What is the treatment for a muscle cramp?

Immediate Treatment of Muscle Cramps

For an active muscle cramp, immediately stop the activity causing the cramp, then stretch and massage the affected muscle until the contraction resolves. 1, 2

Acute Management During the Cramp

• Stop all activity immediately that triggered the cramping episode 2
• Stretch the cramping muscle by gently lengthening it in the opposite direction of the contraction 1, 2
• Massage the affected muscle while maintaining the stretch to help release the involuntary contraction 1, 2
• Apply ice directly to the cramping muscle during the acute episode to help relieve the spasm 2

Post-Cramp Pain Management

• Apply ice for 20-30 minutes if residual muscle tenderness persists after the cramp resolves, treating it like a soft tissue injury 1

When to Seek Medical Attention

You should contact your physician if:

• The cramp began after starting a new medication, particularly diuretics like hydrochlorothiazide which commonly cause electrolyte imbalances 1
• Cramps are persistent and unexplained, as this may indicate hypercalcemia or vascular disease requiring evaluation 1
• Cramps are severe and frequent, which may warrant investigation for underlying neurological conditions including neuropathy, radiculopathy, or motor unit diseases 3

Prevention Strategies

For Exercise-Related Cramps:

• Maintain adequate hydration throughout the day, especially before exercise lasting longer than 1 hour 1
• Replace sodium losses during prolonged exercise in hot environments, particularly if you are a heavy sweater 1
• Ensure adequate electrolyte intake including sodium, potassium, and magnesium, as deficiencies are primary triggers 1, 2

For Nocturnal/Morning Cramps:

• Review all medications with your physician, especially diuretics that cause electrolyte imbalances 1
• Maintain adequate daily fluid intake, as dehydration throughout the day manifests as early morning cramping 1
• Consider electrolyte supplementation if dietary intake is inadequate, focusing on sodium, potassium, and magnesium 1

Pharmacological Options (If Non-Pharmacological Measures Fail)

For severe, disabling cramps that don't respond to stretching and lifestyle modifications:

• Baclofen starting at 10 mg/day with weekly increases of 10 mg/day up to 30 mg/day is effective for severe cramps, particularly in patients with liver disease 2
• Avoid quinine sulfate despite its effectiveness at 400 mg/day for 4 weeks, as it carries significant side effects and is not recommended for routine use 2, 3, 4
• Do not use cyclobenzaprine or other muscle relaxants with the mistaken belief they directly relieve muscle spasm—they do not 2
• Avoid benzodiazepines as they have limited efficacy for persistent pain and carry high risk profiles, especially in older adults 2

Important Caveats

The evidence for cramp treatments is limited by inconsistent diagnostic criteria and unvalidated outcome measures across studies 5. Cramps are notoriously unpredictable and may have different underlying mechanisms in different individuals 6. The immediate stretching and massage approach is universally recommended across guidelines despite limited high-quality evidence, as it is safe, immediately available, and physiologically sound 1, 2.