| A sudden, uncontrollable cramp (contraction) in a muscle is called a spasm. Muscle spasms can occur in any muscle but are most common in the calf and foot. “Charley horse” is a common term for muscle cramps or spasms that occur in the legs.
Common causes of muscle spasm include muscle fatigue, lack of proper stretching or muscle conditioning, which usually occurs during or following extensive exercise, wearing poorly fitted or elevated shoes, excessive sweating that causes dehydration, or a prolonged period of sitting, standing or lying in an uncomfortable position. Grasping writing instruments or household tools for prolonged periods can bring on muscle cramps in the hands and fingers. Muscle spasms often occur during pregnancy. Nearly everyone will experience muscle spasms during their lifetime, often associated with unusual physical exertion.
Low blood levels of potassium, calcium, or magnesium from inadequate dietary intake or excessive excretion can cause muscle spasms. Some medications (e.g., diuretics, corticosteroids, estrogens) can predispose or cause muscle spasms. Compression of nerves in the spine can produce muscle spasms and pain in the legs, as can narrowing of the arteries that supply the legs (arteriosclerosis). Muscle spasms may be signs of more serious neuromuscular disorders such as cerebral palsy (CP), multiple sclerosis (MS), or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). Infectious diseases that affect the nervous system such as poliomyelitis, rabies, and tetanus also can cause painful spasms. In some cases, muscle spasms may have no identifiable cause (idiopathic). |
Source: Medical Disability Advisor
| History: A thorough medical history should include details about the onset of muscle spasms, correlation with activity, their location, timing, aggravating and alleviating factors, any associated signs or symptoms (e.g., weakness, sensory loss, numbness), other medical conditions, medications, and occupation. The individual may experience contractions, sudden pain in a muscle, and symptoms that worsen with movement. The muscle contractions may come and go. The individual may report unusual physical exertion or prolonged sitting, standing, or reclining in an uncomfortable position prior to onset. Physical exam: Physical examination should begin with observation of the affected muscle(s) for any local, involuntary twitching (fasciculation) or visible contraction. Sometimes contraction of a muscle can cause abnormal postures. For example, muscle spasm in the neck (torticollis) can cause the head to turn to one side. Feeling the muscle with the fingers (palpation) may reveal a muscle or muscle group that feels firm or hard. The muscle and all major muscle groups should be checked for strength, tone, range of motion, and whether movement precipitates spasm. A thorough neurological exam including assessment of cranial nerves, sensation, and reflexes is important. Peripheral pulses, capillary refill, and presence of edema should be noted. Tests: Blood tests to determine the levels of sodium potassium, calcium, magnesium, as well as carbon dioxide may be indicated for persistent muscle cramps or in specific situations. Blood flow studies or arteriography may be indicated in some cases. Electromyography and nerve conduction studies may be helpful if a neurologic process is suspected. Additional testing is dictated by the specific circumstances of each case or to rule out certain medical conditions. |
Source: Medical Disability Advisor
| Modalities such as moist heat or ice packs may be applied to the area to help with pain relief. Oral pain relievers (analgesics) and muscle relaxants may be prescribed. Massage and gradual stretching of the muscle can be helpful. The individual may be advised to warm up muscles before exercising and to drink fluids before and during exercise. Persistent muscle spasms may be helped through electrical stimulation of nerves in affected areas (transcutaneous electric nerve stimulation [TENS]) (Aydin). In certain conditions, intractable muscle spasms caused by an underlying disease or disorder may be treated by surgery, radiofrequency, or injection of medication such as botulinum toxin to sever the connection between nerve and muscle and stop the spasms (Vanek). |
Source: Medical Disability Advisor
| In most cases, muscle spasms are relatively mild and will resolve within a few minutes. Any residual discomfort or soreness usually disappears within a day or two. There may be ongoing (chronic) muscle spasms with medical conditions such as multiple sclerosis, spastic cerebral palsy, and torticollis. |
Source: Medical Disability Advisor
| Note on research and authorship The primary focus of rehabilitation following a muscle spasm is to decrease pain and restore function. Since muscle spasms always occur secondary to an underlying condition or injury, it is important to understand the cause of the muscle spasms. Treatment will be based on the underlying etiology and the location of the spasms.
Often in combination with pharmacological treatment, modalities such as heat and cold can be used to control pain. When indicated, gentle stretching and strengthening exercises can be started and progressed as tolerated (Hou). A home program, including the use of modalities (heat, cold) can be taught for the individual to continue independently.
An ergonomic assessment may be beneficial if there is a possibility that work related tasks contributed to the current condition. |
| FREQUENCY OF REHABILITATION VISITS | | Nonsurgical | |
| Physical Therapist | | Up to 3 visits within 2 weeks | |
|
| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor
| Muscle tearing or other injury will complicate the treatment of cramps. |
Source: Medical Disability Advisor
| If the condition persists, activities requiring lifting or excessive physical exertion may be restricted. The individual may require progressive physical conditioning or may need to be reassigned to other tasks if an underlying disease is causing the spasms. If tasks require considerable physical endurance and exertion, plenty of fluids should be provided at the work site to prevent dehydration. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Did individual experience a sudden muscle spasm and pain following unusual or prolonged physical exertion?
-
Was muscle tension or favoring the affected muscle noted during the physical exam?
-
Were diagnostic tests done to rule out electrolyte imbalances or other conditions, such as muscle tears or strain, heat exhaustion, or ischemic claudication?
Regarding treatment:
- Was the individual treated appropriately?
-
Did the individual receive instruction regarding proper warm-up and cool down techniques before and after exercise to prevent recurrent spasm?
-
Has the individual been compliant with treatment recommendations?
Regarding prognosis:
- Did the condition resolve with appropriate relaxation and massage of the muscle, or has individual continued to experience spasms?
-
Has the individual been tested for a possible underlying disease or condition that may be causing the spasms?
-
Was the muscle spasm associated with any complications, such as muscle tearing or other injury to the affected area?
|
Source: Medical Disability Advisor
| Aydin, G., et al. "Transcutaneous Electrical Nerve Stimulation Versus Baclofen in Spasticity: Clinical and Electrophysiologic Comparison." American Journal of Physical Medicine and Rehabilitation 84 8 (2005): 584-592.Hou, C. R., et al. "Immediate Effects of Various Physical Therapeutic Modalities on Cervical Myofascial Pain and Trigger-Point Sensitivity." Archives of Physical and Medical Rehabilitation 83 10 (2002): 1406-1414. National Center for Biotechnology Information. National Library of Medicine. 12 Oct. 2008 <PMID: 12370877>. Vanek, Zeba, and John Menkes. "Spasticity." eMedicine. Eds. Joseph R. Carcione, et al. 29 Aug. 2007. Medscape. 13 Mar. 2009 <http://emedicine.medscape.com/article/1148826-overview>. |
Source: Medical Disability Advisor
| Feedback |
| Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must
include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment.
If you are seeking medical advice, please contact your physician. Thank you! |
Send this comment to:
Sales
Customer Support
Content Development
|
|
| |
|
|
|
|
|
This publication is designed to provide accurate and authoritative information in
regard to the subject matter covered. It is published with the understanding that
the author, editors, and publisher are not engaged in rendering medical, legal,
accounting or other professional service. If medical, legal, or other expert assistance
is required, the service of a competent professional should be sought. We are unable to respond to requests for advice.
Any Sales inquiries should include an email address or other means of
communication.
|