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Abola MTB, Evans NS, Ratchford EV. Vascular Disease Patient Information Page: Leg cramps. Vasc Med 2022; 27:415-417. [PMID: 35411834 DOI: 10.1177/1358863x221088869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Maria Teresa B Abola
- Clinical Research Department, Philippine Heart Center, University of the Philippines College of Medicine, Quezon City, Metro Manila, Philippines
| | - Natalie S Evans
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Elizabeth V Ratchford
- Johns Hopkins Center for Vascular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hawke F, Sadler SG, Katzberg HD, Pourkazemi F, Chuter V, Burns J. Non-drug therapies for the secondary prevention of lower limb muscle cramps. Cochrane Database Syst Rev 2021; 5:CD008496. [PMID: 33998664 PMCID: PMC8127570 DOI: 10.1002/14651858.cd008496.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Lower limb muscle cramps are common and painful. They can limit exercise participation, and reduce quality of sleep, and quality of life. Many interventions are available for lower limb cramps; some are controversial or could cause harm, and often, people experience no benefit from the interventions used. This is an update of a Cochrane Review first published in 2012. We updated the review to incorporate new evidence. OBJECTIVES To assess the effects of non-drug, non-invasive therapies for lower limb muscle cramps. SEARCH METHODS In August 2018 and May 2020, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and reference lists of included studies. We imposed no restrictions by language or publication date. SELECTION CRITERIA We included all randomised controlled trials (RCTs) of non-drug, non-invasive interventions tested over at least four weeks, for lower limb muscle cramps in any group of people, except pregnant women. The primary outcome was cramp frequency. Secondary outcomes were cramp pain severity, cramp duration, health-related quality of life, quality of sleep, participation in activities of daily living, proportion of participants reporting lower limb muscle cramps, and adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed risk of bias, and cross-checked data extraction and analyses according to standard Cochrane procedures. MAIN RESULTS We included three trials, with 201 participants, all 50 years of age and older; none had neurological disease. All trials evaluated a form of stretching for lower limb muscle cramps. A combination of daily calf and hamstring stretching for six weeks may reduce the severity of night-time lower limb muscle cramps (measured on a 10 cm visual analogue scale (VAS) where 0 = no pain and 10 cm = worst pain imaginable) in people aged 55 years and older, compared to no intervention (mean difference (MD) -1.30, 95% confidence interval (CI) -1.74 to -0.86; 1 RCT, 80 participants; low-certainty evidence). The certainty of evidence was very low for cramp frequency (change in number of cramps per night from week zero to week six) comparing the stretching group and the no intervention group (MD -1.2, 95% CI -1.8 to -0.6; 80 participants; very low-certainty evidence). Calf stretching alone for 12 weeks may make little to no difference to the frequency of night-time lower limb muscle cramps in people aged 60 years and older (stretching group median number of cramps in the last four weeks (Md) 4, interquartile range (IQR) 8; N = 48; sham stretching group Md 3, IQR 7.63; N = 46) (U = 973.5, z = -0.995, P = 0.32, r = 0.10; 1 RCT, 94 participants; low-certainty evidence). This trial did not report cramp severity. The evidence is very uncertain about the effects of a combination of daily calf, quadriceps, and hamstring stretching on the frequency and severity of leg cramps in 50- to 60-year-old women with metabolic syndrome (N = 24). It was not possible to fully analyse the frequency data and the scale used to measure cramp severity is not validated. No study reported health-related quality of life, quality of sleep, or participation in activities of daily living. No participant in these three studies reported adverse events. The evidence for adverse events was of moderate certainty as the studies were too small to detect uncommon events. In two of the three studies, outcomes were at risk of recall bias, and tools used to measure outcomes were not validated. Due to limitations in study designs that led to risks of bias, and imprecise findings with wide CIs, we cannot be certain that findings of future studies will be similar to those presented in this review. AUTHORS' CONCLUSIONS A combination of daily calf and hamstring stretching for six weeks may reduce the severity of night-time lower limb muscle cramps in people aged 55 years and older, but the effect on cramp frequency is uncertain. Calf stretching alone compared to sham stretching for 12 weeks may make little or no difference to the frequency of night-time lower limb muscle cramps in people aged 60 years and older. The evidence is very uncertain about the effects of a combination of daily calf, quadriceps, and hamstring stretching on the frequency and severity of leg cramps in 50- to 60-year-old women with metabolic syndrome. Overall, use of unvalidated outcome measures and inconsistent diagnostic criteria make it difficult to compare the studies and apply findings to clinical practice. Given the prevalence and impact of lower limb muscle cramps, there is a pressing need to carefully evaluate many of the commonly recommended and emerging non-drug therapies in well-designed RCTs across all types of lower limb muscle cramps. A specific cramp outcome tool should be developed and validated for use in future research.
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Affiliation(s)
- Fiona Hawke
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, Australia
| | - Sean G Sadler
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, Australia
| | - Hans Dieter Katzberg
- Department of Neuromuscular Medicine, University of Toronto, Toronto General Hospital / UHN, Toronto, Canada
| | - Fereshteh Pourkazemi
- University of Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, Australia
| | - Vivienne Chuter
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, Australia
| | - Joshua Burns
- University of Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, Australia
- The Children's Hospital at Westmead, Sydney, Australia
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Garrison SR, Korownyk CS, Kolber MR, Allan GM, Musini VM, Sekhon RK, Dugré N. Magnesium for skeletal muscle cramps. Cochrane Database Syst Rev 2020; 9:CD009402. [PMID: 32956536 PMCID: PMC8094171 DOI: 10.1002/14651858.cd009402.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Skeletal muscle cramps are common and often occur in association with pregnancy, advanced age, exercise or motor neuron disorders (such as amyotrophic lateral sclerosis). Typically, such cramps have no obvious underlying pathology, and so are termed idiopathic. Magnesium supplements are marketed for the prophylaxis of cramps but the efficacy of magnesium for this purpose remains unclear. This is an update of a Cochrane Review first published in 2012, and performed to identify and incorporate more recent studies. OBJECTIVES To assess the effects of magnesium supplementation compared to no treatment, placebo control or other cramp therapies in people with skeletal muscle cramps. SEARCH METHODS: On 9 September 2019, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, CINAHL Plus, AMED, and SPORTDiscus. We also searched WHO-ICTRP and ClinicalTrials.gov for registered trials that might be ongoing or unpublished, and ISI Web of Science for studies citing the studies included in this review. SELECTION CRITERIA Randomized controlled trials (RCTs) of magnesium supplementation (in any form) to prevent skeletal muscle cramps in any patient group (i.e. all clinical presentations of cramp). We considered comparisons of magnesium with no treatment, placebo control, or other therapy. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion and extracted data. Two review authors assessed risk of bias. We attempted to contact all study authors when questions arose and obtained participant-level data for four of the included trials, one of which was unpublished. We collected all data on adverse effects from the included RCTs. MAIN RESULTS We identified 11 trials (nine parallel-group, two cross-over) enrolling a total of 735 individuals, amongst whom 118 cross-over participants additionally served as their own controls. Five trials enrolled women with pregnancy-associated leg cramps (408 participants) and five trials enrolled people with idiopathic cramps (271 participants, with 118 additionally crossed over to control). Another study enrolled 29 people with liver cirrhosis, only some of whom suffered muscle cramps. All trials provided magnesium as an oral supplement, except for one trial which provided magnesium as a series of slow intravenous infusions. Nine trials compared magnesium to placebo, one trial compared magnesium to no treatment, calcium carbonate or vitamin B, and another trial compared magnesium to vitamin E or calcium. We judged the single trial in people with liver cirrhosis and all five trials in participants with pregnancy-associated leg cramps to be at high risk of bias. In contrast, we rated the risk of bias high in only one of five trials in participants with idiopathic rest cramps. For idiopathic cramps, largely in older adults (mean age 61.6 to 69.3 years) presumed to have nocturnal leg cramps (the commonest presentation), differences in measures of cramp frequency when comparing magnesium to placebo were small, not statistically significant, and showed minimal heterogeneity (I² = 0% to 12%). This includes the primary endpoint, percentage change from baseline in the number of cramps per week at four weeks (mean difference (MD) -9.59%, 95% confidence interval (CI) -23.14% to 3.97%; 3 studies, 177 participants; moderate-certainty evidence); and the difference in the number of cramps per week at four weeks (MD -0.18 cramps/week, 95% CI -0.84 to 0.49; 5 studies, 307 participants; moderate-certainty evidence). The percentage of individuals experiencing a 25% or better reduction in cramp rate from baseline was also no different (RR 1.04, 95% CI 0.84 to 1.29; 3 studies, 177 participants; high-certainty evidence). Similarly, no statistically significant difference was found at four weeks in measures of cramp intensity or cramp duration. This includes the number of participants rating their cramps as moderate or severe at four weeks (RR 1.33, 95% CI 0.81 to 2.21; 2 studies, 91 participants; moderate-certainty evidence); and the percentage of participants with the majority of cramp durations of one minute or more at four weeks (RR 1.83, 95% CI 0.74 to 4.53, 1 study, 46 participants; low-certainty evidence). We were unable to perform meta-analysis for trials of pregnancy-associated leg cramps. The single study comparing magnesium to no treatment failed to find statistically significant benefit on a three-point ordinal scale of overall treatment efficacy. Of the three trials comparing magnesium to placebo, one found no benefit on frequency or intensity measures, another found benefit for both, and a third reported inconsistent results for frequency that could not be reconciled. The single study in people with liver cirrhosis was small and had limited reporting of cramps, but found no difference in terms of cramp frequency or cramp intensity. Our analysis of adverse events pooled all studies, regardless of the setting in which cramps occurred. Major adverse events (occurring in 2 out of 72 magnesium recipients and 3 out of 68 placebo recipients), and withdrawals due to adverse events, were not significantly different from placebo. However, in the four studies for which it could be determined, more participants experienced minor adverse events in the magnesium group than in the placebo group (RR 1.51, 95% CI 0.98 to 2.33; 4 studies, 254 participants; low-certainty evidence). Overall, oral magnesium was associated with mostly gastrointestinal adverse events (e.g. diarrhoea), experienced by 11% (10% in control) to 37% (14% in control) of participants. AUTHORS' CONCLUSIONS It is unlikely that magnesium supplementation provides clinically meaningful cramp prophylaxis to older adults experiencing skeletal muscle cramps. In contrast, for those experiencing pregnancy-associated rest cramps the literature is conflicting and further research in this population is needed. We found no RCTs evaluating magnesium for exercise-associated muscle cramps or disease-state-associated muscle cramps (for example amyotrophic lateral sclerosis/motor neuron disease) other than a single small (inconclusive) study in people with liver cirrhosis, only some of whom suffered cramps.
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Affiliation(s)
- Scott R Garrison
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | | | - Michael R Kolber
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - G Michael Allan
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Vijaya M Musini
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Ravneet K Sekhon
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Nicolas Dugré
- Department of Pharmacy, University of Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Canada
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Lorenzo M, Schaeffer M, Haller DM, Maisonneuve H. Treatment of nocturnal leg cramps by primary care patients over the age of 60. Fam Pract 2018; 35:29-33. [PMID: 28985304 DOI: 10.1093/fampra/cmx062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Approximately one out of two individuals over the age of 60 suffers from nocturnal leg cramps. These often have an important impact on the person's quality of life. Different drug and non-drug treatments are proposed to treat these cramps, but none to date have been shown to be both safe and effective. The objective of this study was to describe the drug and non-drug treatments used by primary care patients suffering from cramps. METHODS We used data collected as part of two cross-sectional surveys of patients aged 60 years and older attending general practices in the French region of Alsace. We asked the participants suffering from cramps if they were currently using a treatment for their cramps. We distinguished potentially harmful from unharmful treatments. RESULTS Overall, 632 patients suffering from cramps were included in our study. Only 133 patients (19.5%) were taking a treatment for cramps. 82 patients used one or several of 17 different drug treatments. 58 patients used one or several of 13 different types of non-drug treatments. Potentially harmful treatments, mostly Quinine made up 16,7% (n = 25) of all treatments used for cramps. CONCLUSIONS This study sheds light on the great diversity of therapeutic practices for cramps in outpatient care. Many of the treatments reported by patients have not previously been described in the medical literature. We recommend GPs to ask their patients about the treatments they take for cramps in order to make sure that they are safe.
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Affiliation(s)
- Mathieu Lorenzo
- Department of General Practice, Faculty of Medicine, University of Strasbourg, Strasbourg, France - Clinical Investigation Unit INSERM - CIC 1434, Strasbourg, France
| | - Mickaël Schaeffer
- Public Health Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Dagmar M Haller
- Primary care unit, University of Geneva, Geneva, Switzerland
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Behringer M, Harmsen JF, Fasse A, Mester J. Effects of Neuromuscular Electrical Stimulation on the Frequency of Skeletal Muscle Cramps: A Prospective Controlled Clinical Trial. Neuromodulation 2017; 21:815-822. [PMID: 29164749 DOI: 10.1111/ner.12728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 09/14/2017] [Accepted: 10/03/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We investigated if neuromuscular electrical stimulation (NMES) of calf muscles prevents spontaneous calf cramps. MATERIALS AND METHODS In 19 individuals affected by more than or equal to one calf cramp per week the gastrocnemius of the predominantly affected leg was stimulated twice a week (intervention leg, IL) over six weeks (3 × 6 stimulation trains at 30 Hz above the individual cramp threshold frequency). The other leg served as control (CL). The participants were advised to record all spontaneous muscle cramps from two weeks before the intervention until two weeks after the last NMES session. RESULTS The number of spontaneous calf cramps in the two weeks after the intervention was 78% lower (2.1 ± 6.8 cramps) in the stimulated (p < 0.001) and 63% lower (2.0 ± 6.9 cramps) in the unstimulated calves (p < 0.001), when compared to the two weeks prior to the intervention (IL: 9.6 ± 12.4 cramps; CL: 5.5 ± 12.7 cramps). Only in the IL, this improvement was accompanied by an increase in the cramp threshold frequency from 15.5 ± 8.5 Hz before the NMES intervention to 21.7 ± 12.4 Hz after the intervention. The severity of the remaining calf cramps tended to be lower in both legs after the intervention. CONCLUSIONS The applied stimulation protocol seems to provide an effective prevention strategy in individuals affected by regular calf cramps.
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Affiliation(s)
- Michael Behringer
- Institute of Sports Sciences, Goethe University Frankfurt, Frankfurt, Germany
| | - Jan-Frieder Harmsen
- German Research Center for Elite Sports-momentum, German Sport University Cologne, Cologne, Germany
| | | | - Joachim Mester
- German Research Center for Elite Sports-momentum, German Sport University Cologne, Cologne, Germany
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Miller KC, Harsen JD, Long BC. Prophylactic stretching does not reduce cramp susceptibility. Muscle Nerve 2017; 57:473-477. [PMID: 28796278 DOI: 10.1002/mus.25762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 07/22/2017] [Accepted: 08/05/2017] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Some clinicians advocate stretching to prevent muscle cramps. It is unknown whether static or proprioceptive neuromuscular facilitation (PNF) stretching increases cramp threshold frequency (TFc ), a quantitative measure of cramp susceptibility. METHODS Fifteen individuals completed this randomized, counterbalanced, cross-over study. We measured passive hallux range of motion (ROM) and then performed 3 minutes of either static stretching, PNF stretching (hold-relax-with agonist contraction), or no stretching. ROM was reassessed and TFc was measured. RESULTS PNF stretching increased hallux extension (pre-PNF 81 ± 11°, post-PNF 90 ± 10°; P < 0.05) but not hallux flexion (pre-PNF 40 ± 7°, post-PNF 40 ± 7°; P > 0.05). Static stretching increased hallux extension (pre-static 80 ± 11°, post-static 88 ± 9°; P < 0.05) but not hallux flexion (pre-static 38 ± 9°, post-static 39 ± 8°; P > 0.05). No ROM changes occurred with no stretching (P > 0.05). TFc was unaffected by stretching (no stretching 18 ± 7 Hz, PNF 16 ± 4 Hz, static 16 ± 5 Hz; P = 0.37). DISCUSSION Static and PNF stretching increased hallux extension, but neither increased TFc . Acute stretching may not prevent muscle cramping. Muscle Nerve 57: 473-477, 2018.
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Affiliation(s)
- Kevin C Miller
- School of Rehabilitation and Medical Sciences, Central Michigan University, 1208 Health Professions Building, Mount Pleasant, Michigan, 48859, USA
| | - James D Harsen
- School of Rehabilitation and Medical Sciences, Central Michigan University, 1208 Health Professions Building, Mount Pleasant, Michigan, 48859, USA
| | - Blaine C Long
- School of Rehabilitation and Medical Sciences, Central Michigan University, 1208 Health Professions Building, Mount Pleasant, Michigan, 48859, USA
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Park SJ, Yoon KB, Yoon DM, Kim SH. Botulinum Toxin Treatment for Nocturnal Calf Cramps in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. Arch Phys Med Rehabil 2017; 98:957-963. [DOI: 10.1016/j.apmr.2017.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/17/2016] [Accepted: 01/12/2017] [Indexed: 11/26/2022]
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Rabbitt L, Mulkerrin EC, O'Keeffe ST. A review of nocturnal leg cramps in older people. Age Ageing 2016; 45:776-782. [PMID: 27515677 DOI: 10.1093/ageing/afw139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/27/2016] [Indexed: 11/13/2022] Open
Abstract
Nocturnal leg cramps are common and troublesome, especially in later life, and have a significant impact on quality of life, particularly sleep quality. This article reviews the current state of knowledge regarding the diagnosis, frequency, pathophysiology and management of cramps. Recent evidence suggests that diuretic and long-acting beta-agonist therapy predispose to leg cramps. There is conflicting evidence regarding the efficacy of prophylactic stretching exercises in preventing cramps. Quinine remains the only medication proven to reduce the frequency and intensity of leg cramps. However, the degree of benefit from quinine is modest and the risks include rare but serious immune-mediated reactions and, especially in older people, dose-related side effects. Quinine treatment should be restricted to those with severe symptoms, should be subject to regular review and requires discussion of the risks and benefits with patients.
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Affiliation(s)
- Louise Rabbitt
- Geriatric Medicine, Galway University Hospitals , Galway, Ireland
| | | | - Shaun T O'Keeffe
- Unit 4, Geriatric Medicine, Merlin Park Regional Hospital, Merlin Park Hospital, Galway, Ireland
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Behringer M, Spieth V, Montag JCK, Willwacher S, McCourt ML, Mester J. Cramp Training Induces a Long-Lasting Increase of the Cramp Threshold Frequency in Healthy Subjects. Neuromodulation 2016; 21:809-814. [PMID: 27641444 DOI: 10.1111/ner.12525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/03/2016] [Accepted: 08/14/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A low cramp threshold frequency (CTF) is associated with an increased cramp susceptibility. Recent data indicate that the CTF can be substantially increased by a cramp training consisting of electrically induced muscle cramps (EIMCs). This study investigated if four cramp training sessions induce sustained effects on the CTF. METHODS In ten healthy male subjects, EIMCs were induced in the gastrocnemius medialis of one leg (intervention leg, IL) twice a week, while the opposite leg served as control leg (CL). The stimulation protocol consisted of three sets of six bipolar rectangular wave pulsed currents (5 sec on, 10 sec off) at 30 Hz above the individual CTF. RESULTS After four cramp training sessions (2 weeks) the CTF differed (p < 0.001) from pre-values in the IL (pre: 19.2 ± 1.4 Hz post 29.8 ± 8.0 Hz) but not in the CL (pre: 18.2 ± 1.5 Hz post 19.6 ± 2.8 Hz; p > 0.05). Thereafter, the CTF remained elevated in the IL for 22 days (22 days post: 22.2 ± 3.2 Hz; p < 0.05) when compared to pre and was significantly (p < 0.05) higher than that of the CL 5, 10, and 14 days after the intervention. CONCLUSION The applied cramp training induced a long-term CTF increase of 14 days.
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Affiliation(s)
- Michael Behringer
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany.,German Research Center of Elite Sports (momentum), German Sport University Cologne, Cologne, Germany
| | - Volker Spieth
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Johannes Caspar Konrad Montag
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany.,German Research Center of Elite Sports (momentum), German Sport University Cologne, Cologne, Germany
| | - Steffen Willwacher
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Molly Leigh McCourt
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Joachim Mester
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany.,German Research Center of Elite Sports (momentum), German Sport University Cologne, Cologne, Germany
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Behringer M, Link TW, Montag JCK, McCourt ML, Mester J. Are Electrically Induced Muscle Cramps Able to Increase the Cramp Threshold Frequency, When Induced Once a Week? Orthop Rev (Pavia) 2015; 7:6028. [PMID: 26605029 PMCID: PMC4592932 DOI: 10.4081/or.2015.6028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/28/2015] [Indexed: 11/23/2022] Open
Abstract
The cramp threshold frequency (CTF) is known to be positively correlated with the individual cramp susceptibility. Here we assessed CTF changes after two bouts of electrically induced muscle cramps (EIMCs). The EIMCs (6×5 sec) were unilaterally induced twice (separated by one week) in the gastrocnemius of an intervention group (n=8), while 5 participants served as control. The CTF increased from 25.1±4.6 Hz at baseline to 31.4±9.0 Hz and 31.7±8.5 Hz 24 h after bout 1 and 2 (P<0.05). Thereafter, the CTF declined following both bouts to reach values of 28.0±6.7 Hz and 29.1±7.7 Hz after 72 h after bout 1 and 2. Creatine kinase (CK) activity and perceived discomfort during cramps was lower after bout 2 (P<0.05). CTF, CK, and discomfort did not change in CG. That is, a single bout of EIMCs induces a 24 h CTF increment and a second bout sustains this effect, while perceived discomfort and muscle damage decreases. This short term effect may help athletes to reduce the cramp susceptibility for an important match.
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Affiliation(s)
- Michael Behringer
- Institute for Training Science and Sport Informatics, German Sport University of Cologne , Germany
| | - Tobias Walter Link
- Institute for Training Science and Sport Informatics, German Sport University of Cologne , Germany
| | | | - Molly Leigh McCourt
- Institute for Training Science and Sport Informatics, German Sport University of Cologne , Germany
| | - Joachim Mester
- Institute for Training Science and Sport Informatics, German Sport University of Cologne , Germany
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Garrison SR. Prophylactic stretching is unlikely to prevent nocturnal leg cramps. J Physiother 2014; 60:174. [PMID: 25132650 DOI: 10.1016/j.jphys.2014.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 05/06/2014] [Indexed: 11/25/2022] Open
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Hallegraeff JM, de Greef MH, van der Schans CP. A clear definition of nocturnal leg cramps is essential for comparability of research. J Physiother 2014; 60:174-5. [PMID: 25084635 DOI: 10.1016/j.jphys.2014.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/26/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Mathieu H de Greef
- Hanze University of Applied Sciences; University Medical Center Groningen, The Netherlands
| | - Cees P van der Schans
- Hanze University of Applied Sciences; University Medical Center Groningen, The Netherlands
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Vidot H, Carey S, Allman-Farinelli M, Shackel N. Systematic review: the treatment of muscle cramps in patients with cirrhosis. Aliment Pharmacol Ther 2014; 40:221-32. [PMID: 24942957 DOI: 10.1111/apt.12827] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 01/20/2014] [Accepted: 05/19/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Up to 88% of patients with hepatic cirrhosis experience painful muscle cramps resulting in sleep deprivation and impaired quality of life. Management is often based on poor evidence with varying degrees of success in controlling the frequency and severity of muscle cramps in this group. AIM To review systematically the treatment options for muscle cramps in cirrhosis. METHODS A systematic review of the relevant databases to identify treatments for muscle cramps in patients with hepatic cirrhosis was performed. Studies meeting the selection criteria were reviewed and quality of the papers was rated using a validated quality rating scale. The results for each treatment are reported. RESULTS Eighteen publications were identified as eligible for inclusion in this systematic review. The majority (n = 15) of these were treatment/intervention reports. Only three randomised-control studies were identified. A wide range of treatments were identified including zinc, 1-α-hydroxy vitamin D, vitamin E, branched chain amino acids, taurine, l-carnitine, nuiche-shen-qi-wen, eperisone hydrochloride, intravenous albumin and quinidine. There were some reported improvements in muscle cramps with most interventions with the exception of vitamin E but the evidence predominantly relies on case study reports. There is a lack of randomised-controlled clinical studies to support using these interventions. CONCLUSIONS There appear to be a number of promising treatments for muscle cramps in cirrhosis. However, there remains a need for further double-blinded, randomised, controlled clinical investigations to support routine use of these interventions to treat muscle cramps in patients with hepatic cirrhosis.
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Affiliation(s)
- H Vidot
- Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, Australia; Centenary Institute, University of Sydney, Sydney, Australia
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Maxwell SK, Kokokyi S, Breiner A, Ebadi H, Bril V, Katzberg HD. Characteristics of muscle cramps in patients with polyneuropathy. Neuromuscul Disord 2014; 24:671-6. [PMID: 24878228 DOI: 10.1016/j.nmd.2014.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/04/2014] [Accepted: 04/24/2014] [Indexed: 11/17/2022]
Abstract
Muscle cramps are common in the general population and can be disabling for patients, but there is little evidence comprehensively evaluating cramp characteristics in patients with polyneuropathy. This study describes the prevalence and characteristics of muscle cramps in this patient group. Patients over 18 diagnosed with polyneuropathy were invited to join the study. Patients completed nerve conduction studies, the Toronto Clinical Neuropathy score, neuropathy-specific Vickrey's Quality of Life Assessment and a self-administered questionnaire examining demographics, neuropathy symptoms and cramp characteristics. Two hundred and twenty-five participants were enrolled (28.0% female). Sixty-three percent of patients experienced cramps, occurring on average 6 times per week, lasting 10.5 min and scoring 6 out of 10 on a pain scale and described as disabling by 43.6% of patients. No significant difference was found in cramp prevalence according to underlying pathophysiology (p = 0.52) or fiber type (p = 0.41). Patients with disabling cramps rated their physical (p < 0.0001) and mental (p = 0.04) quality of life lower than patients without disabling cramps. This study confirms that muscle cramps are common, disabling and associated with reduced quality of life in patients with polyneuropathy. Similar prevalence of cramps across predominant nerve fiber type suggests a role of sensory afferents in cramp generation, although this needs to be confirmed in larger cohorts.
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Affiliation(s)
- Sarah K Maxwell
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Seint Kokokyi
- Division of Neurology, University Health Network, Toronto, Ontario, Canada
| | - Ari Breiner
- Division of Neurology, University Health Network, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Hamid Ebadi
- Division of Neurology, University Health Network, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Vera Bril
- Division of Neurology, University Health Network, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Hans D Katzberg
- Division of Neurology, University Health Network, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
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Hawke F, Chuter V, Burns J. Impact of nocturnal calf cramping on quality of sleep and health-related quality of life. Qual Life Res 2013; 22:1281-6. [PMID: 23011494 DOI: 10.1007/s11136-012-0274-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2012] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate the impact of nocturnal calf cramping (a condition that affects one in two people over 60 years of age) on quality of sleep and health-related quality of life. METHODS Eighty adults who experienced nocturnal calf cramp at least once per week and eighty age- and sex-matched controls who never experienced nocturnal cramp were recruited from the Greater Newcastle and Central Coast regions of New South Wales, Australia. All participants completed the SF-36v2 and the Medical Outcomes Study Sleep Survey (MOS-SS). RESULTS People who experienced nocturnal muscle cramps reported more sleep disturbance (p < 0.001), less adequate sleep (p = 0.001), less quantity of sleep (p = 0.02) and more snoring (p = 0.03). Both sleep problem summary indices for the MOS-SS identified people who experienced nocturnal muscle cramp as having more sleep problems than the controls. People who experienced nocturnal muscle cramps had lower health-related quality of life for the SF-36 domains role physical (p = 0.007), bodily pain (p = 0.003) and general health (p = 0.02). SF-36 domains that primarily relate to mental health were not significantly different between groups. The impact of nocturnal calf cramps on health-related quality of life was largely explained by their negative impact on quality of sleep. CONCLUSIONS Nocturnal calf muscle cramps are associated with substantially reduced quality of sleep and reduced physical aspects of health-related quality of life.
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Affiliation(s)
- Fiona Hawke
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Westmead, NSW, Australia.
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Fat MJL, Kokokyi S, Katzberg HD. Neurologist practice patterns in treatment of muscle cramps in Canada. J Foot Ankle Res 2013; 6:2. [PMID: 23302663 PMCID: PMC3545839 DOI: 10.1186/1757-1146-6-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 12/18/2012] [Indexed: 11/10/2022] Open
Abstract
Recently an article provided patient perspectives on therapies and perceived effectiveness in preventing muscle cramps. However, there are few studies evaluating physicians’ point of view in the management of this common symptom. In our study, we studied physician practice patterns in the treatment of muscle cramps by surveying a group of neurologists in Canada. We demonstrated that most physicians use a combination of pharmacological and non-pharmacological methods in treating muscle cramps. The most commonly used medications are baclofen, quinine and gabapentin, of which baclofen and quinine were reported to be the most tolerated.
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Affiliation(s)
- Mary Jane Lim Fat
- Toronto General Hospital / University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
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