Leg pain athlete cramps calf

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Muscle cramps are painful contractions of the muscle that happen involuntarily (i.e. without the athlete intending then to happen). Leg cramps affect most people training hard, particularly running at some point and a common site for cramps is the calf muscles.

Skeletal muscle cramps are one of the most common problems encountered in endurance sports. The specific cause has not been definitively studied. Also the differences between the rate of muscle cramps in elite and recreational athletes is not known..

There are a variety of medical conditions that cause muscle cramps such as pregnancy induced cramps, night cramps in older patients, rare hereditary conditions, diabetes, electrolyte abnormalities, and muscle diseases.

The majority of athletes sustaining a muscle cramp have Exercise Associated Muscle Cramps (EAMC).

EAMC are painful involuntary spasmodic contractions of skeletal muscle that occurs during or immediately after strenuous exercise. The theories on the cause of EAMC are related to dehydration and blood electrolyte levels. A recent hypothesis, however, suggests the problem to be abnormal spinal control of motor neuron activity especially when a muscle contracts in a shortened position. Such an example is cramping of the calf muscle while the foot is plantar flexed (the muscle is therefore shortened) and the gastrocnemius muscle contracts when one is asleep.

The risk factors of EAMC are older age, higher body mass index, shorter daily stretching time, irregular stretching habits and family history of cramping, high intensity training.

The 2 most important observations from all studies looking at risk of EAMC are muscle fatigue, and, second, poor stretching habits.

The initial treatment of the cramping athlete on the field includes:

1.Passive stretching of the affected muscle and holding the muscle in a stretched position. The return of the muscle to normal length will not precipitate a cramp.

2. Keep the athlete at a comfortable "cool" temperature and provide water. Sports drinks can be used to replenish glucose and electrolytes. DO NOT USE SALT TABLETS.

3. If the athlete is cramping in multiple muscle groups, transportation to the emergency may be required..

Coaches should advise the athlete:

1. to be well conditioned (most cramps occur early in the season)
2. regularly stretch muscles prone to cramping
3. maintain adequate nutrition (carbohydrates and fluid)
4. reduce exercise intensity and duration if necessary

Muscle cramps don't discriminate between the star athlete and someone who barely moves. You may be competing in a long-distance bike race, taking leisurely laps in the pool or sleeping soundly in bed. Suddenly, a muscle seizes up and grips you in pain.

A cramp is caused by anything that interferes with the muscle's natural ability to contract and relax. Take a foot spasm, for example. When feet are flexed for propulsion while swimming or when tight bedsheets force your toes downward, the muscle tendons become overstretched and the nerves extending through your foot and into your calf can become hyperexcitable. When this happens, the nerve signals become confused, according to Robert Nirschl, M.D., assistant professor of orthopedic surgery at Georgetown University School of Medicine in Washington, D.C. The result: a painful cramp. "Your muscles may get the message to contract, but not to relax," he explains.

Profuse perspiration can also cause a muscle cramp. Heavy sweating drains your body of important minerals: potassium, sodium, magnesium and calcium. These minerals, called electrolytes, carry electrical charges to the nerves that control a muscle's impulse to contract and relax. Lack of fluids can upset the delicate balance of electrolytes, causing nerve signals to misfire.

If you've actually injured a muscle from overuse, a cramp may go into a continuous contraction, or spasm. While "cramp" and "spasm" are often used interchangeably, a spasm generally means the muscle fibers have "locked up" to protect the injured muscle.

People who have conditions that interfere with blood circulation or muscle metabolism can experience repeated cramps. These conditions include diabetes, rheumatoid arthritis and thyroid disease.

Here's how to ease out of the grip of a muscle cramp, no matter what the cause.

Stretch and squeeze. Stretch a cramped leg muscle with one hand and alternately squeeze and release the muscle with the other hand. "This mechanical kneading restores blood flow and generally helps relax the spasm and tightness in seconds," says Dr. Nirschl.

Point your toes back toward your chin. This is a quick way to halt a leg cramp while swimming, according to Harry Daniell, M.D., clinical professor in the Department of Medicine at the University of California, Davis, School of Medicine.

Cool it. If stretching doesn't release a cramp and the muscle's in painful spasm, an ice massage will numb the area, according to Irene von Estorff, M.D., assistant professor of rehabilitation medicine at the New York HospitalCornell Medical College in New York City. Rub the ice over the cramped muscle for three to five minutes. Make sure to keep the ice moving so you don't harm skin tissue.

Pinch your upper lip. Oddly enough, pinching the area above the upper lip with your finger and thumb can make a leg cramp vanish, according to Dr. Nirschl. He's not sure why this works, but there are two possible reasons: The upper lip may be a pressure point that helps relax the muscle. Or, he says, it simply may be that the pain of the pinch distracts you from the pain of the cramp until it releases on its own.

Quench your thirst pronto. "If you're exerting yourself, dripping with sweat and suddenly feel a cramp in your thigh, take a few swigs of water or whatever fluid is handy," says Robert Wortmann, M.D., chairman of the Department of Medicine at East Carolina University School of Medicine in Greenville, North Carolina. If you follow swigging with stretching, the cramp should vanish quickly.

Keep on sipping. "To prevent cramping during a sweaty workout, take three or four normal swallows of water every ten minutes," says Owen Anderson, Ph.D., editor of Running Research News.

Pass up the salt. Whatever you do, avoid taking salt tablets or very salty liquids such as soft drinks when you're perspiring. "Salt actually draws fluid out of muscles and into the stomach," says Dr. Nirschl.

Pack a sports drink on a hot day. If you're going to be sweating profusely during a long hike, you may need to replace potassium and other electrolytes that plain water can't provide. "Sipping electrolyte sports drinks such as Gatorade at regular intervals may be a good idea," says Dr. Nirschl. These replacement drinks also contain glucose, which helps electrolytes get absorbed quicker than plain water.

Do wall push-ups before bedtime. "In a study with 44 people, we found that calf-stretching exercises, performed three times per day for a week, helped cure nocturnal leg cramps," says Dr. Daniell. To perform the calf stretch, he says, stand facing a wall about two feet away. Place your hands on the wall and slowly lean forward, keeping your heels in contact with the floor. Hold the position for ten seconds and relax for five seconds. Do this two more times.

Serve yourself a quinine nightcap. "This age-old remedy seems to work for nocturnal leg cramps," says Dr. Daniell. Possibly, quinine make nerves less excitable. In any case, taking quinine and vitamin E tablets (like Q-vel) or 12 ounces of plain tonic water each night probably won't hurt, and it may help. But talk to your doctor first.

A bout of severe cramp may cause damage to the muscle. Fibers of the muscle may be torn due to the shear strength of the muscle contraction. If this happens the muscle will be painful for some time afterwards. It is essential the a full rehabilitation program with sports massage treatment is undertaken to restore the muscle to it's original condition. The injury can be treated in the same way as a muscle strain.

Here are some other causes of calf pain to consider.

DVT, or deep vein thrombosis, is a blood clot that develops in a deep vein, and frequently produces calf pain. A blood clot and its resulting leg aches, calf pain and swelling usually occur either when a vein has been damaged, or when circulation is extremely poor. People traveling on long trips – who are inactive for long periods of time – frequently develop blood clots and complain of calf pain, bringing about the nickname for DVT: “Economy Class Syndrome.” Please note: You’re especially at risk for DVT and its resulting calf pain if you’re overweight and/or over age 40.

When arteries harden and become blocked, circulation decreases and produces leg and calf pain. This condition, called intermittent claudication, occurs when your muscles are not receiving enough oxygen, and usually occurs during exercise or anytime you walk long distances. You will typically feel calf pain, but you can also experience painful symptoms in the feet, thighs, hips or buttocks. You can relieve symptoms like calf pain with rest, though they will recur when you try to walk or exercise again.

Chronic venous insufficiency is the end stage result following deep vein thrombosis (DVT) and thrombophlebitis (blood clots in the legs), and frequently produces calf pain, severe leg swelling, varicose veins, skin discoloration and much more. It’s important to seek treatment for venous insufficiency early to prevent real damage to your legs and to help relieve symptoms like calf pain.

Many other factors and occurrences can lead to calf pain. It’s important to see your doctor about your calf pain to ensure the right course of treatment.

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