Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Muscle Spasm


Related Terms

  • "Charley Horse"
  • Muscle Cramp

Differential Diagnosis

  • Amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease)
  • Arterial occlusive disease
  • Chemical poisoning
  • Dehydration
  • Demyelinating disorders (e.g., multiple sclerosis)
  • Electrolyte imbalance (e.g., hypocalcemia, hypomagnesemia)
  • Fasciculation
  • Infectious diseases (e.g., polio, tetanus, rabies)
  • Medication usage (e.g., diuretics, corticosteroids, estrogens)
  • Muscle strain or tear
  • Rare metabolic diseases of the muscle
  • Respiratory alkalosis
  • Spinal injury or disease

Specialists

  • Internal Medicine Physician
  • Neurologist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Rheumatologist

Comorbid Conditions

Factors Influencing Duration

Individuals in poor physical condition may be more prone to experience muscle spasms associated with tasks requiring physical exertion such as lifting or straining. Muscles could be re-injured, lengthening disability time. For these individuals, a program of progressive physical conditioning is very important.

Medical Codes

ICD-9-CM:
724.8 - Other Symptoms Referable to Back; Ossification of Posterior Longitudinal Ligament NOS; Panniculitis Specified as Sacral or Affecting Back
728.85 - Muscle Spasm
729.82 - Cramp

Overview

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



Diagnosis

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



Treatment

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



Prognosis

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



Rehabilitation

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
SpecialistMuscle Spasm
Physical TherapistUp 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



Complications

Muscle tearing or other injury will complicate the treatment of cramps.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

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



Failure to Recover

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



References

Cited

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.