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Musculoskeletal system
Cramp is the involuntary spasm of a muscle or group of muscles. Cramp can happen during vigorous activity, after repeated movements, while resting or following a large meal. Excessive sweating in very hot weather can also be a cause. Cramp that occurs mainly in bed at night, known as night cramps, is particularly common in the elderly and may be sufficiently severe as to disturb sleep. About 1 in 3 people over the age of 60, and about half those over 80 regularly experience leg cramps.
If levels of oxygen in the blood drop, either from exercise or following digestion of a heavy meal, a build up of a waste product called lactic acid in the muscles can occur. Muscles can only store a limited amount of lactic acid, so when this limit is exceeded the affected muscle may go into spasm, causing the cramp.

Cramp may also be caused by a loss of sodium from the body. Levels of sodium affect the way that muscles work. If a lot of sodium is lost through sweating cramps may occur. Certain medicines such as diuretics (water tablets) also cause the loss of sodium and their use may increase the risk of getting cramp. Low levels of calcium in the blood and poor circulation can also be a cause of muscle cramps.
The calf muscles of the legs are the most common sites for cramp. Pain is the main symptom and it is usually confined to the area over the muscle involved. The muscle may be knotted and tense, and can easily be felt as a hard, tender cord. This spasm may last for a few moments or a few minutes and, once relieved, the muscles may continue to feel tender for a further 1 or 2 days.

Attacks of night cramps may occur in bouts lasting for a few days to several weeks, with intervals of several weeks between each series of attacks.
Severe and persistent night cramps may need medication. Calcium channel blockers, such as diltiazem, have been used to treat night cramps. Vitamin B complex, including vitamin B6, has also been shown to be effective.

There is a medicine available without the need for a prescription called Crampex that may help both treat and prevent muscle cramps from recurring. Crampex contains calcium gluconate and colecalciferol, that increase levels of calcium in the blood, and nicotinic acid, that helps improve circulation to the leg muscles.

Quinine sulphate and quinine bisulphate have been prescribed for the treatment of cramp for many years. However, there is no evidence for quinine's long term effect or safety for preventing or treating leg cramps. Serious side effects including thrombocytopenia (low level of platelets in the blood) resulting in bruising and bleeding, and in some cases death have been associated with its use. Consequently, although quinine is still available for the treatment of malaria, it is recommended that quinine is only used as a last resort for the treatment of cramp, when all other methods have been tried and when cramp is seriously affecting the person's quality of life. If quinine is used, it should initially be used on a trial basis for about 4 to 6 weeks to determine if it is providing any benefit, and the person should be closely monitored for side effects.
When to consult your pharmacist
If you suffer from night cramps, your pharmacist may recommend tablets such as Crampex and will advise you to take the tablets at night for a time until you think the bout has passed.

Simple analgesics such as ibuprofen or paracetamol may also be recommended if your muscle remains painful after the cramp has gone.

Let your pharmacist know if you are taking any medicines when asking for advice about cramp, as sometimes they may be the cause of the problem.
When to see your doctor
See your doctor if sleep is being seriously impaired or if troublesome attacks continue frequently. Also see your doctor if you have other symptoms besides cramp. If your doctor thinks that your medicine may be the cause of cramp, an alternative medicine may be prescribed.
Living with cramp
Regular stretching exercises can help prevent cramp from developing. Stand about 1 metre from a wall with your heels on the floor and tilt forward with your hands against the wall. Stretch until a moderate pulling sensation is felt in the calves and hold the position for 10 seconds, then return to an upright posture and relax for 10 seconds before repeating. Continue for 5-10 minutes three times a day until symptoms have improved.

If exercising, always stretch your muscles and warm up beforehand. Drink plenty of fluids before, during and after exercise. Isotonic drinks that replace fluid, salts and glucose lost during exercise may help. After exercising, gently warm down by gradually reducing your level of exercise activity and finish by gently stretching each of the muscle blocks from head to toe.

If you get cramp try rubbing and stretching the cramped muscle. Get your partner or friend to help. Lie on your back, raise the leg affected by cramp and ask your partner or friend to push on the underside of your toes so that your foot flexes towards your body, thereby stretching your calf muscles. Walking on the affected leg will also stretch the muscle and relieve the cramp. The rubbing of embrocations or liniments into the leg muscle can help ease pain.

If you suffer from night cramps try gently rubbing in circular movements with the tips of the fingers over the affected muscle. Keeping the bedclothes loose or raising the legs on a pillow may also help.
Useful Tips
  • Build up your exercise levels gradually to allow the muscles to stretch and strengthen
  • Do not swim out of your depth if you are prone to cramps
  • Drink plenty of fluids in hot weather

Reviewed on 11 October 2010