A muscle cramp is an involuntary contraction of a muscle that occurs suddenly and does not relax. In this article, we talk about determining, and managing muscle cramps with some important recommendations to handle them.

Involuntary, often excruciating spasms of a muscle or group of muscles characterise the condition known as a muscle cramp. Some individuals suffer from frequent, severe, and even debilitating muscular cramps. In a cross-sectional prevalence survey of 365 outpatients aged 65 or older in the United Kingdom, 50% report regular cramping.

Another study of 515 senior veterans reveals a similar incidence of 56%, with half experiencing cramps at least weekly. When the motor system is under stress, either from a neuromuscular illness or physiologic stress such as dehydration or excessive activity, cramps occur more often. Continuous, involuntary, painful, and localised contraction of a complete muscular group, a single muscle, or specific muscle fibres characterise muscle cramps.

Generally, the cramp might linger from a few seconds to a few minutes due to idiopathic or recognised reasons in healthy individuals or in the presence of illness. By palpating the cramped muscle, a knot will be revealed. In sports, muscular cramps caused by exercise are the most common ailment needing medical/therapeutic intervention. The precise aetiology is poorly known, and potential causes depend on the physiological or pathological state in which cramps manifest.

Multiple medical problems, such as hypomagnesemia, hypocalcemia, hypothyroidism, and renal or hepatic failure, maybe the cause of cramps in addition to neurologic disorders. cramps are also common in the latter trimester of pregnancy and among marathon runners and other sports. When no underlying cause of recurring muscle cramps can be discovered, they are referred to as idiopathic muscular cramps, which might vary in appearance from patient to patient but are often more pronounced in the lower leg and foot muscles and at night.

1. In normal OPD practice in primary care cramps are prevalent. In various research between 37 and 56% of individuals are impacted. 
2. Cramping is an underappreciated yet clinically significant occurrence. There are many significant practical consequences.
3. The high incidence of cramps and their connection with sleep disruption emphasises the need for doctors to inquire about cramps prior to administering symptomatic therapies for insomnia.

Assessment

Humans have long been susceptible to cramps. The medical literature does not specify when the first cramp phenomenon was originally documented, separating it from a benign occurrence relative to a symptomatological event.

In addition to the patient's medical history, the patient's upright and walking posture must be evaluated during a patient examination. It is vital to determine if muscle imbalances exist. The muscles must be palpated to ensure that the tissue is uniform on both sides of the body.

The practitioner asks the patient to activate the muscular region where cramps often occur (voluntary contraction) in order to determine if repetitive mechanical active tension is the cause of the cramp. It should also do a passive muscular stretch to see whether the cramp occurs in the absence of active patient stress. A cramp generated by a passive stretch may be a symptom and not the result of a benign occurrence.

Management

The American Academy of Neurology (AAN) published symptomatic therapy for muscular cramps recommendations in February 2010 and Reaffirmed them on July 16, 2022. The American Association of Neuromuscular and Electrodiagnostic Medicine has supported the recommendations.

Question 1: Is there anything besides drugs that helps with muscle cramps?

Patients use a variety of nonpharmacologic therapy prior to prescription medication, although there is little evidence to support their usage. Patients routinely utilise hydration, especially for exercise-associated cramps; nevertheless, no formal research supports its benefit. Insufficient evidence exists to determine if calf stretching reduces the incidence of muscular cramps.

Recommendation- None

Question 2: Does quinine work to treat cramps in the muscles?

On the basis of research findings, quinine derivatives are efficient in reducing the frequency of muscular cramps, although to a limited degree. In addition, these agents are associated with severe but uncommon adverse effects.

Recommendation- Quinine derivatives may help relieve muscular cramps in certain cases (Level A evidence), but they shouldn't be used as first-line therapy. These drugs should only be taken when cramps are really severe, no other agents alleviate symptoms, and side effects are carefully monitored. They should only be administered after the patient has been informed of the possibly severe adverse effects.

Question 3: What other pharmaceutical options exist for relieving muscle cramps?

Naftidrofuryl, vitamin B complex, and diltiazem may be useful in the treatment of muscular cramps based on single Class II research. Magnesium preparations (two Class II trials) and gabapentin (one ALS research) are probably ineffective for the treatment of muscular cramps, according to the available data.

Recommendation- For the treatment of cramps, naftidrofuryl, diltiazem, and vitamin B complex could be used.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.