Calf cramps: Causes and treatment

Brief overview

  • Description: Calf cramps are sudden, short, involuntary and painful contractions of a muscle part, a whole muscle or a muscle group in the calf.
  • Causes: usually unknown or harmless (e.g., severe muscle tension during exercise, severe water and salt loss due to sweating, etc.). More rarely, calf cramps are signs of a disease (e.g., hypothyroidism, diabetes, kidney weakness, varicose veins) or side effect of medication.
  • What helps against cramps in acute cases? Stretching, gentle massage, heat applications
  • Prevention: e.g. regular training, gentle stretching (before sports and bedtime), drinking enough, magnesium-rich diet, taking magnesium supplements if necessary, avoiding nicotine, caffeine and stimulants such as ephedrine

Calf cramps: Description

Muscle cramps mostly occur in the legs and here preferably in the calf. Calf cramps are therefore the most common and probably also the best-known form of muscle cramp.

Muscle spasms, i.e. painless cramps of the muscles, are to be distinguished from muscle cramps. Also to be distinguished are fasciculations – visible, irregular and involuntary twitching of muscle fiber bundles without movement effect (e.g. twitching eyelid). They are not painful, but often unpleasant.

Calf cramps and other muscle spasms occur especially at night and are not uncommon. Almost everyone has a muscle cramp now and then. For example, over 90 percent of young adults report occasional cramps. Then, as people age, muscle cramps become more frequent: 33 to 50 percent of people over age 65 have a cramp regularly (at least once a week).

Calf cramps: Causes

Basically, calf cramps and other muscle spasms are divided into three categories by medical experts, depending on their origin:

  1. Paraphysiological cramps: Occasional cramps during pregnancy and after physical exertion, usually caused by a disturbance in the electrolyte and water balance – for example as a result of heavy sweating.
  2. Symptomatic cramps: They are accompanying symptoms of diseases, such as disorders in the nervous system, muscles or metabolism. Medications can also cause muscle cramps (such as calf cramps) as a side effect.

Calf cramp usually harmless

Less commonly, calf cramps are a symptom of a serious condition (e.g., hormonal or metabolic disorders, vascular disease, kidney disease) or a side effect of medication.

Below is more detailed information on possible causes of calf and other muscle cramps.

Disturbances of the electrolyte and water balance

Dehydration

Magnesium deficiency

A magnesium deficiency (hypomagnesemia) can also cause calf cramps or muscle spasms. An undersupply of the mineral can result, for example, from an unbalanced diet or diets, diabetes mellitus, alcoholism or intestinal and kidney diseases. A deficiency also often develops during pregnancy, when there is an increased need for magnesium.

Other electrolyte disorders

Potassium deficiency (hypokalemia) and calcium deficiency (hypocalcemia) are also among the possible causes of muscle spasm:

Disorders of hormone balance and metabolism

Various hormonal and metabolic disorders can cause symptomatic muscle cramps if they upset water and electrolyte balance. Examples:

  • Hypothyroidism: common signs of hypothyroidism include poor performance and concentration, rapid fatigue, and memory problems. In addition, the muscles tend to cramp.
  • Diabetes mellitus: Initial symptoms are increased urination and a strong feeling of thirst. Muscle cramps (such as calf cramps) can be caused here initially by electrolyte disturbances, later they can be the result of diabetic nerve damage (polyneuropathy).
  • Kidney diseases: The kidneys play the central role in regulating fluid balance. Weakness of the kidneys or even kidney failure can therefore trigger cramps, among other things.

Musculoskeletal disorders

Now and then, symptomatic muscle cramps are the result of muscle diseases (myopathies). These rare disorders may be congenital or acquired and are typically associated with muscle weakness. Sometimes, cramping muscle pain also occurs.

Nervous disorders

Neurological disorders and diseases that may be associated with symptomatic muscle spasms include:

  • Motor neuron diseases: These are diseases that progressively destroy nerve cells that stimulate muscle movement. The most common form is amyotrophic lateral sclerosis. Its symptoms include muscle weakness, muscle atrophy and muscle spasms.
  • Radiculopathies: These are diseases of the nerve roots (in the area of the spine), for example triggered by a herniated disc. For example, nerves that control the leg muscles can be affected, which can result in muscle cramps (such as calf cramps), among other things.

Vascular diseases

Medications and stimulants

There are a number of medications that can cause muscle spasms. These include:

  • Certain high blood pressure medications: Angiotensin II receptor blockers (AT1 antagonists) and some beta blockers.
  • Bronchodilators used to treat asthma, e.g., salbutamol
  • Cisplatin and vincristine (cancer drugs)
  • Lovastatin (drugs to treat elevated blood lipid levels)
  • Diuretics (diuretic, dehydrating drugs)
  • Tolcapone (drug against Parkinson’s disease)
  • Contraceptive pill (“birth control pill”)
  • Pyrazinamide (anti-tuberculosis drug)
  • Raloxifene (used to prevent and treat osteoporosis)
  • Teriparatide (for the treatment of osteoporosis)

Various stimulants (such as amphetamines, cocaine, caffeine, nicotine, ephedrine, and pseudoephedrine) can also cause muscle cramps.

Calf cramps: treatment and first aid

If cramps are a drug side effect, the doctor will prescribe an alternative drug if possible.

First aid for acute muscle cramps

Stretching

In acute cases (e.g., muscle cramp during sports or nighttime calf cramp), it usually helps to stretch the painful, cramping muscle – this can often stop the cramp.

If, on the other hand, you have a cramp in the thigh at the front, the stretching goes as follows: Stand up straight, grab the foot of the leg in question and pull it toward your butt – until you feel the stretch at the front of your thigh. If this one-leg stand is too wobbly for you, you can hold onto the wall or a chair with your other hand.

Gentle massage

Heat

Warm compresses and hot baths also have a relaxing effect on cramped muscles – or a hot water bottle can be placed on the aching muscles.

By the way: conventional painkillers such as acetylsalicylic acid (ASA) or paracetamol do not help against muscle cramps.

Calf cramps: When to see a doctor?

Calf cramps and other muscle spasms that occur only occasionally are usually harmless. However, be sure to see a doctor if the painful cramps are

  • occur more frequently,
  • do not go away on their own or with stretching and gentle massage and/or
  • Are accompanied by other symptoms such as nausea, numbness, tingling, or limited range of motion.

Your first point of contact in such cases is your family doctor. He can refer you to a specialist if necessary.

Calf cramps: examinations & diagnosis

  • Where do the cramps occur?
  • When and how often do you have the cramps?
  • Approximately how long does a single cramp last?
  • Are there specific situations or events that may trigger your cramps?
  • Do you have any other symptoms (e.g., muscle weakness, numbness, diarrhea, sensitivity to cold, weight gain, etc.)?
  • How about your alcohol consumption?
  • Are you using any medications? If so, which ones?
  • Do you have any pre-existing medical conditions?

A physical examination gives the doctor an indication of your general health. He may palpate under muscles and joints and test muscle reflexes. In addition, he will look for abnormalities that may indicate the cause of the muscle cramps (e.g. dry skin and mucous membranes as well as standing skin folds in case of dehydration or swollen face, dull hair and hair loss in case of hypothyroidism).

  • Measurement of electrical muscle activity (electromyography): This can be used to check whether a muscle disease or nerve disorder is present.
  • Measurement of nerve conductivity (electroneurography): This allows the doctor to test the functionality of peripheral nerves and detect any nerve damage.

Further examinations

In some cases, a muscle biopsy is also necessary to confirm or exclude a (suspected) cause of muscle spasms. This is necessary, for example, in amyotrophic lateral sclerosis.

Differentiation of other disorders

What the physician must consider in his examinations: Painful muscle contractions of other origin as well as symptoms that resemble muscle cramps must be differentiated from systemic muscle cramps. These include, for example:

  • Tetany: The term refers to the continuous or periodic cramping of muscles throughout the body. Thus, these spasms are much more extensive and prolonged than normal muscle spasms. In addition, they are often accompanied by repeated short muscle twitches. Triggers of tetany include rickets, chronic kidney failure, pancreatitis, traumatic brain injury, and vomiting. Sometimes the cause of tetany remains unknown (idiopathic tetany).
  • Stiff Man Syndrome (Stiff Person Syndrome): This is a rare neurological disorder associated with slowly increasing muscle stiffness in the trunk and limbs and painful shooting cramps.
  • Muscular ischemia: Patients with “smoker’s leg” (peripheral arterial occlusive disease, pAVK) may experience calf pain during physical exertion because the calf muscles are not supplied with enough blood (reduced blood flow = ischemia). This may feel like a calf cramp, but it is not (no muscle contraction!).

Calf cramps: Prevention

The following tips can help prevent occasional calf cramps (and other muscle cramps), such as those caused by exercise or lack of fluids and electrolytes:

  • gentle stretching: Gentle stretching before exercise as well as before bed makes muscles and tendons more flexible. This reduces the likelihood that they will contract involuntarily (during or after exercise or while sleeping).
  • No exercise after eating: You should not exercise immediately after eating.
  • Avoiding caffeine and nicotine
  • Avoidance of stimulants: If possible, you should also avoid stimulants such as ephedrine and pseudoephedrine (such as those contained in decongestant cold remedies).
  • correct footwear: Sometimes incorrect footwear (e.g. high-heeled pumps) or a foot malposition such as splayfoot or flatfoot is the reason for muscle cramps (e.g. foot cramps or calf cramps). Then the appropriate shoes and if necessary insoles help.