by Rob Lamberts, MD
Cramps can happen anywhere in the leg, but this article will focus on those leg cramps that happen in the calves. So wouldn’t that make them charlie calves? I don’t know. I guess I’ll have to ask Grammar Girl.
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What Is a Cramp?
A cramp is the tightening of a muscle into the contracted state. Muscles have two states: relaxed and contracted. A muscle is relaxed when all of the fibers within the muscle are elongated. When the muscle does its job, calcium goes into the muscle cells and sodium rushes out. Doing so causes the fibers to shorten and the muscle to pull--doing it’s work.
That is not a problem in the short term, when the muscle is doing what it’s supposed to do. But when a muscle stays contracted, a sharp and intense pain occurs.
What Causes Cramps?
Why do cramps occur? One reason is a decreased supply of oxygen. If you’ve ever gotten a “stitch in the side” when exercising, you’ve experienced this phenomenon. When the work of the muscle outstrips the flow of blood and supply of oxygen, the muscles cramp up. That doesn’t happen under normal circumstances in the leg--even with significant exertion. But when the blood supply to the leg muscles is compromised, specifically from a build-up of cholesterol plaques in the arteries, the muscles will cramp. The cramping of the calves during exercise is something called claudication, which heralds the presence of peripheral artery disease, or PAD. I’ll talk more about this later.
What Causes Leg Cramps?
In general, cramps are a sign that things are out of balance.
Another, less serious, reason for leg cramps is that the electrolytes are out of balance. Electrolytes are the chemicals that help the muscle contract, the main ones being sodium, potassium, and calcium. If any of these gets out of whack, the muscle doesn’t work like it should, resulting in cramping. This electrolyte imbalance is often the cause of those painful cramps that wake you up at night.
What Causes an Electrolyte Imbalance?
What causes these electrolytes to get messed up? There are a number of things that can lead to this:
Overheating and sweating: Overheating and sweating a lot will cause the body to lose sodium, potassium, and magnesium.
Medications: Certain medications can also cause the body to lose these chemicals, the most common of which is the water pill, or diuretic.
Medical problems: Finally, there are medical problems that can cause the balance of these chemicals in the blood to go awry.
Other Causes of Leg Cramps
In addition to claudication and electrolyte imbalance, the last of the major causes of leg cramps are medications. Besides the aforementioned diuretics, other medications, such as blood pressure and cholesterol drugs, can make the muscles ache and even cramp up.
Sometimes the cramps are a mystery. A good portion of the time, leg cramps at night don’t have a clear cause. That makes their treatment more challenging (and it drives both doctor and patient a little crazy).
When Should You Worry About Leg Cramps?
When should you worry about leg cramps? In general, cramps are a sign that things are out of balance. If you have pain in your legs whenever you walk and the pain gets better after resting, tell your doctor. That might be a sign of claudication and the narrowing of the blood vessels in the legs could be a sign that you have narrowing of other blood vessels in your body, such as those supplying the heart and brain. People with claudication are at a significantly increased risk of having a heart attack.
Leg cramps that begin after you’ve started a medication are also concerning. Sometimes the medications could be causing a decrease in blood flow to the legs, and sometimes (as is the case with certain cholesterol medications) they could be damaging the muscles. Technically, the pain from cholesterol medications is not a crampy pain, but generalized aches--though everyone is different.
What Should You Do About Leg Cramps?
So what should you do about leg cramps? For those people who have seen their doctor and have had more serious problems ruled out, leg cramps can still be a great nuisance, and treating them can be a challenge (which in doctor speak means that we can’t always fix the problem). Here are some treatments for leg cramps that have worked in my practice:
Potassium and magnesium - Even if lab tests are negative, sometimes taking potassium and magnesium can improve the symptoms. Magnesium supplements are safe (although they tend to loosen the bowels some), but potassium supplements shouldn’t be taken without some supervision by your doctor.
Cut back on alcohol and caffeine - Both of these can cause mild dehydration, which can make muscle cramps more likely.
Stretches - Leg stretches before bedtime can improve symptoms.
Medications - Quinine is an old medication that works really well. The problem is that it not only interacts with other medications, but it can itself have significant toxicity too. It’s not available on the market for leg cramps, but some people find drinking a little tonic water, which contains quinine, can help. Diphenhydramine, or Benadryl taken at bedtime can help as well. When all else fails, talk to your doctor. There are some prescription medications that can help as well.
Finally, I want to mention that leg cramps are not the same thing as restless leg syndrome, which is not as painful but equally irritating. I’ll cover that and PAD in a future article.
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Let me once again remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!
Origin of the term Charlie Horse
I also like the entry in Wikipedia, which gives different culture’s terms for a Charlie Horse:
In the German-speaking world, it is commonly known as a Pferdekuss (horse's kiss), while in Norway it is referred to as a lårhøne (thigh hen), in Sweden as a lårkaka (thigh cake), in the Netherlands as an ijsbeen (ice leg) and in France as a béquille (crutch). In Portugal, it is known as a paralítica, roughly translated to "paralyzer". In Japan it is known as komuragaeri (??????), which is literally "cramp in the calf". In northeastern Italy, it is commonly called a lopez, while in the northwest it is called vecchia (old woman) or dura ("hard one" or "tough one"); in the south of the country, instead, it is called morso di ciuccio (donkey bite). In some areas of central Italy, it is called opossum.