Introduction
Calf cramps are an annoying problem that affects men and women, young and old alike.
At their origin we find precise risk factors; we are talking about risk factors and not causes, as subjectivity seems to play a predominant role on the onset (gravity and frequency) of calf cramps.
Logically, the physio-pathological mechanisms remain the same for everyone, but not everyone seems to have the same importance.
Cramps
Definition of cramps
Muscle cramps (in English cramp or charley horse) are involuntary contractions of voluntary striated muscles, strong, painful and sudden, lasting between a few seconds and several minutes, which sometimes cause a real uncontrolled muscle shortening.
Cramps can arise in various situations due to different causes; some people are more subject than others.
Extremely painful and sometimes poorly controllable night cramps are particularly feared. The districts most affected by cramps are the lower limbs.
Anatomy
Legs: short anatomical reference
As anticipated, the lower limbs (composed respectively of the buttocks, thighs, legs and feet) are the districts most affected by cramps. It is quite common to mistake the identification of the muscles affected by this phenomenon, especially in the calf area (where the muscles are numerous and some are small or deeply located). Moreover, even the thighs but above all the legs are formed by a set of many specific muscles, of which most of us ignore the existence. Discussing cramps in the calves it is therefore necessary to make a brief anatomical reference to the muscles that make up the leg:
Legs: flexor and extensor muscles of the foot
- Leg flexors: gastrocnemius or twins, soleus, frail plantar, poplitealus, long flexor of the big toe, long flexor of the fingers
- Leg extensors: long finger extensor, long toe extender
- Adductors of the leg: tibialis anterior, tibialis posterior
- Abductors of the leg: anterior peroneal, long peroneal, short peroneal.
Calves
Calf muscles
Calf is a generic, aspecific and vulgar term, which indicates a particular area of the leg.
The calves, located in the posterior, lateral and medial part of the leg, contain most of the leg muscles.
Physiology
How and why do cramps occur?
A cramp is the involuntary contraction of voluntary striated muscles. To accurately explain the occurrence of cramps we should go through the final stages of neuro-muscular transmission. Being an interesting topic but perhaps a little difficult and complicated to summarize in a few lines, below we will limit ourselves to underline that, for the correct motor functioning, it is essential that:
- The intra- and extra-cellular fluids are in hydro-saline, therefore electric equilibrium
- Neurotransmitters, especially acetylcholine, freely exercise their function as messengers
- Cellular organelles, membrane channels, gap junctions and neuromotor plaques are not compromised.
Causes
Causes of cramps
When the cramps become frequent and intense, and occur mainly during the day, in the summer period and / or in the motor activity, we must suspect one or more of the following risk factors:
- Lack of one or more mineral salts:
- Potassium
- Magnesium
- Sodium
- Calcium (very rarely, almost only in pathological conditions)
- Deficiency of water or dehydration
- Deficiency of muscle glycogen
- Pharmacological therapies (beta-2 agonists for asthma, diuretics for hypertension, etc.)
- Excessive effort with respect to individual abilities; it occurs mainly in the sedentary.
Night Cramps
Night cramps in the calves: are they different?
If the cramps are sudden spasms, the nocturnal ones in the calves are even more formidable because, in the full tranquility of sleep, they catch on by surprise becoming even more painful.
They arise more easily when you fall asleep or when you wake up and are particularly devious; night cramps in the calves do not respond to preventive treatments, which work instead on sports or daytime cramps in general.
Causes of night cramps in the calves
Although nocturnal calf cramps are quite common, their causes are still partly unknown. Generally, large muscle strains are blamed, but many people suffer from this discomfort even when they are not busy.
Another factor not to be excluded is that of nutritional deficiencies, but people suffering from cramps in the calves also suffer from nocturnal cramps.
There are those who point their finger at blood circulation; however, nocturnal cramps can also occur in healthy people without venous return complications, regardless of whether they spend most of their time standing or sitting.
A possible role of pH in intra- and extra-cellular fluids has also been hypothesized; on the other hand, it would not be explained why they occur at night.
Given the correlation between nocturnal calf cramps and moments of entry and exit from sleep, at present the most accredited hypothesis involves involuntary neuro-muscular contractions (phases 1 and 2 of NREM sleep) associated with all the aforementioned risk factors.
Remedy
Remedy for calf cramps
To cancel a cramp in the calves it is essential to stretch the affected muscle fibers. Needless to say, the sooner action is taken, the more likely we are to limit the pain, the difficulty of execution and the possibility of recurrence.
On a practical level, we recommend:
- Sit up without straining your calf
- Stretch the whole leg and pull the tip of the foot towards you (in the direction of the knee)
- If we do not have the right mobility of the hip and back in order to reach the foot, it can be very useful to help each other with a rope or rolled sheet / towel / dress flap to pass under the foot and hold for both ends with the hands, on which to exercise traction keeping the knee straight.
- Deeply massage the affected area to relax the muscle tissue.
The role of temperature is not clear. We know that the cold increases the chances of daytime cramps and injuries, especially during sports. This would explain why many people take advantage of the bathroom or hot packs. However, the reason why others feel relief in applying cold packs remains a mystery.
Prevention
Prevention of calf cramps
The prevention of calf cramps is above all dietary and behavioral.
- First of all, in the case of drug therapy, it is advisable to discuss it with your doctor. If the condition becomes unsustainable it may be necessary to change the therapeutic strategy.
- In the case in which the calf cramps are related to a lack of athletic preparation, it is absolutely essential (also to reduce the possibility of injury) to approach the motor activity in a progressive and gradual way
- In all cases, the practice of adequate specific muscle warming of the calves before an intense effort, and an appropriate stretching protocol at the end, can eliminate most of the cramps in the sportsmen
- Follow an adequate diet and, eventually, supplement:
- The first fundamental rule, especially in the summer, especially for those who have intense sweating, is NOT to remain without water to drink. Dehydration is among the first predisposing factors of cramps, even in the calves
- Then, in the diet they must not miss:
- Fresh fruits and vegetables, rich in potassium and magnesium. These minerals, essential for nerve signal transmission, are potentially deficient in the diet and tend to be excreted by sweating
- Whole grains and legumes, rich (as well as magnesium) of complex carbohydrates: complex carbohydrates are essential to replenish stocks of muscle glycogen
- Discretionary salt which, without exaggerating, helps to maintain a constant intake of this mineral expelled in important quantities with sweating.
Note : we do not refer to calcium intake as it is rarely so low as to create hypocalcemia and, in which case, it would be the consequence of even serious pathologies.
