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8th October 2020
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Cramps and Muscle Spasms

Cramps and Muscle Spasms

It’s a common misconception that cramps are caused by dehydration or electrolyte imbalance. Even for sport-related cramps, there is little to no evidence of this.


Causes of cramps

There is a lot we don’t know about cramps. The general understanding is that cramps affect voluntary muscle, but the cramp itself is involuntary. This is likely down to excessive excitability in a nearby nerve. Part of the muscle in question goes into spasm, so there must be a neurological driver. Beyond that, knowledge is scarce.

Who do cramps affect?

It’s not unusual to experience the ocassional cramp, but some groups of people experience them more than average.


The theory to explain why cramping is more common after exercise is about fatigue of nerves. After running, the nerves in the leg are fatigued in a similar way to the muscles. As they recover, they misfire and send involuntary signals to the muscles.

Gradual increase of exercise may increase the endurance of nerves, but there is no evidence to suggest stretching before exercise will reduce chance of cramping. Links between dehydration or electrolyte imbalance and cramping have not been proven in human research.

Over 60 year olds

Night cramps affect roughly a third of the older population. These symptoms most commonly affect the calf and may benefit from stretching during an episode. One reason over 60s are affected may be because of their likely use of multiple medications. There is a particularly strong link with statins and diuretics.

Manual therapy and exercise have been proven to be effective among this group.

Pregnant women

We see more leg cramps among pregnant women, but it is not entirely clear why. Cramping affect roughly half of pregnancies, and occur more frequently overnight. The third trimester is the time when this is most prevalent. As hormonal changes affect physiology from the first trimester, cramping can be more prevalent from the start.

As with other cases, we are not entirely sure why pregnant women are more affected than the general population. There are theories about weight gain and changes in circulation, but they are not strongly supported.

People with Fibromyalgia

A relatively common symptom among people with fibromyalgia is cramping. The cause is thought to be neurological as it is among other groups. However it is likely associated with the neurological element of fibromyalgia.

There are also links between a high numbers of cramps and people with:

  • Renal disease
  • Liver cirrhosis
  • Diabetes

Treatment for cramps

Evidence has shown that manual therapy can be effective for managing cramps. This is particularly effective for night cramps in over 60 year olds. Considering current theories, increasing exercise may also help to prevent this condition. Despite this, before exercise has not been proven effective for prevention. Some patients find that stretching during an episode does help to relieve pain, however.

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