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You don’t have to be an athlete to get a muscle cramp. You could be lying in bed, about to drift off to sleep when a sudden, involuntary and painful tightening of your calf or foot arch jolts you out of your sleepy state. It can be seconds or minutes before the cramp subsides on its own.
Such nocturnal leg cramps are pretty common, according to a 2017 study , which found that about 30 per cent of adults have night cramps at least five times a month. And it’s not because you were running a marathon earlier in the day, although active people are more prone to muscle cramps. Cramps needn’t occur at night either.
Sitting at your desk the whole day, or not stretching or exercising regularly, can also trigger these painful episodes. Even though muscle cramps aren’t exactly causes for concern, physiotherapists do get queries about them from time to time: Are you more prone to cramps as you age? Can drinking sports drinks really help to minimise them? Can you prevent cramps at all? We find out. "Muscle cramps are sudden, involuntary contractions of a muscle," said Dr Ang Mu Liang, an orthopaedic surgery consultant with National Healthcare Group's Woodlands Health.
"Cramps occur when the muscle fibres are overexcited, often due to nerve impulses that misfire or inadequate electrolyte levels such as potassium, calcium, or magnesium necessary for normal muscle contraction," said Dr Ang. The misfiring that he is referring to involves your lower motor neurons, which are the nerve cells in your spinal cord and brain. Simplistically, these neurons collect nervous impulses from your central nervous system and transmit them to the muscles in your body to create movement.
Muscle cramps are caused by these “lower motor neurons having hyperactive, high-frequency, involuntary nerve discharge”, said Core Concepts’ physiotherapist Ernie Goh. Pretty much like your muscle getting rid of an over-accumulation of impulses when you overwork it. But, on the whole, “experts are not entirely sure why some healthy individuals get muscle cramps and others do not”, said Zachary Poon Qi Jing, a senior physiotherapist with Sengkang General Hospital.
“The spontaneous nature of leg cramps makes observing and studying them difficult.” The two leading hypotheses, he said, are muscle fatigue and electrolyte imbalances. If overworking the muscles is a cause of cramps, why do we get them when we're just lying in bed and trying to fall sleep? Poon suggested that the mechanism behind night cramps is different from the ones in the day such as muscle fatigue and electrolyte imbalances from being active.
" The leading hypothesis for muscle cramps at night is the transition from rapid eye movement (REM) sleep to non-REM sleep," he said. "During REM sleep, it is hypothesised that we have low muscle tone (tension in a muscle at rest) and during the transition phase to non-REM sleep, the sudden uptake of muscle tone may result in muscle cramps," said Poon. Goh said that cramps are not directly caused by age “but indirectly as we tend to get less active as we age; hence, the muscles fatigue easier”.
Age may also appear to play a role mainly because older people tend to have disorders relating to the nervous and metabolic systems, and are more likely to take multiple medications – all of which can increase the likelihood of muscle cramps, Poon explained. Dr Ang, however, observed that "w ith age, muscle mass declines and the ability of the muscles to respond to nerve signals decreases". "Additionally, older adults often have poorer circulation and may experience reduced flexibility and hydration levels, all contributing to more frequent cramps," he said.
"I see cases of muscle cramps in elderly patients, especially those who are physically inactive, dehydrated or on certain medications. Cramps are common in patients with underlying musculoskeletal issues such as joint arthritis or neurological issues such as nerve injury," he said. Generally, the muscles that are most frequently used and fatigued are usually the ones that cramp up, said Poon.
In older adults, cramps have been reported to be more common in the calves, he said. According to Dr Ang, these are the five common muscles that tend to cramp, along with their causes: Cramps in different muscles may feel differently but they are typically painful and associated with the tightening of the muscle in question, said Poon. Cramps often “present as an involuntary explosive onset and gradual self-easing” and “only one muscle is involved”.
Dr Ang added that the affected muscle may feel hard to the touch and be difficult to move. "Some may experience tingling or twitching before the cramp fully sets in, which can be an early warning sign." The sensations that can pass for a muscle cramp can range from muscle spasming to tightening, twinging, straining, swelling or seizing, said Goh.
“Sensations that aren’t typical would be sharp pain.” “Based on research, no particular treatment is recommended,” said Goh. “But we typically force a sustained stretch on the affected muscle to stop the involuntary contractions.
Typically, if the cramp is due to fatigue, you should stop the activity and take a break from it.” Try stretching the cramping muscle in the opposite direction, advised Poon. For instance, if a cramping calf is forcing your foot into the tiptoe position, pull the foot back into a toe-up position, he suggested.
Also, "applying heat can help relax the muscle, then subsequently applying ice intermittently may reduce the pain", recommended Dr Ang. “It usually helps if you replenish your electrolytes, such as eating a banana for potassium, and drinking an isotonic drink”, said Goh. “If it is due to medications or chronic diseases, seek your physician’s advice on what is appropriate and safe.
” You may feel like someone’s carving out your calf muscle when a cramp hits, and wonder: Is there any damage in the aftermath? “Despite the pain and discomfort, muscle cramps are benign and do not cause any damage by the affected muscles and surrounding structures,” said Poon. That stiff, achy, burning or even tingling sensation after the cramp has subsided is the result of a lack of blood flow to the area, causing trigger points or knots in your muscles, said Goh. If you have chronic muscle cramps that are accompanied with muscle weakness, poor coordination, bruising or skin discolouration, swelling or persistent numbness, see a doctor.
Dr Ang warned that muscle cramps can be a sign of serious issues when they occur frequently and severely, especially when accompanied by the abovementioned symptoms. "This can indicate poor blood circulation caused by peripheral artery disease, nerve compression from spinal conditions, or muscle disease," he said. If your calf is prone to cramping, for example, perform specific calf exercises at an appropriate level, advised Goh.
This will help to slowly build up its tolerance for activity, delay muscle fatigue and therefore, a lesser likelihood of cramps, he explained. If it’s for overall prevention, adopt a more active lifestyle and “increase muscular capacity and tolerance to physical activity”, said Poon. Avoiding physically strenuous tasks in hot and humid environments can help to reduce the recurrence of a muscle cramp as well, he said.
And try calf stretches, quadricep stretches and hamstring stretches to prevent cramps in these likely muscles, said Poon. Dr Ang added that s tretching before bed can help prevent night cramps. Meanwhile, it helps to consider magnesium, potassium and calcium supplements to prevent cramps caused by electrolyte imbalances, said Dr Ang.
"These supplements help in muscle contraction and relaxation processes.".
