Muscle cramps: why they happen and how to relieve them

A cramp is when a muscle tightens without you trying to tighten it, and it doesn’t relax. The muscle feels hard or bulging and it hurts. According to MedlinePlus, the most common places are the back of the lower leg (the calf) and the back and front of the thigh; cramps also happen in the feet, hands, arms, belly and along the ribs.

They are very common and can usually be stopped by stretching the muscle.

According to MedlinePlus, cramps can come from:

• Overusing or injuring a muscle, for example during exercise
• Dehydration and low minerals such as sodium, potassium or calcium. In Puerto Rico’s heat, heavy sweating makes them more likely: see heat cramps and heat stroke and dehydration
• Medicines: diuretics (water pills) can lower potassium; cholesterol statins are among the medicines that rarely cause serious muscle damage
• An underactive thyroid: see hypothyroidism
• Kidney problems: see high creatinine
• Pregnancy and menstruation
• Heavy drinking

MedlinePlus recommends:

• Stopping the activity and stretching the muscle: for the calf, straighten your leg and pull your toes toward you
• Massaging the muscle
• Using heat when the cramp starts, and ice once the pain has improved
• If the muscle is still sore, an over-the-counter anti-inflammatory may help
• Drinking water; if you sweated a lot, a sports drink helps replace minerals

Many leg cramps strike at night and wake you with a hard, knotted calf. The causes are the same as above: a day of hard work or long hours on your feet, too little water, heavy sweating in the heat, or a medicine such as a diuretic.

When one hits, sit or stand, straighten your leg and pull your toes toward you until the muscle lets go, then massage it. To have fewer, drink enough water during the day and make calf stretches part of your routine. If cramps wake you several nights a week, an evaluation and a blood test are worth it.

To have fewer cramps, MedlinePlus advises exercising within your ability, drinking plenty of fluids while you exercise, eating foods with potassium (such as orange juice and bananas) and stretching to improve flexibility.

You see Dr. Diana Nieves Castro, a Puerto Rico-licensed general practice physician with several years of emergency-department experience, in English or Spanish. She asks when the cramps started, how long they last, how often they happen, which muscles, whether you have had vomiting, diarrhea or heavy sweating, whether you are pregnant, which medicines you take and whether you exercise hard or drink alcohol.

We evaluate, diagnose and treat. If the cramps are severe or keep coming back, we give you a lab order for a lab near you: electrolytes (potassium, calcium, magnesium), kidney function, thyroid and glucose. We check whether any of your medicines could be causing them. If appropriate, the doctor prescribes and we send your prescription to your pharmacy.

Quinine is not for cramps: according to MedlinePlus, it should not be used to treat or prevent nighttime leg cramps, because it has not been shown to work and can cause serious side effects.

Doctor online 24/7: if cramps wake you at night, video visits are available around the clock on your phone or computer. An online doctor visit has the same price for every age.

Go to the ER if you have:

• Calf pain that won’t go away, with a swollen, red or warm leg: it may be a blood clot, not a cramp. See swollen legs
• Severe muscle pain with dark urine (red or cola-colored) or passing little urine, especially after hard exercise, heat or a fall: it may be rhabdomyolysis, a muscle injury that damages the kidneys
• Cramps with confusion, very hot skin or fainting in the heat: it may be heat stroke, call 911