Charlie Horse

Imagine you are laying there in bed all cozy and comfy and you shift your leg or foot a bit when bam, your leg or foot suddendly goes into an intense spasm. What do you do? You try moving the leg around to see if a different position will make the spasm disappear. Sometimes this works, but usually it doesn’t. You try to stretch the muscle stabbing you with intense pain. Sometimes this helps, but usually it doesn’t. Maybe you try to get up and just swing the leg around thinking that this will increase circulation and make it better. Again, sometimes this works, but usually it doesn’t. This horrible pain may just fade away after a few minutes or other times it lasts a long time. Eventually, the spasm lets go just as mysteriously as it appeared. That may be the end of it, but sometimes the muscle is sore as if you strained it. What is going on?

I occasionally get these nasty leg cramps. They seem to have become more common in the last ten years. What causes these? I dove into the research to find out what is what and guess what? Nobody knows! There are a few theories, but there is almost zero research. How do you study something that appears only randomly? More importantly, where is the profit in researching something that is seen as just a bother, and not a life-threatening disease – at least most of the time? I say this because there are nasty diseases that count cramps as a symptom, particularly cramps that come on and don’t let go. There are types of cancer that can trigger cramps as well as vascular disease conditions where blood flow is restricted creating poor oxygen to the muscles that will then trigger cramps that get worse when you try to use the muscles. When you have these persistent types of cramps, then it is time for a visit to the doctor to get things checked out. Typically this amounts to an ultrasound of the tissues involved.

Another common cause of leg/foot cramps is medication. The biggest offender is statin drugs. If you get cramps from your statin cholesterol drugs, let your doctor know as this is an indication you need to stop taking the drugs. This includes Lipitor, Crestor, Zocor, Livalo, and Altoprev. Next on our list are osteoporosis drugs like Forteo and Evista. Synthetic estrogen medications also like to create leg cramps. Less common, but still in the running, are the non-steroidal anti-inflammatory drugs like Naproxen, Celebrex, and Ibuprofen. Calcium channel blocker heart medications also can trigger cramps as it is calcium that initiates muscle contraction everywhere in the body and these heart drugs affect the entire body, not just the heart. I am not saying to stop taking medications, but if you are getting cramps from your meds, talk to your doctor about possibly switching to a different medication. On the opposite side of the equation, the medication quinine has traditionally been used to fight leg cramps, but it has a bunch of other nasty side effects.

In the scientific literature, there are two main theories regarding the common causes of typical leg cramps. There is the electrolyte crowd and the neurogenic crowd. Both of these are attempts to explain nighttime leg cramps based on clinical conditions that will cause leg cramps at times. If a hospital patient has a kidney problem that causes their electrolyte levels to drop out of the proper range, this can trigger muscle cramps anywhere in the body. You hear the advice all the time from well-meaning folks who say to increase your electrolytes if you get nighttime leg cramps. The problem with this story is that folks who get frequent leg cramps and get their blood levels of electrolytes checked have no issues with low electrolytes. Electrolyte imbalances produce a whole list of symptoms besides leg cramps, which we folks with common nighttime leg cramps do not have. This same electrolyte theory has a stepchild theory blaming dehydration as the cause of leg cramps. This is just the electrolyte theory dressed in different clothes. Too much water can also induce muscle cramps.

The other big alternate theory says that nerve irritation is the trigger for leg cramps. The problem here is that nerve irritation generally decreases at night. A nerve irritation cause should create cramps anytime. This is also true of the electrolyte theory. Nerve irritation should also respond to anti-inflammatory meds or painkillers, and these don’t seem to have any effect on leg cramping. There may still be some truth to this theory but via a different neurological pathway which I will suggest in a minute.

One recent study that offers some help is stretching the involved muscles several times during the day. This reduces the frequency and intensity of the cramps. This study was done on a group of patients over the age of 60; the most common group of folks who experience leg cramps. Here is a nice video showing these stretches.  How to Stop Leg Cramps at Night (for 50+)  These are very simple to do and deal with the most common muscles involved: the calves, hamstrings, and quads. Personally, these are not the muscles that bite me. For me, it is either the inner thigh or the arch of my foot. Another study has found that vitamin K2 reduces cramps.

What I do when a leg cramp strikes is first gently move the leg or foot around to try to find the spot where it hurts the least. If I pause at that spot for a minute or two, the cramp will often let go. If not then I hobble into the kitchen for an old home remedy – vinegar. I first learned of this from a patient who brought me a bottle of Old Amish Muscle Tonic. I gave it a try and by golly, it worked! The cramp went away in about a minute after taking this tonic. It contains apple cider vinegar, ginger, and garlic. Eventually, I emptied the bottle. Rather than just buying more I decided to try just the apple cider vinegar, and that worked as well. Just to be curious, I then tried plum vinegar and that also worked. I like the taste of plum vinegar better. I put about a tablespoon of vinegar in a quarter cup of water along with a couple drops of stevia liquid and this has become my nighttime cramp remedy.

So why does this work? It has nothing to do with the vinegar getting into the system and doing something to the blood or electrolytes. That takes at least 30 to 60 minutes to happen. This works in one minute! The idea I came up with which I have since heard repeated by other therapists is that the cramp is caused by a brain glitch in the signals to the muscles and the intense sour taste of the vinegar somehow resets this brain scramble. I experience every day how tiny stimuli to the nervous system can reset muscle balance in my patients. So I figured this reaction to vinegar worked along the same lines. There is no objective research data to confirm this, so it is just my hypothesis. Being practical, I am more interested in results anyway. So give this remedy a try and see if it works for you.

David

 

Ellen

Ellen and I did something completely new for Thanksgiving – we went out to a restaurant! Susie gave us the idea and we gave it a try. No two days of cooking, no house cleaning, no massive dish washing Thanksgiving evening. Dinner was delicious and we enjoyed ourselves thoroughly.

Melatonin? When and how much?