Muscle Spasms

1 Muscle Spasms Summary

Muscle spasms are involuntary contractions of one or more muscles in the body that cause pain. One of the most common muscles spasms is that of skeletal muscles. These spasms may occur after a period of physical activity or at night.

The duration of spasm may range from few seconds to several minutes. The pain may be periodic and mild, or continuous and severe. Foot and calf muscles are prone to muscle spasms, in addition to arms, abdomen, thigh, and muscles attached to the rib cage.

The affected muscle becomes hard to touch when compared to normal ones. In some cases, these muscles are distorted and may look as if they are twitching.

The spasms may recur before resolving on its own. A muscle twitch is different from a muscle spasm in that it refers to the uncontrolled movement of a small segment of a larger muscle. It is often seen under the skin.

It affects people of all age group irrespective of the intensity of physical activity. It may happen at any time, while walking or sitting, during exercise, and sometimes during sleep. Some individuals have an increased risk of getting spasms even with small amount of exertion.

Elderly people (above 65 years of age), those who over exercise and infants have a high risk of getting spasms in different parts of the body. Athletes involved in endurance sports and those who are ill also have a high risk of developing spasms.

There are several possible causes for muscle spasms, this includes: 

  • Over exertion of muscles
  • Exercising in heat
  • Muscle fatigue
  • Deficiency of minerals
  • Pinched nerve
  • Dehydration
  • Insufficient stretching before an activity
  • Side effects of certain medications

In most of the cases, gentle stretching of muscles may help to relieve the spasms. If muscle spasms recur or are very painful, one should get doctor’s advice for the underlying cause of the problem.

In some cases, the smooth muscles present in the walls of the internal organs like colon may undergo spasm and cause severe pain. Menstrual cramps, passing a kidney stone, and pain associated with diarrhea are all caused by these muscle spasms.

Dystonia is a special type of muscle spasm caused by an abnormality in the chemicals involved in signal transduction in the brain.

Medical history and physical examination are the first steps in the diagnosis of muscle spasms. Understanding the circumstances including, onset, duration, frequency, rhythmicity, and muscle group involved help to identify the possible causes of spasms.

Recent illnesses, medications and comorbidities also provide clues regarding the underlying cause. History of physical activity and work also will be discussed. Blood tests, angiography, ultrasound, and sleep studies are also often recommended to diagnose the cause.

Treatment depends on the cause of muscle spasm. Keeping the body well hydrated is one of the most common home treatments recommended for controlling spasms. Appropriate stretching and massaging of the affected muscle also may be of help.

Pain relief medications and muscle relaxants are used to control pain. Muscles spasms often resolve without any specific treatment. But those who have recurring pain should diagnose the underlying cause of spasm and undergo treatment for the same.

2 Causes

Muscle spasm may be caused by a number of factors. It depends on body part involved in spasm, predisposing factors and the environmental conditions. Overusing or overstretching a muscle, or holding the muscle for a long duration may lead to spasm.

Forceful contraction of the muscle may happen as the overuse leads to the insufficient amount of energy and fluid in the muscle. The spasm may affect the whole muscle or involve just a part of the muscle.

In some cases, the neighboring muscle groups are also involved in the spasm. Overuse is often seen in athletes and some construction workers, where one particular set of muscles are put to use for a long duration.

This is particularly true while working in hot environment. The spasms are often seen in the large muscles that are mostly used during the activity. Spasms or cramps associated with working in hot condition is known as heat cramps.

Some other common cause of muscle spasms include:

  • Starting an exercise routine or new exercise may cause muscle spasms. For example doing sit ups at an increased intensity, all on a sudden, may affect the abdominal muscles.
  • Dehydration is another common cause of muscle spasms. Lack of enough water and electrolytes in the muscle cells cause the proteins to trigger contraction of muscle fibers. Insufficient and abnormal supply of nutrients and energy lead to irritation of the muscle leading to spasm.
  • Narrowing of arteries leads to muscle spasms because of an inadequate supply of energy and nutrients. The flow of blood to the legs is affected by peripheral artery disease and this results in muscle cramps in legs.
  • Over exercise may result in leg muscle spasms, particularly in the night. It usually affects the muscles of the calf and toe.
  • Recurrent muscle spasms are associated with chronic pain in the neck and back. Injury and arthritic changes in the spine often result in the spasms of the large muscle in the groups.
  • Spasms are also caused by diabetes, kidney disease, anemia, and hormone issues.
  • Amyotrophic lateral sclerosis, multiple sclerosis, and spinal cord injury are some of the nervous system issues that result in muscle spasm.
  • Smooth muscle spasms as in intestinal walls results in waves of pain. This includes
  • Passing of kidney stones through urinary tract cause rhythmic spasm of the ureter walls and cause pain. Pain caused by this spasm is often associated with nausea and vomiting and is called renal colic.
  • Gastroesophageal reflux disease (GERD) causes irritation of esophagus leading to spasm of esophageal muscles.
  • The muscular wall of the colon may undergo spasm during diarrhea-causing colicky pain.
  • Menstrual cramps are caused by spasms of uterine wall during periods.
  • High levels of cholesterol and smoking lead to spasm of coronary arterial walls. It is also seen during alcohol withdrawal, drug abuse, stress and certain medications.

Dystonia is a condition characterized by forceful contraction of muscles and twisting resulting in movement disorders. These spasms may result in uncontrolled repetitive movements and people with the condition may fail to maintain normal body posture.

The condition is progressive and with time more aggressive and frequent spasms may be noted. Blepharospasm, torticollis, laryngeal dystonia are some common dystonias.

3 Diagnosis and Treatment

Severe, long-lasting spasms that recur may need medical attention to diagnose the underlying cause of spasm. The first steps in evaluation of cause are a physical examination and medical history.

To start with, the doctor collects information on the onset of spasm, the duration, frequency, rhythmicity, and the muscle groups involved in the spasm.

Information on recent diseases, medications were taken, food supplements and herbal remedies may also help in identifying the probable cause of the spasm.

History of diseases like diabetes, hypothyroidism, spinal cord injury, and kidney disease also should be shared. Other information that would be of use in diagnosis includes work and exercise pattern or routine followed.

Physical examination is helpful in identifying many of the underlying causes including atherosclerosis in the leg. Smooth muscle spasms are associated with severe pain and require emergency admissions.

Kidney stones and gall bladder pain are controlled by narcotic painkillers. Specific treatment is given for nausea and vomiting associated with these conditions.

Other tests and investigations are recommended when physical examination and medical history do not reveal the actual cause of the spasm.

Blood tests with complete blood count, electrolytes, glucose test, creatinine and thyroid function tests are commonly recommended. Spasms caused by muscle or nerve disorder are confirmed using electromyography. Peripheral artery disease is detected using CT scan and MRI. 

Most forms of skeletal muscle spasms can be prevented successfully. Dehydration and imbalances in electrolytes are two most common causes of this condition and hence having plenty of fluids helps to avoid spasms.

If the same is caused by vomiting or diarrhea, controlling the conditions is of help in preventing spasms in skeletal muscles. Keeping oneself well hydrated is important while working in a hot environment. Stretching and warming up before exercises can prevent many types of spasms.

Spasm of large skeletal muscle is treated by gently stretching the muscle. This helps to break the spasm cycle. Medications like anti-inflammatory drugs, pain relief medications, narcotics and muscle relaxants are suggested for relief of pain and spasm.

Treatment for smooth muscle spasms depends on the underlying cause of the condition. Spasms felt in the night are hard to treat. Quinines, vitamin B complex, gabapentin, diltiazem are commonly recommended to control pain and spasm in the night.

Dystonias are treated using medications and the type of medication depend on the individual. Some common drugs used in the treatment of dystonia include anti-Parkinsonism drugs, muscle relaxants, levodopa, risperidone, carbamazepine and botulinum toxin type A.

Prevention is the best possible care for muscle spasms. Outlook of treatment also depends on how well the underlying condition is resolved, particularly in the case of peripheral artery disease. Many movement disorders that cause muscle spasms, when controlled successfully completely resolve the symptom.

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