Updated on 05/01/2024
Muscle cramp is the sudden and unexpected painful contraction of a single muscle or group of muscles. Cramps are relieved by stretching the affected muscle. Muscle cramps are common and have an annual incidence of 37% in healthy individuals.
They are typically experienced during or after exercise. Some individuals, especially those with leg cramps, may experience them primarily at night. They can be painful and last from a few seconds to several minutes.
Muscle cramps are classified into exercise-induced (or physiological), idiopathic (often occurring at night), and symptomatic (related to an underlying cause or triggered by an external factor). Most patients, especially the elderly, have multiple causes for symptomatic cramps. Only a small number of patients with muscle cramps receive a diagnosis of neuromuscular disease.
These are the most common type of muscle cramps and are a physiological response to prolonged and intense exercise. They can be attributed to dehydration, electrolyte imbalance, or the neuromuscular hypothesis. Interestingly, the incidence increases during the last three months of pregnancy.
They occur without an underlying cause and are more common in older individuals, primarily affecting the calf or foot muscles. They are often experienced at night.
Symptomatic muscle cramps are associated with various neurological and systemic diseases. They can be triggered or exacerbated by certain medications or external factors.
Exercise-induced and idiopathic muscle cramps are generally benign and non-progressive. The main principle in these cases is to prevent triggers. When symptomatic cramps are suspected, a comprehensive differential diagnosis is necessary.
In adults, muscle cramps are often seen in motor neuron diseases, radiculopathies, peripheral neuropathies, and metabolic or mitochondrial myopathies.
To avoid unnecessary investigations, the most important aspect is obtaining a thorough medical history and conducting neurological and systemic examinations. Cramps that start in middle age, widespread cramps, or cramps occurring in muscles other than the calves and feet may indicate an underlying disease. In such cases, blood tests, electromyography, genetic tests, and even muscle biopsy may be performed.
Individuals with exercise-induced or idiopathic cramps should be reassured that cramps are common and harmless. In symptomatic cramps, the underlying disease is treated. Metabolic disorders such as electrolyte imbalance, vitamin deficiencies, and hypothyroidism should be addressed. Medications known to cause cramps should be discontinued, excessive alcohol consumption should be avoided, and particularly caffeine intake in the evening should be minimized. Sufficient hydration is important for preventing cramps. If these measures are ineffective, medication therapy is also possible.
Dijkstra J.N ve ark. Muscle cramps and contractures: causes and treatment. Pract Neurol 2023;23:23–34