Understanding Muscle Spasm: Treatment and Causes

What you’re experiencing might be a muscle spasm or cramp. A muscle spasm is a sudden, involuntary, and often painful contraction of one or more muscles that cannot be immediately relaxed [1]. This involuntary tightening is the body’s natural response to various triggers, including muscle fatigue, dehydration, nerve irritation, or underlying medical conditions [2]. While this phenomenon can affect any skeletal muscle, it is distinct from myotonia (which involves delayed relaxation after a voluntary contraction).

Who is at Risk?

Muscle spasms can happen unexpectedly, regardless of age, lifestyle, or activity level. You could experience a spasm while walking, sitting, exercising, or even sleeping. Unfortunately, some individuals are prone to muscle spasms and may experience them frequently, including:

• Older adults, potentially due to age-related changes in muscle mass and circulation [3].
• Athletes or those participating in vigorous or prolonged exercise.
• Pregnant women, often due to increased weight, altered circulation, or mineral changes.
• People who are overweight or sedentary.

Muscle Spasm Causes

A range of factors can contribute to muscular spasms, such as electrolyte imbalance, poor muscle conditioning, and certain medical conditions [2].

• Working in hot environments (e.g., construction and factory workers, athletes) can lead to dehydration and electrolyte imbalances (such as low levels of sodium, calcium, potassium, or magnesium), which can impair normal muscle function [4]. It can cause spasms and random contractions, leaving people more prone to muscle cramps.
• Muscular spasms often result from overuse or holding an awkward position for a prolonged period or participating in vigorous physical activity without adequate preparation, such as proper warm-up and stretching [1]. Furthermore, the risk of developing spasms increases with age, being overweight, and pregnancy. In some cases, however, the cause of these spasms is not known (idiopathic cramps).

When Spasms Indicate a Potential Underlying Condition

While most spasms are benign, persistent or unusual cramping may be a secondary symptom of certain underlying medical conditions [3]:

Circulatory Issues

Conditions like Peripheral Artery Disease (PAD) (often caused by arteriosclerosis) may lead to leg cramps during walking (a condition called claudication) due to insufficient blood flow and oxygen to the muscles [2].

Neurological Conditions

Cramps are occasionally reported as a feature in complex neurological disorders, including Multiple Sclerosis (MS) and Amyotrophic Lateral Sclerosis (ALS). It is crucial to note that these diseases typically present with numerous other hallmark symptoms and muscle cramps alone are rarely a sufficient basis for diagnosis [1].

Muscle Spasm Symptoms

Muscle spasms can range from a slight pinch to an excruciating experience. Muscle spasms may present as:

• Sudden, sharp pain in a specific muscle group
• A visibly tightened or twitching muscle
• A firm knot felt under the skin
• Temporary inability to use the affected muscle
• Cramps during rest or activity, especially at night

Persistent, frequent, or debilitating spasms may suggest an underlying condition and require medical evaluation.

Muscle Spasm Diagnosis

To diagnose the cause of muscle spasms, a healthcare provider will assess your full medical and medication history and conduct a physical examination [3]. Key areas of inquiry include:

• When the spasms occur (e.g., at night, during exercise, or only with activity)
• Duration and severity of cramps
• Associated symptoms such as weakness, numbness, or swelling
• Medical history (e.g., diagnosis of diabetes, kidney disease, neurological issues)
• Current Medications, as some (e.g., diuretics, statins) can cause cramps [4]
• Diagnostic tests, such as blood tests, may be ordered to check for electrolyte imbalances, kidney function, or other abnormalities. Further tests (e.g., electromyography or nerve conduction studies) may be needed if a neurological cause is suspected [3].

Treatment and Management of Muscle Spasms

Most simple muscle spasms resolve spontaneously and do not require medical treatment. However, several effective self-care strategies and medical treatments can help manage and prevent them.

Self-Care for Immediate Relief:

• Stop the activity that triggered the cramp.
• Gently stretch the affected muscle (e.g., pull the toes toward the head for a calf cramp) and massage the area.
• Apply warmth (heating pad or warm bath) to tight muscles or ice if soreness persists, especially after the acute spasm subsides.

Over-the-Counter Management:

• Over-the-counter pain relievers such as paracetamol (acetaminophen) or ibuprofen may help with residual muscle soreness but do not treat the cramp itself [2].
• Use of naproxen and ibuprofen should be under medical advice, especially in older adults or those with gastrointestinal risk or kidney problems.

Prescription Management (For Frequent or Underlying Conditions)

For cramps that are frequent, debilitating, and confirmed by a physician to be a symptom of an underlying neurological or severe medical condition, specific medications may be prescribed by a specialist.

• Muscle Relaxants: Such as Baclofen or Tizanidine, which act on the central nervous system to potentially reduce muscle tone and spasticity [5].
• Nerve Agents: In rare, severe cases, medications like certain Benzodiazepines (e.g., diazepam) may be used for very short-term relief, but their use carries significant risks of tolerance and dependence.

Critical Warning: These medications are typically reserved for cramps related to diagnosed chronic conditions (e.g., MS, ALS, spinal cord injury), not for simple, common muscle cramps. Their use requires specialised diagnosis, ongoing monitoring, and careful risk assessment with your doctor [5].

Lifestyle Advice for Prevention

• Regular light exercise and daily static stretching, especially for calves and hamstrings [4].
• Ensure adequate hydration and electrolyte balance, particularly before, during, and after strenuous activity and in hot environments.
• Avoid caffeine and alcohol before bed if experiencing nocturnal cramps, as these can be dehydrating and affect sleep quality [2].

When to Seek Medical Attention

• You should seek medical help if cramps are accompanied by or you experience:
• Muscle weakness (which could indicate a neurological issue)
• Redness or swelling (which could suggest a blood clot or deep tissue inflammation)
• Persistent recurrence without a clear cause (idiopathic cramps that don’t respond to self-care)
• Cramps that are severe or interfere with daily activities.

Muscle spasms can be painful but are usually harmless. With proper hydration, nutrition, and physical activity, they can often be prevented or reduced. It is always advisable to consult a healthcare provider for a thorough evaluation if your cramps are new, severe, or persistent, to rule out any underlying medical issues.

Disclaimer

The information provided in this article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

References

[1] Swash, M., Czesnik, D., & De Carvalho, M. (2018). Muscular cramp: causes and management. European Journal of Neurology, 26(2), 214–221. https://doi.org/10.1111/ene.13799

[2] Dijkstra, J. N., Boon, E., Kruijt, N., Brusse, E., Ramdas, S., Jungbluth, H., Van Engelen, B. G., Walters, J., & Voermans, N. C. (2022). Muscle cramps and contractures: Causes and treatment. Practical Neurology, 23(1), 23–34. https://doi.org/10.1136/pn-2022-003574

[3] Katzberg, H. D., Khan, A. H., & So, Y. T. (2010). Assessment: Symptomatic treatment for muscle cramps (an evidence-based review). Neurology, 74(8), 691–696. https://doi.org/1212/wnl.0b013e3181d0ccca

[4] Miller, K. C., Stone, M. S., Huxel, K. C., & Edwards, J. E. (2010). Exercise-associated muscle cramps. Sports Health A Multidisciplinary Approach, 2(4), 279–283. https://doi.org/10.1177/1941738109357299

[5] MedlinePlus. (2019, October). Baclofen: MedlinePlus Drug Information. U.S. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a682530.html