cramps

Cramped up

Your Health DR GITA MATHAI

We humans can perform highly complex and coordinated actions. We have muscles under voluntary control, which obey commands relayed by the brain. Movements are smooth and synchronised as opposing groups of muscles work in tandem. However, muscles occasionally fail to obey the commands of the brain. They contract and go into a painful “spasm”, refusing to relax. The agonising discomfort prevents further movement. After a few minutes (which seem like an eternity) the muscle relaxes. The cycle may or may not recur. If cramps occur during a sport, the competitor may be massaged on the field or led off it. If they occur in the night, the pain wakes the person up. About 95 per cent of the population experiences cramps at some time in their life. They occur in all age groups (including children) but become more common with increasing age. Diagnosing a cramp is not difficult. The sufferer knows he has developed a cramp. The severe pain makes him stop the activity or wakes him up from sleep. The muscle is tight, sore and a hard tender knot can be felt. Although the cramp disappears in a few minutes, the soreness may persist for days. Cramps can occur due to: • Fracture of the underlying bone. Overlying muscles tend to go into an unrelenting protective painful spasm. • Overuse injury like in writing, typing or computer use. The fingers assume abnormal painful positions from which they cannot voluntarily be straightened. • Excessive sweating because of the heat — with or without exercise — which depletes the body of salt (sodium). • Electrolyte imbalances and shift of body fluids due to liver (cirrhosis) or kidney disease (renal failure) or the hormonal changes of pregnancy, with hyperventilation or vomiting. • Withdrawal from alcohol, sleeping tablets and anxiety agents like valium in addicts. • Deficiencies of the B group of thiamine (B1), pantothenic acid (B5), and pyridoxine (B6) and vitamin E. The exact mechanism is not known but these vitamins are thought to stabilise the nerve membranes • Medications such as diuretics, statin group of drugs raloxifene, parkinson’s disease medications, nifedepine, asthma medications like terbutaline and ventorlin. Cramps usually occur due to the levels of minerals and electrolytes in the body going “out of sync”. This is because unbalanced or low levels (particularly of sodium, calcium or magnesium) cause hyper excitability of the nerve endings going to the muscles. They are unable to obey commands from the central areas of the brain to relax. Low levels of calcium and magnesium can occur in pregnancy and with increasing age unless they are supplemented. Calcium can be taken as tablets. Supplements work well provided the level of vitamin D3 in the body is adequate. Aerobic physical exercise helps ingested calcium get into the system. The safest way to supplement magnesium is with an adequate intake of greens, grains, meat and fish, bananas and nuts. Sometimes the calf muscles pain when walking. After a period of rest the pain disappears and walking can be continued. This is not true cramps but claudication. It occurs as a result of inadequate blood supply to the muscle. It requires medical evaluation. Cramps can usually be stopped if the muscle is stretched in the opposite direction. For calf cramps that means placing both feet flat on the ground, keeping the leg straight and rocking back on toes and heels. Alternatively you can stand half your height distance away from a wall, stretch arms out and balance against the wall. If still in bed and unable to move, keep the feet straight and stretch the toes towards the head. For “writer’s cramp”, place hands flat against a wall with fingers facing downward. Gently massage the cramped muscle. Then apply warmth with a heating pad or hot water. This will help the muscle to stay relaxed. If the cramp is associated with fluid loss, water and electrolyte replacement is needed. Salted buttermilk, lime juice, commercially available electrolyte solutions, or ORS (oral rehydrating solution) packets can be used. Caffeine containing beverages (coffee, tea and colas) aggravate dehydration. Exercise, (even in the elderly) should start and end with stretching. Hydration should be adequate. The amount of water required depends on the intensity of the exercise and the weather. If thirst develops it means that dehydration has already set in. Older people and young children do not experience appropriate thirst. Muscle cramps usually disappear on their own and do not require specific medication. If they occur frequently without exercise or dehydration and are accompanied by severe discomfort, and skin colour or texture changes, then they may be due to some other disease process. This requires medical evaluation. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in