What are the causes of severe muscle cramps (muscle spasms)?

From the Guidelines

Severe muscle cramps can be managed through several approaches, with the most recent and highest quality study suggesting that baclofen (10 mg/day, with a weekly increase of 10 mg/day up to 30 mg/day) and albumin (20-40 g/week) may be effective in treating muscle cramps in patients with liver disease 1.

Management of Severe Muscle Cramps

For immediate relief, gently stretch and massage the affected muscle while applying heat to increase blood flow.

• Stay hydrated by drinking water regularly throughout the day, as dehydration is a common trigger.
• Electrolyte imbalances often cause cramps, so consider taking magnesium supplements (300-400mg daily), potassium-rich foods, or electrolyte drinks like Pedialyte or sports drinks.
• Over-the-counter medications such as ibuprofen (Advil, 200-400mg) or naproxen (Aleve, 220mg) can help reduce pain and inflammation.

Prevention and Underlying Conditions

For prevention, maintain regular physical activity with proper warm-ups and cool-downs, and ensure adequate vitamin D and calcium intake.

• If cramps are frequent, severe, or accompanied by swelling, redness, or weakness, seek medical attention as they may indicate underlying conditions like peripheral artery disease, nerve compression, or medication side effects.
• Certain prescription medications like quinine (though rarely prescribed now due to side effects), muscle relaxants like cyclobenzaprine (5-10mg), or anti-seizure medications like gabapentin may be prescribed by your doctor for persistent cases.

Heat-Induced Muscle Cramps

Heat-induced muscle cramps can be managed with rest, cooling off, and drinking an electrolyte-carbohydrate mixture, such as juice, milk, or a commercial electrolyte-carbohydrate drink 1.

• Stretching, icing, and massaging the painful muscles may be helpful.
• Exercise should not be resumed until all symptoms have resolved.

From the Research

Severe Muscle Cramps

• Severe muscle cramps, also known as exercise-associated muscle cramps (EAMCs), are a common issue among physically active individuals 2, 3.
• The causes of EAMCs are multifactorial, but dehydration and electrolyte deficits are considered to be contributing factors 2, 4, 5.
• Studies have shown that consuming a carbohydrate-electrolyte beverage before and during exercise in a hot environment may delay the onset of EAMCs 2.
• Additionally, ingesting an oral rehydration solution (ORS) during exercise has been found to decrease muscle cramp susceptibility 4, 5.
• In contrast, water intake after dehydration has been shown to make muscles more susceptible to cramp, but this effect can be reversed by consuming electrolytes 5.
• Treatment of acute EAMCs typically includes self-applied or clinician-guided gentle static stretching until symptoms abate 3.
• Prevention strategies for EAMCs should be individualized and based on a thorough medical history, as well as identification of unique risk factors 3.

Prevention and Treatment

• To prevent EAMCs, it is recommended to consume a carbohydrate-electrolyte beverage or ORS during exercise, especially in hot environments 2, 4, 5.
• Gentle static stretching can be used to treat acute EAMCs 3.
• Individualized prevention strategies, based on a thorough medical history and identification of unique risk factors, may be more effective than generalized advice 3.

Electrolytes and Hydration

• Electrolyte deficits, particularly sodium and chloride, can contribute to the development of EAMCs 4, 5.
• Consuming electrolytes, such as those found in ORS, can help to prevent EAMCs 4, 5.
• Hydration is also important, but water intake alone may not be sufficient to prevent EAMCs, especially if electrolyte levels are low 5.