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Muscle Cramps

Muscles | November 1, 2016 | Author: Naturopath

co enzyme q10, exercise, Muscles

Muscle Cramps

A muscle cramp is a sporadic and uncontrolled contraction of the skeletal muscle causing severe pain, stiffness, and protruding or knotting of the muscle. The severity of muscle cramps can range from mild discomfort with limited effects, to extreme pain and severe debilitation. Muscle cramps affect people of all ages, gender, and health status and for a variety of reasons.

Causes of muscle cramps

Exercise-associated muscle cramps

Exercise-associated muscle cramps (EAMC) are among the most common conditions that require medical intervention in athletic settings. There are two main theories for what causes EAMC: dehydration and electrolyte imbalance and altered neuromuscular control.

  • Dehydration and electrolyte imbalance theory suggests that the extracellular fluid compartment becomes progressively contracted due to sweating out of electrolytes (sodium, calcium, chloride, potassium, and magnesium)  causing a loss of interstitial volume. The result is a mechanical distortion of nerve endings and an increase in the surrounding ionic and neurotransmitter concentrations, leading to over excited motor nerve endings and sporadic discharge - a muscle cramp.
     
  • Altered neuromuscular control theory suggests that EAMC derive from altered reflex control mechanisms in reaction to neuromuscular fatigue.  This more specifically suggests that muscle overload and fatigue cause the Golgi tendon organs to decrease activity and the muscle spindles to increase activity. This results in increased activity to the alpha motor neuron, which eventually creates a muscle cramp. This second theory is recognized as the more likely cause of EAMC and stretching has been shown to reestablish the balance between the impulses to the alpha motor neuron, and is the most successful therapy for acute EAMC.

EAMC is one of the most frequent medical complications ultra-distance runners have to confront. Despite this fact the etiology of the condition, and the risk factors, are still not well known. One study concluded that a past history of EAMC and an overall faster running pace are independent risk factors for EAMC in a race. The researchers also added that inadequately tapering just before a race may also cause EAMC during the race. 

Statin medication

Hydroxy-methyl-glutaryl-coenzyme-A (HMG-CoA) reductase inhibitors or “statins” are used by patients to treat hypercholesterolemia, and to manage increased cardiovascular disease (CVD) risk.

One of the most common side effects of statins are statin-associated muscle symptoms (SAMS), which includes muscle pain and aching, muscle cramps, and weakness. SAMS has been reported by 10-25% of patients that are receiving statin therapy. 

The diagnosis of SAMS is subjective for both the physician and patient because there is no diagnostic criteria.

Myalgia (muscle pain and aching), cramps, and weakness usually involve large muscle groups, like the thigh, buttocks, back, and shoulders. In comparison, cramping usually involves the small muscles of the hands and feet. These symptoms have been shown to be more frequent in patients that are physically active.

Statins inhibit the synthesis of coenzyme Q10 (CoQ10). It is thought that because of the role of CoQ10 in mitochondrial energy synthesis, statin-induced CoQ10 deficiency can be a cause in the development of SAMS. A study was completed to evaluate the possible benefits of supplementing CoQ10 in patients with SAMS. The researchers discovered that the patients that took the CoQ10 supplement had reduced symptoms of SAMS, including the amount and intensity of muscle cramps.

Nocturnal leg cramps

Nocturnal leg cramps are cramps of the hamstrings, calf muscles, or foot muscles that are sporadic, painful, uncontrolled, unrelenting, and occur rapidly. During a cramp, the muscles that are involved become tender and hard, and may persist from seconds to several minutes. These cramps are more common in women and people with comorbidities, particularly neurological and cardiovascular disease. The cause of nocturnal leg cramps is unknown. A study was done that showed nightly stretching of the hamstring and calf muscles substantially decreased the severity and occurrence of nocturnal leg cramps in subjects that normally suffered from them.

Chronic venous disorders

Chronic venous disorders (CVDs) are caused by abnormal or diseased veins, which creates problems like chronic venous insufficiency (CVI), varicose and spider veins, leg pain and inflammation, and more. CVDs of the lower extremities are very common.

Symptoms can consist of muscle cramps, aching, pain, tightness, and more.

Methods that have been shown to alleviate muscle cramps associated with CVDs include exercise, weight loss, massage and compression therapy (wearing elastic stocking/socks).

Chronic Venous Insufficiency

Chronic Venous Insufficiency (CVI) is defined by persistent venous hypertension, or high blood pressure, of the lower limbs. Extended venous hypertension in CVI can cause calf muscles to weaken and produce pain, muscle cramps, heaviness, restless leg syndrome, and edema, among other symptoms. Venous hypertension can also cause a reduction in range of ankle motion (ROAM).

If patients that suffer from CVI start physical therapy early, like compression stockings and exercise programs, symptoms can be alleviated, and ankle flexibility and venous drainage can be improved. It was found that patient compliance was poor in adhering to their physical therapy, so new bandaging techniques were established to relieve symptoms. Research found that elastic kinesio taping can increase lymphatic and vascular flow; alleviating pain, cramps and other symptoms, and correct joint misalignment.

In summary

Muscle cramps affect many people, and for many different reasons. The types of cramps, frequency, and severity vary from person to person. The best strategy for managing muscle cramps depends on the individual, and there is not a “one size fits all” approach. Different methods must be used consistently in order to notice results. The take home is to remember to adequately hydrate with water, address any nutritional deficiencies, keep physically active and stretch....

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References

Nelson Nicole L, Churilla James R. A Narrative Review of Exercise-Associate Muscle Cramps: Factors That Contribute To Neuromuscular Fatigue And Management Implications. Muscle Nerve. 2016;54:177-185. doi:10.1002/mus.25176.

Schwellnus Martin P, Allie Siddieq, Derman Wayne, Collins Malcolm. Increased running spped and pre-race muscle damage as risk factors for exercise-associated muscle cramps in a 56 km ultra-marathon: a prospective cohort study. Br J Sports Med. 2011;45:1132–1136. doi:10.1136/bjsm.2010.082677.

Thompson Paul D, Panza Gregory, Zaleski Amanda, Taylor Beth. Statin-Associated Side Effects. J Am Coll Cardiol. 2016; 67(20):2395-2410. http://dx.doi.org/10.1016/j.jacc.2016.02.071

Fedacko Jan, Pella Daniel, Fedackova Petra, et al. Coenzyme Q10 and selenium in statin-associated myopathy treatment. Can J Physiol Pharmacol. 2013;91:165–170. http://dx.doi.org/10.1139/cjpp-2012-0118.

Wrona M, Jockel K, Pannier F, Bock E, Hoffmann B, Rabe E. Association of Venous Disorders with Leg Symptoms: Results from the Bonn Vein Study 1. Eur J Vasc Endovasc Surg. 2015;50:360-367. http://dx.doi.org/10.1016/j.ejvs.2015.05.013.

Wittens C, Davies A, Baekgaard N, et al. Editor's Choice – Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678–737. doi:10.1016/j.ejvs.2015.02.007.

Aguilar-Ferrandiz Maria Encarnacion, Castro-Sanchez Adelaida Maria, Mataran-Penarrocha Guillermo A, Garcia-Muro Francisco, Serge Theyrs, Moreno-Lorenzo Carmen. Effects of Kinesio Taping on Venous Symptoms, Bioelectrical Activity of the Gastrocnemius Muscle, Range of Ankle Motion, and Quality of Life in Postmenopausal Women With Chronic Venous Insufficiency: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2013;94:2315-2328. http://dx.doi.org/10.1016/j.apmr.2013.05.016.

Hallegraeff Joannes M, Schans Cees P van der, Ruiter Renne de, Greef Mathieu HG de. Stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults: a randomized trial. J Physiother. 2012;58(1):17-22. doi:10.1016/S1836-9553(12)70068-1.

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