient peripheral neurological disorder.

• #2 Muscle Cramps

  https://practicalneurology.com/articles/2019-aug-july/muscle-cramps

  A muscle cramp is a hyperexcitable neurologic phenomena of excessive, involuntary muscle contractions. It is important to distinguish between myogenic and neurogenic muscle cramps, because each has unique pathophysiology and management. The origin and propagation of neurogenic muscle cramps localizes to peripheral and central targets, including the neuromuscular junction, where mechanical disruption and electrolyte disturbances can influence hyperexcitability and cramp generation. Injury to peripheral nerve components including the motor neuron cell bodies or the motor axons can result in ephaptic transmission and development of muscle cramps. Dysfunctional intramuscular small fiber sensory afferents are also proposed to be involved in cramp generation. Centrally, persistent inward currents mediated by GABAergic transmitters at the spinal level can amplify incoming sensory input and lead to the propagation and amplification of cramp potentials. Disruption of chloride, sodium, and potassium channels and inadequate amino acids concentrations disrupt membrane currents to generate muscle cramps.

• #3 Nocturnal Leg Cramps | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0815/p350.html

  Up to 60 percent of adults report that they have had nocturnal leg cramps. The exact mechanism is unknown, but the cramps are probably caused by muscle fatigue and nerve dysfunction rather than electrolyte or other abnormalities. […] The precise mechanism of leg cramps is unknown, but several myopathic, neurologic, and metabolic causes have been suggested. Most cases of leg cramps are idiopathic. Electromyographic studies suggest that leg cramps originate in the lower motor neurons with hyperactive, high-frequency, involuntary nerve discharge. […] Exercise research suggests that muscle fatigue is a primary cause of leg cramps. Studies of endurance athletes show that a higher-than-normal intensity of exercise is associated with leg cramps. The mechanism of this association remains unclear. Nerve dysfunction or damage has been suggested as a cause of leg cramps because of the high prevalence in patients with neurologic conditions such as parkinsonism.

• #4 Muscle Cramps

  https://www.unm.edu/~lkravitz/Article%20folder/musclecramps.html

  Muscles cramps are abrupt, harsh, involuntary muscle contractions that can cause mild-to-severe agony and immobility (Minetto et al.,2013). […] While they are widely discussed by fitness pros, until recently, little has been known about the actual physiology of cramps, which we will discuss in this research column. […] The newest concept of muscle cramps is a neuromuscular theory (Giuriato et al., 2018). Currently, this theory has evolved to have two different origins: a central (i.e., spinal column) and a peripheral (i.e., neuromuscular junction) origin which are discussed below. The central, or spinal, origin theory suggests that the involuntary contraction of a muscle cramp occurs when nerve messages to the spinal column are altered, perhaps due to muscle fatigue. This results in an imbalance of excitatory (from muscle spindles) and inhibitory spinal messages (golgi tendon organs) to muscles. This neural signaling imbalance to muscle leads to enhanced muscle cell excitability and a muscle cramp.

• #5 Muscle Cramps Explained by Science | Muscle Cramp Treatment Options

  https://www.physiotutors.com/wiki/muscle-cramps-explained/

  Schwellnus et al. (2009) popularized the idea that cramps occur due to an altered reflex control mechanism in response to neuromuscular fatigue. Specifically, muscle overload and fatigue engender an imbalance of the excitatory drive from muscle spindles and the inhibitory drive to the alpha motor neuron, which ultimately produces a localized cramp. This hypothesis has experimental support, as skeletal muscle fatigue has been shown to reduce inhibitory input to alpha motor neurons from the Golgi Tendon Apparatus and to increase excitatory input from the muscle spindles in animal models. […] At last, it appears that stretching is the most effective treatment in relieving acute fatigue-induced muscular cramping, as it is believed to increase tension in the Golgi tendon organ, resulting in an increased afferent reflex inhibition to the alpha motor neuron.

• #6

  https://hammernutrition.com/blogs/advanced-knowledge/muscle-cramps?srsltid=AfmBOooSRoFqyVGV0Vu8nEpjcZ-S11woTQkom_GE605ebPmutru1wA1_

  In animal studies, abnormal reflex activity in the muscle spindle (increased exercise) and the Golgi tendon organ (decreased activity) has been observed in fatigued muscle. Schwellnus et al.*, have hypothesized that EAMC is caused by sustained abnormal spinal which appears to be secondary to muscle fatigue. „Local muscle fatigue is responsible for increased muscle spindle afferent and decreased Golgi tendon organ afferent activity. Sustained abnormal reflex activity would explain increased baseline EMG activity between bouts of cramping. Passive stretching invokes afferent activity from the Golgi tendon organ, thereby relieving the cramp and decreasing EMG activity.”*

• #7 What causes muscle cramps in exercise?

  https://www.mysportscience.com/post/what-causes-muscle-cramps-in-exercise

  This is the classical explanation for muscle cramps, that dehydration and loss of electrolytes through sweating can cause muscle cramps. Because electrolytes are required for proper muscle function, including contracting and relaxing, electrolyte depletion (both in the blood and the muscle) could plausibly result in disrupted and uncontrolled muscle contraction (i.e. cramping). […] Although cramping often occurs in prolonged exercise in the heat, cramping can also occur without dehydration or electrolyte imbalance and in cool environments. Therefore, there must be other causes for cramps that occur in these conditions. Cramping can be triggered by activities beyond exercise, including repetitive, small muscle group activities like typing, writing or pressing buttons. It was suggested that cramps could be caused by abnormal activity of the nerve that control muscle activity, originating in the central nervous system. However, the cause of the abnormality was, and is, unclear, though it is suggested to be caused by increasing fatigue. The increased fatigue is thought to cause increased muscle activation, whilst the inhibition of excessive activation that normally controls contraction is reduced. This leads to uncontrolled contraction, leading to a muscle cramp.

• #8 Muscle Cramps – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/muscle-cramps

  Muscle cramps are more likely when you exercise in hot weather because sweat drains your body’s fluids, salt, and minerals (i.e., potassium, magnesium, and calcium). Loss of these nutrients may also cause a muscle to spasm. […] Although the exact cause of muscle cramps is unknown (idiopathic), some researchers believe inadequate stretching and muscle fatigue lead to abnormalities in the mechanisms (bodily processes) that control muscle contraction. […] When your body is poorly conditioned, you are more likely to experience muscle fatigue, which can alter spinal neural reflex activity. Overexertion depletes a muscle’s oxygen supply, leading to build-up of waste product and spasm. When a cramp begins, the spinal cord stimulates the muscle to keep contracting.

• #9 Muscle Cramps

  https://www.unm.edu/~lkravitz/Article%20folder/musclecramps.html

  The scientific evidence of a neuromuscular theory is mounting (Giuriato et al., 2018). The research appears to show that in some incidences, fatigued muscle is unable to fully relax. This condition leads to the imbalance of excitatory signals in relation to inhibitory messages to the muscle. Thus, current research findings appear to suggest that the central origin theory is the primary mechanism responsible for the muscle cramp (Giuriato et al., 2018).

• #10 Mechanisms of cramp contractions: peripheral or central generation?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3249048/

  There is still a debate on the origin of muscle cramps, which may be from the peripheral or the central nervous system. […] These findings suggest the relevance of spinal involvement in both the origin and sustenance of muscle cramps. […] These results indicate a spinal involvement at the origin of cramps and during their development. […] However, they do not exclude the possibility that cramps can be elicited exclusively at the periphery. […] The relative role of peripheral and spinal mechanisms in the cramp origin and development is indeed still a matter of debate. […] The cramps in the blocked condition were substantially shorter than those with intact spinal loop, indicating that the sustenance of cramps is also strongly dependent on the presence of the spinal loop. […] Overall, the presented findings prove the importance of central mechanisms in the generation and development of ordinary muscle cramps. […] From the data presented, it can be concluded that the spinal involvement has relevance for the origin of cramps and for their development and that, therefore, peripheral mechanisms are not responsible for cramp origin or development.

• #11 Nocturnal Leg Cramps | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0815/p350.html

  Neither exercise-related cramps nor nocturnal cramps have been associated with hypovolemia (caused by dehydration) or disturbances of electrolytes such as potassium, sodium, and magnesium. […] Medication-related leg cramps are most commonly associated with intravenous iron sucrose, conjugated estrogens, raloxifene (Evista), naproxen (Naprosyn), and teriparatide (Forteo), although the overall incidence is very low. […] Several medical conditions are associated with leg cramps. A study of outpatient veterans reported leg cramps in 75 percent of those with peripheral vascular disease, 63 percent of those with hypokalemia, and 62 percent of those with coronary artery disease. […] The occurrence of leg cramps is an important opportunity for family physicians to diagnose and treat conditions such as venous insufficiency, peripheral vascular disease, and peripheral neuropathy.

• #12 6 causes of leg cramps | Saudi German Health

  https://saudigermanhealth.com/en/medical-blog/6-causes-leg-cramps

  A leg cramp is a sudden and involuntary contraction of one or more muscles. Though generally harmless, muscle cramps can cause severe pain and make it temporarily impossible to use the affected muscle. […] Narrowing of the arteries that deliver blood to the leg muscles reduces their functionality and increases the risk of recurrent leg cramps. Consult your doctor if you experience frequent leg cramps. […] The muscular contraction and relaxation mechanism requires a certain balance of sodium, potassium, magnesium, and calcium. […] Over-exertion of the body results in muscle fatigue, which increases the risk and occurrence of leg cramps. […] Leg cramps can potentially be a side effect of certain prescription drugs such as diuretics, conjugated estrogens, and statins. […] Wearing shoes that dont fit or support your feet well can cause muscle fatigue and cramps.

• #13 Muscle Cramp: Types, Causes, Diagnosis, Treatment & Prevention

  https://www.medicinenet.com/muscle_cramps/article.htm

  Muscle cramps can occur in any muscle; cramps of the leg muscles and feet are particularly common. […] Most authorities agree that true cramps are caused by hyperexcitability of the nerves that stimulate the muscles. […] True cramps are commonly associated with the vigorous use of muscles and muscle fatigue (in sports or with unaccustomed activities). […] Dehydration increases the likelihood of true cramps. […] Low blood levels of either calcium or magnesium directly increase the excitability of both the nerve endings and the muscles they stimulate. […] In tetany, all of the nerve cells in the body are activated, which then stimulate the muscles. […] The name tetany is derived from the effect of the tetanus toxin from a tetanus infection on the nerves. […] Dystonic cramps, in which muscles that are not needed for the intended movement are stimulated to contract, are not as common as true cramps.

• #14 Sleep-related leg cramps | MedLink Neurology

  https://www.medlink.com/articles/sleep-related-leg-cramps

  Sleep-related leg cramps may be either idiopathic or related to other diseases or drugs; however, no significant differences in clinical presentation due to a specific etiology have been evidenced. […] Metabolic and hormonal disorders such as muscle glycogenosis, hypothyroidism and hypoparathyroidism, diabetes mellitus, and fluid and electrolyte disturbances (hypocalcemia, hypomagnesemia, hyponatremia, and uremia) are associated with cramps that may occur predominantly or exclusively during sleep. Such conditions as low levels of minerals, extracellular fluid volume depletion, and sedentary activity have been noted as potential contributing factors in elderly patients. […] Cramps are contractions of muscles brought about by sustained recruitment of one muscles motor units. EMG studies show that cramping is attended by a contraction of a slowly moving fraction of muscle fibers with extremely short potentials and unlike maximal voluntary contraction. Explicative hypotheses implicate an abnormal excitability of the muscular membrane or of the terminal motor axon at the muscle entry point (motor point).

• #15 The effectiveness of Magnesium in muscle cramps – Pharmanutra

  https://www.pharmanutra.it/en/ultramag-lefficacia-del-magnesio-nei-crampi-muscolari/

  The underlying cause of a muscle cramp, although not yet fully clarified scientifically, seems to focus on two potential mechanisms: one is related to dehydration and the other is related to neurological disorders (neuromuscular). […] Magnesium, in addition to being involved in this cycle of reactions, also influences the process of muscle contraction/relaxation by intervening in contrast to the action of calcium, as an increase in its intracellular concentration gives the signal to trigger muscle contraction. On the contrary, when within the muscle cell the amount of calcium decreases and the concentration of magnesium increases, muscle relaxation occurs. […] Muscle cramps are still a little-known topic of muscle physiology, and scientific experiments are controversial about their etiology. Surely, knowing the mechanism behind muscle contraction, cyclic magnesium supplementation can be effective in modulating and managing these sudden and painful episodes, especially when they are recurrent.

• #16 Muscle Cramps Explained by Science | Muscle Cramp Treatment Options

  https://www.physiotutors.com/wiki/muscle-cramps-explained/

  In a 12-year summary report of marathon medical issues, cramping accounted for 6.1% of medical encounters, with 1.2 cases per 1.000 participants. However, exercise-associated muscle cramps are a problem in other vigorous sports too. […] It has long been thought that cramps are resulting from dehydration and electrolyte imbalance. The theory behind it is that the extracellular fluid compartment becomes increasingly contracted due to sweating, leading to a loss of interstitial volume. In addition, excessive sweating can lead to concomitant sodium, calcium, magnesium, chloride, and potassium deficits. Both of these effects are reasoned to lead to mechanical deformation of nerve endings and an increase in surrounding ionic and neurotransmitters concentrations, which leads to hyperexcitable motor nerve terminals and spontaneous discharge.

• #17 Muscle Cramps

  https://practicalneurology.com/articles/2019-aug-july/muscle-cramps

  The pathophysiology of myogenic muscle cramps, in contrast, is usually the result of disrupted energy production in muscle cells and occurs most commonly in metabolic myopathies associated with disorders of glycogen, lipid, or mitochondrial metabolism. Metabolic myopathies cause deficient ATP levels. Because muscle relaxation is an adenosine triphosphate (ATP)-dependent active process, actin and myosin chains do not disengage, causing an electrically silent cramp. The metabolic defect may also cause accumulation of potentially toxic metabolites that further aggravate ATP deficiency. Myopathic cramps are also a potential symptom of myopathies linked to muscle membrane or intramuscular structural dysfunction in acquired and hereditary myopathies. […] Pathologic states that disrupt the homeostatic environment or structural integrity of the neuromuscular axis or spinal connections also lead to muscle cramps. People with medical conditions in which fluid shifts occur are especially vulnerable to muscle cramps. Neurologic conditions in which peripheral nerve is affected are particularly prone to muscle cramps as a positive motor symptom. This includes motor neuron diseases, such as amyotrophic lateral sclerosis (ALS), where muscles cramps are an early and common symptom that may eventually fade as denervation becomes advanced. Axonal neuropathies including hereditary neuropathies, acquired neuropathies, and idiopathic neuropathies can be associated with muscle cramps.

• #18 Potential Prevention Strategy for Exercise Associated Muscle Cramps – Damien Howell PT

  https://damienhowellpt.com/potential-prevention-strategy-for-exercise-associated-muscle-cramps/

  Exercise associated muscle cramp (EAMC) is a painful, spasmodic, and involuntary contraction of muscle that occurs during or immediately after exercise. […] The exact mechanism or cause of EAMC still remains unclear. […] There are two hypotheses of why EAMC occurs. […] Electrolyte depletion and dehydration hypothesis: The cramp is due to the change/decrease in hydration and serum electrolyte status induced by exercise. […] Altered neuromuscular control hypothesis: The cramping is in response to abnormal spinal reflex activity. Muscle cramps occur when the muscle is a position of shortened length. […] The muscle cramp hypothesis is there is an Imbalance between signals coming from sensory nerves in the muscle (muscle spindle) to the spinal cord and a decrease in nerve signals coming from the spinal cord back to the muscle which inhibits the muscle contraction (Golgi tendon organ). The imbalance in spinal reflex leads to a muscle cramp.

• #19 Potential Prevention Strategy for Exercise Associated Muscle Cramps – Damien Howell PT

  https://damienhowellpt.com/potential-prevention-strategy-for-exercise-associated-muscle-cramps/

  Interestingly, exercise associated muscle cramps only seem to occur when the muscle is contracting when in a shortened or slackened position. […] While there is a correlation between the active contraction of a muscle in a slackened position with the onset of EACM the pathophysiological mechanism or why is, yet to be determined.

• #20 Muscle Cramps

  https://practicalneurology.com/articles/2019-aug-july/muscle-cramps

  Myopathic cramps are common in metabolic myopathies, which present with exercise intolerance, myoglobinuria, and exertional cramps. The most common disorder of carbohydrate metabolism is McArdles disease, which presents with exercise-induced myalgias and muscle cramps, pain that intensifies with exercise, and electrically silent contracture. […] Investigation can be directed when muscle cramps are particularly bothersome, severe, or frequent. A practical approach is to consider first whether cramps are neurogenic or myogenic. Nerve conduction studies and needle EMG can be helpful in differentiating neurogenic from myogenic cramps. For myogenic cramps, investigations should be tailored to diagnose underlying metabolic myopathies. If cramps are found to be an isolated finding not associated with any identifiable neurogenic, myogenic, or metabolic source, they can be labelled as idiopathic and treated as such.

• #21 Nocturnal Leg Cramps / Charlie Horses | Sherman, TX | Vein Center of North Texas

  https://veincenternorthtexas.com/services/nocturnal-leg-cramps-charlie-horses/

  Nocturnal Leg Cramps are just one of the many symptoms of saphenous insufficiency. […] Venous insufficiency is one of the most common conditions associated with leg cramps, particularly recurrent leg cramps and nighttime leg cramps, known as nocturnal leg cramps (NLC). […] Modern medicine has not yet unraveled the precise mechanism responsible for leg muscle cramps. […] If your medical history or physical examination suggests venous insufficiency, a duplex ultrasound evaluation can create images of the veins while simultaneously assessing the blood flow within the veins. […] If you are found to have significant deterioration of your venous circulation, Dr. Hayes will likely recommend definitive treatment to restore normal circulation and alleviate your leg cramps.

• #22 Muscle Cramp: Types, Causes, Diagnosis, Treatment & Prevention

  https://www.medicinenet.com/muscle_cramps/article.htm

  A contracture is a condition that may mimic a muscle cramp. […] Numerous medicines can cause cramps. […] Potent diuretic medications can induce cramps by depleting body fluid and sodium. […] Several vitamin deficiency states may directly or indirectly lead to muscle cramps. […] Poor circulation to the leg muscles, which results in inadequate oxygen to the muscle tissue, can cause severe pain in the leg muscle. […] The primary causes of cramps include muscle overuse or strain, dehydration, and imbalances in electrolytes such as potassium, calcium, and magnesium.

• #23 What is the Relationship Between Leg Cramps and Venous Disease?

  https://ljvascular.com/vein-conditions/what-is-the-relationship-between-leg-cramps-and-venous-disease/

  Leg cramps occurring at night (nocturnal leg cramps) are a common symptom of venous disease. […] The exact mechanism that causes cramping in the legs is uncertain. […] But, when the cramping is caused by poorly functioning veins, the symptoms are often alleviated by correcting the underlying problem. […] Varicose Veins and underlying venous insufficiency are a common cause of night cramps, or leg cramps occurring at night. […] A recent study showed that prolonged standing at work may be an important risk factor for varicose veins and nocturnal leg cramps. […] You may also have undiagnosed venous reflux.

• #24 When to See a Doctor About Leg Cramps: Clement Banda, MD: Dermatologist

  https://www.mdveins.com/blog/when-to-see-a-doctor-about-leg-cramps

  Though the process behind leg cramps isnt fully understood, in most cases the experience is harmless. […] However, the factor with the greatest potential for harm is problems with blood flow. Poor blood return to the heart from the legs through veins can cause significant leg cramps. This is most pronounced at night when the leg muscles are least active. […] Cramping can be looked at as the bodys own defense mechanism to get the blood moving again. Hence the relief of cramps when one gets out of bed and walks around a bit.

• #25 Sleep-related leg cramps | MedLink Neurology

  https://www.medlink.com/articles/sleep-related-leg-cramps

  Although some studies hypothesized a central origin of muscle cramps, due to an abnormal CNS drive acting on the lower motor neuron or increased fusal and decreased Golgi tendon organ activity, causing changes in presynaptic input and spinal motor neuron excitation, the peripheral theory remains more convincing. […] Lower limb muscle weakness is suggestive of being a risk factor for the development of nocturnal leg cramps in the elderly, which was seen in a case-controlled study where the authors concluded that age-related modifications in type II muscular fibers may expose to higher risk of nocturnal cramps. […] Sleep-related leg cramps may have a genetic basis. Familial nocturnal cramping of the legs associated with myoclonic jerks and leading to painful awakenings has been observed to recur in a three-generation family, transmitted in an autosomal dominant fashion.

• #26 Muscle Cramps: Causes and Treatments | Live Science

  https://www.livescience.com/muscle-cramps.html

  If you tend to get muscle cramps, you may have a genetic predisposition based on the type of collagen in your tendons, according to research by Malcolm Collins, a professor of exercise science and sports medicine at the University of Cape Town in South Africa. […] The best way to relieve cramps? Forcefully stretch the cramping muscle. This stops the muscle from contracting and allows the relaxation signals to be received. […] Several studies have found that athletes who cramped were often running faster than their normal speeds. Exercising in hot or humid conditions is more tiring and will cause muscles to fatigue faster. […] Once cramps hit, they can be relieved by stretching the muscle. To prevent nocturnal cramping, stretching leg muscles before bed has been shown to help, and there are some prescription medications that have varying levels of effectiveness in preventing and treating cramps.

• #27 Association between physical activity and Nocturnal Leg Cramps in patients over 60 years old: a case-control study | Scientific Reports

  https://www.nature.com/articles/s41598-020-59312-9

  Nocturnal Leg Cramps (NLC) are painful, involuntary contractions of muscles. NLC is a specific entity of idiopathic cramps occurring at rest in the lower limb during the night. NLC are associated with a reduced quality of sleep and reduced physical component scores on the SF36 quality of life questionnaire. Among patients over 60 years old the cramp prevalence varies from 46% to 56%. Nonetheless, patients rarely report NLC to their general practitioners. One of the reasons may be the known lack of both effective and safe treatments. […] Specific medical conditions and drug treatments have been identified to be associated with muscle cramps. Recently, we also showed a strong association with the global consumption of alcoholic beverages. Still, most cramps are considered idiopathic and their physiological mechanism remains unclear. Some authors suggest that neuromuscular structures located in muscle, tendons and nerve fibres seem to be involved in the trigger of muscle cramps. Congruently with this assumption, musculoskeletal conditions associated with sedentary lifestyle as well as work postures, prolonged standing and western habit of sitting instead of squatting have been suspected of causing cramps and specifically NLC. We hypothesize that there may be an association between sedentary lifestyle and NLC.

• #28 Association between physical activity and Nocturnal Leg Cramps in patients over 60 years old: a case-control study | Scientific Reports

  https://www.nature.com/articles/s41598-020-59312-9

  We observed a strong association between a sedentary lifestyle and Nocturnal Leg Cramps. To our knowledge, this study is the first highlighting such an association. Our results support Hawkes recommendation to explore the impact of muscle strength training on nocturnal leg cramping in an elderly population. In this case-control study, muscle weakness in the lower limbs of cases was associated with night-time cramps. At a histological level, Hawke et al. suggest that age-related modifications in the type II muscular fibres (responsible of a fast and strong contraction that do not last) may expose to higher risk of NLC. Cases may present a modification of the ratio between type I and type II fibres with a higher level of type II fibres, making them more susceptible to modifications and therefore to cramps.

• #29

  https://consensus.app/questions/what-medications-cause-leg-cramps/

  Leg cramps, particularly nocturnal leg cramps, are a common and often painful condition that can significantly disrupt sleep and quality of life. […] Various medications have been identified as potential causes of leg cramps. […] Quinine has been widely used to treat nocturnal leg cramps, but its efficacy and safety are subjects of ongoing debate. […] Diuretics, commonly prescribed for hypertension and other cardiovascular conditions, are frequently associated with leg cramps. The mechanism is believed to involve electrolyte imbalances, particularly hypokalemia (low potassium), hypomagnesemia (low magnesium), and volume contraction. […] -Agonists, often used in the treatment of asthma and other respiratory conditions, are another class of medications linked to leg cramps. […] Carnitine deficiency, sometimes induced by long-term use of pivalate-containing antibiotics, can also lead to leg cramps.

• #30 Muscle cramps — a mini review of possible causes and treatment options available with a special emphasis on diabetics — a narrative review | Roy | Clinical Diabetology

  https://journals.viamedica.pl/clinical_diabetology/article/view/65174

  Muscle cramps are characterized by sudden, painful involuntary contraction of the muscles. […] The etiology of the cramps are diverse and some time the cramps are idiopathic. There are many underlying pathophysiological disorders like hypocalcemia, hypomagnesemia, hypothyroidism, and hepatorenal dysfunction which causes muscle cramp. Similarly, diabetes mellitus results in muscle cramps due to electrolytic imbalance, hypoglycemia, peripheral arterial insufficiency, and neuropathies. […] Although the pathophysiology and etiology of the muscle cramp are understood to some extent, the same is less explored from diabetes mellitus perspective. Hence the objective of this review is to explore the underlying factors responsible for muscle cramps in diabetes so that proper strategy for pharmacotherapy can be made to manage this condition.

• #31 Leg Cramps – Centre of Health – Melbourne Naturopath

  https://thecentreofhealth.com.au/general-health/leg-cramps/

  Leg cramps are painful and sometimes scary since it can feel like your body is literally trying to rip its own muscles. If you do enough research you will find that the cause of leg cramps is not precisely known. […] Leg cramps occur due to a wide variety of causes. One important cause is menstruation. During menses, women lose a significant amount of blood. This results in loss of iron (from hemoglobin) and other minerals like potassium and magnesium. […] Depletion of these vital minerals causes increased irritability of the skeletal muscles of the calf and lower limbs, precipitating painful spasms of the muscles. […] Diabetes is a condition caused by an increase in blood sugar (blood glucose). This results in increased urine output for the diabetic patient, also called polyuria in medical parlance. A substantial amount of electrolytes like sodium, potassium and magnesium are excreted in this increased urine loss. This causes an imbalance in the diabetic patient’s electrolyte levels in the blood. Hypokalemia or reduced potassium levels triggers increased irritability of the skeletal muscle fibers with resultant muscle spasms and leg cramps.

• #32 Leg Cramps – Centre of Health – Melbourne Naturopath

  https://thecentreofhealth.com.au/general-health/leg-cramps/

  It is not one factor alone, but a combination of all these pathologies that contributes to increased incidence of painful muscle spasms in diabetics. […] Children are usually very active and often do not know the limits and risks of prolonged and strenuous physical exercise or activity. This is the commonest cause of leg cramps in children. There is excessive build up of certain chemicals like lactic acid in the skeletal muscles of the thigh and the calf. […] Prolonged exercise is believed to alter this inhibitory system resulting in hyperactive muscles and consequent muscle cramps. […] Other causes of cramps in children include electrolyte imbalances, specifically potassium and magnesium deficiency.

• #33 Treating Muscle Cramps in Patients with Cirrhosis: A Reviewlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na32955/2013/11/25/treating-muscle-cramps-patients-with-cirrhosis

  Muscle cramps are common in liver disease, especially in patients with cirrhosis, among whom the prevalence ranges from 22% to 88% based on varying definitions of cramps. […] The underlying mechanism of muscle cramps in cirrhosis is still not fully elucidated, but possibilities include alterations in three overlapping categories: nerve function, energy metabolism, and electrolytes and plasma volume. […] Nerve dysfunction in cirrhosis may be due to structural alterations and oxidative stress leading to increased excitability of motor neurons. […] Altered regulation of amino acid and protein metabolism in cirrhosis likely contributes to muscle cramps. […] Shifts in plasma volume may also contribute to cramps.

• #34 Pickle Juice for Dialysis-related Muscle Cramps: Fact or Myth? – Renal Fellow Network

  https://www.renalfellow.org/2021/09/27/pickle-juice-for-dialysis-related-muscle-cramps-fact-or-myth/

  Patients with kidney disease who receive chronic hemodialysis experience a multitude of disease related symptoms which affects their quality of life. […] One such debilitating symptom is muscle cramps during or after dialysis. Cramps occur when muscles contract on their own and can be quite painful. Dialysis-related muscle cramps are estimated to occur in about 21-74% of dialysis treatments. Muscle cramps can occur during and in between dialysis treatments as well as during sleep, leading to poor quality of sleep, anxiety and depression. The exact pathophysiology of muscle cramp remains unclear and a plethora of treatments are tried with variable success. […] Although the exact mechanism for muscle cramps is not known, hemodialysis-related fluid and electrolyte shifts are reported as a primary cause. Other contributing factors are vitamin and electrolyte deficiency, muscle fatigue, neurologic dysfunction, and impaired oxygen delivery to the muscles.

• #35 Pickle Juice for Dialysis-related Muscle Cramps: Fact or Myth? – Renal Fellow Network

  https://www.renalfellow.org/2021/09/27/pickle-juice-for-dialysis-related-muscle-cramps-fact-or-myth/

  Neural mechanisms that normally inhibit muscle contraction are inhibited by muscle fatigue, leading to uninhibited muscle contraction and cramps. This is more prevalent in older age groups, where physical deconditioning and associated metabolic disturbances are common and in the dialysis population. […] Foods with pungent tastes like vinegar, mustard, or pickle juice can stimulate an oropharyngeal neural reflex that inhibits hyperactive motor neurons. This can lead to muscle relaxation and relief of cramps, and may explain why these nontraditional methods help with muscle cramping. […] The pathophysiology of cramps remains poorly understood and results of current treatment are variable.

• #36 Dr. Roach: Nocturnal leg cramps a common problem

  https://www.detroitnews.com/story/life/advice/2021/06/09/keith-roach-nocturnal-leg-cramps-common-problem/116918204/

  Nocturnal leg cramps are extremely common. As many as 60% of Americans report having nocturnal leg cramps. Usually no cause is identified, but electrolyte abnormalities usually too-low blood levels of sodium, potassium, magnesium or phosphate can predispose a person to developing cramps. […] Effective treatments to stop a cramp when it is happening is a forceful stretching of the affected muscle. […] Bananas have a lot of sugar, magnesium and potassium. If your husband has had low levels of these, a banana a day or more might possibly help correct the abnormality. […] There is no way that eating a banana can stop an attack within minutes based on its electrolyte or other nutritional content. […] Pickle juice has been used by athletes to stop muscle cramps, and a study showed that not only is it rapidly effective, but that the mechanism is through the brain and nerve cells, essentially telling the muscle to stop cramping, not through electrolytes going to muscles. I suspect that a similar mechanism is helping your husband. […] Regular moderate exercise, stretching, proper footwear and loose bedding all can help prevent leg cramps.

• #37 Mustard for Cramps: Is It Helpful?

  https://www.healthline.com/nutrition/mustard-for-cramps

  As a result, a signal is sent out in your body that prevents the nerves in your muscles from becoming overly excited and causing muscles to cramp. […] Still, more research is needed to prove that mustard is effective for this purpose and that it works by this mechanism. […] No evidence supports the notion that mustard is an effective remedy for leg cramps. However, recent findings suggest that certain molecules in mustard may trigger various effects that could prevent muscles from cramping. […] Currently, there’s a lack of scientific evidence on the effectiveness of using mustard to help treat or prevent muscle cramps. […] While many people claim that ingesting mustard can help ward off or treat leg cramps, evidence supporting its use for these purposes is currently lacking. […] Still, recent studies have suggested a mechanism that may indicate that this popular condiment has the potential to help ward off leg cramps.

• #38 Association between physical activity and Nocturnal Leg Cramps in patients over 60 years old: a case-control study | Scientific Reports

  https://www.nature.com/articles/s41598-020-59312-9

  Some specific positions are risk factors for lower limb cramps. According to the squatting theory, muscle and tendon shortening are suspected of increasing the risk of occurrence of Nocturnal Leg Cramps. Several studies have shown the potential benefits of stretching methods to prevent cramps. However, contradictory results, limitations and biases of these studies prevent the interpretation of the results and their clinical application. Our study suggests focusing on specific trainings designed especially for an elderly population.

• #39 Why Does My Leg Hurt So Badly After a Leg Cramp?

  https://blog.missouriveincare.com/blog/why-does-my-leg-hurt-so-badly-after-a-leg-cramp

  Leg cramps or Charley Horses are sudden and very painful muscle contractions in the calf muscles. They can last for a few minutes and can hurt the muscles by pinching the blood vessels. This intense constriction can cause lingering soreness. This explains why your leg still hurts and remains sore even after a cramp. […] The mechanism behind a leg cramp is somewhat similar to what happens during a heart attack. Both situations occur due to a decrease in the circulation of blood – in the event of a cardiac arrest, there is a decrease in blood flow to the heart, while in the case of a leg cramp, it affects the muscles in the leg. The medical phrase for this situation is ischemia, which indicates limited or insufficient circulation of blood to an organ or specific area of the body. […] The build-up of lactic acid in your calf muscle is the reason your calf remains sore after a leg cramp. As the muscle contracts intensely and involuntarily, it produces a byproduct called lactic acid, which not only causes pain but eventually leads to the cessation of the muscle contraction. Lactic acid accumulation within the muscle tissue has several effects.

• #40 Does alcohol cause leg cramps?

  https://www.confidanthealth.com/help-with-alcohol-use/does-alcohol-cause-leg-cramps

  Alcohol can cause nocturnal leg cramps by damaging the tiny muscle fibers of the thigh, leg, and feet. […] Alcohol contributes to the buildup of lactic acid in the leg muscles, resulting in leg cramps. […] Alcohol consumption can lead to muscle tissue damage and deficiencies of vitamin B, vitamin D, iron, zinc, and potassium. Moreover, alcohol contributes to the accumulation of lactic acid inside leg muscle tissues. […] Alcohol accelerates muscle wasting by decreasing protein synthesis and increasing protein degradation. […] It is a well-known fact that heavy use of alcohol can cause liver damage. On the other hand, lactic acid (a by-product produced during muscle activity) is metabolized by the liver. When the liver gets damaged by alcohol intake, it becomes challenging for the liver to metabolize lactic acid at the same pace. It results in the accumulation of lactic acid, which can exacerbate the symptoms.

• #41 Why Does My Leg Hurt So Badly After a Leg Cramp?

  https://blog.missouriveincare.com/blog/why-does-my-leg-hurt-so-badly-after-a-leg-cramp

  Overall, the production of lactic acid during intense and involuntary muscle contractions not only causes pain but also plays a significant role in the cessation of muscle contraction. The resulting sensation is similar to the soreness experienced after an intense workout, where lactic acid accumulation in the muscles leads to discomfort. This accumulation is also responsible for the tenderness in the affected area, lasting sometimes up to 2-3 days post-cramp.

• #42 Muscle Cramps: Causes and Treatments | Live Science

  https://www.livescience.com/muscle-cramps.html

  Muscle spasms are the sudden, intense and uncontrollable contraction of muscles. […] Many experts agree that the strongest scientific evidence points to muscle cramps being caused by a miscommunication between the tendon that controls the muscle and the nervous system. According to a 2009 review by Dr. Martin Schwellnus, a professor and sports medicine physician at the University of Pretoria in South Africa, the miscommunication that causes exercise-associated muscle cramps (EAMC) is most likely the result of muscle fatigue. […] When a muscle becomes fatigued, the signals between the tendon and the central nervous system essentially become confused. Instead of signaling for the muscle to contract, and then relax, the central nervous system sends more signals for the muscle to keep contracting. The signal to relax doesn’t get through and the muscle cramps.

• #43 Management of Nocturnally Occurring Benign Idiopathic Leg Cramps

  https://www.uspharmacist.com/article/management-of-nocturnally-occurring-benign-idiopathic-leg-cramps

  Waking up abruptly from sleep due to an acutely painful leg cramp can be a jolting experience. […] The most common types of leg cramps, however, are: Benign idiopathic leg cramps in the absence of a causative disorder, typically at night, and Exercise-associated leg cramps during or immediately after exercise. […] While the exact mechanism is unknown, the probable cause is thought to be muscle fatigue and nerve dysfunction rather than electrolyte or other abnormalities. […] The diagnostic approach for idiopathic muscle cramps is one of exclusion. […] Nonpharmacologic therapy forms the cornerstone of management of muscle cramps in the acute phase. […] Data are extremely sparse regarding ongoing prevention of muscle cramps. […] Pharmacists should be aware that most drugs prescribed to prevent cramps (e.g., magnesium, calcium supplements, quinine, benzodiazepines) are not recommended due to lack of demonstrated efficacy. […] Specific exercises improve muscle and tendon flexibility and can reduce muscle, nerve, or central nervous system neuronal activity in the stretched muscles. […] Benign idiopathic leg cramps among older, generally healthy adults are a common nocturnal symptom.

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