Muscle cramps are characterized by painful, continuous, involuntary, and localized contraction of a complete group of muscles, individual single muscle, or selected muscle fibres. Generally, the cramp can occur from minutes to seconds for known or idiopathic causes with healthy people or in the case of diseases. The cramp reveals itself as a knot if the muscle area is palpated. 

Muscle cramps related to exercise is the most frequent condition that requires therapeutic/medical intervention at the time of sports. The etiology specific for this condition is still unknown and possible causes hinge on the pathological or physiological situation in which the cramp appears. It should be kept in mind that a painful contraction limited to a distinct area does not necessarily explain that the reason of the cramp is local. 

In very few cases, if a cramp is essentially local, it is an effect concerning the integrity of the whole system of the body, somatic, and emotional. 

The epidemiology of cramps remains unclear because of their different appearances and lack of a single text considering the degree of cramps. For instance, elderly individuals in France aged 65-69, nocturnal leg cramps (NLCs) in the American population, and calf cramps occuring in pregnant women present in China all highlight different aspects of this condition. In the US, 46% of COPD patients experience muscle cramps, while 74% of athletes and individuals in high-heat environments report cramps. 32% of children suffering from type1A Charcot-Marie-Tooth disease suffer from calf cramps, with the prevalence increasing with age in Australia. Studies indicate that cramps are a significant issue in various sports, with no clear correlation between sex and the occurrence of cramps. 

The pathophysiology of muscular cramps varies and is often influenced by the underling pathological condition of a patient. For instance, in athletic and healthy individuals, there is no definitive relation between fluid depletion and electrolyte imbalance as a direct source of cramps.  

In patients undergoing dialysis, although electrolytes are often depleted during treatment, there is no clear connection between dialysis and the occurrence of cramps. Nonetheless, muscle cramps are very common in this kind of patients.  

The etiology of muscle cramps varies depending on the condition in which they occur. It is important to note the potential physiological or pathological differences, as different scenarios can lead to cramps. 

Muscle cramps associated with heat often occurs during sports and intense physical activity. In these conditions, massive losses of sweat and electrolytes are considered as the possible underlying mechanism of pathology in such situations. 

In healthy subjects, the prognosis for the appearance of cramps is always benign. 

Regarding the examination, the posture of a patient of the person should be noticed, both when standing and walking. It means that possible existence of muscular imbalance should be understood. All mentioned muscles should be palpated in one’s patient to make sure the tissue is homogenous on both sides of the body. 

The patient is made to contract the muscle voluntarily in which the cramps usually develop, so that the healthcare professional can understand whether the cramp is provoked by continous mechanical active stress. It must also involve a passive muscle stretching to check if the cramp happens in the absence of active stress. Cramp that occurs due to passive stretch might be associated with symptoms rather than a harmless event. 

Various pathological conditions are associated with cramps of which few are described as following: 

NLC (Nocturnal Leg Cramps):  

NLC’s affect 37% of American population who are above 60 years, affecting the calf muscle area. Leg pains in the nighttime can be diagnosed with cramps and muscular stretching. The exact cause is unknown, but potential causes include work-related activities, neurological disorders, metabolic and hormonal disorders, electrolyte disturbances, drug consumption and nerve root compressions. NLCs may also occur as a result of neurological causes, as people over 60 experience a loss of medullary neurons, leading to neuromuscular coordination. 

Leg cramps in pregnant women: 

Muscle cramps are common during pregnancy, affecting about 50% of women, especially in the nights during the third trimester. Causes may include neuromuscular function changes, peripheral nerve comoressions, increased lower limb muscle works and weight gain. Night cramps may cause delay in fetal growth and early births. Currently no treatment is available. 

EAMC (Exercise-associated muscle cramp) 

EAMC is a common event resulting from physical activity. There are two hypotheses, a transient peripheral neurological disorder and electrolyte imbalance and dehydration. The main cause is peripheral fatigue, with muscle contractions increasing neuromuscular spindles and Golgi tendon organs. Stretching before physical activity does not prevent cramps. 

Writer cramp (WC) 

It is a hand dystonia affecting 30-50 year olds, affecting the central neural network, affecting areas of the cortex, cerebellum, and basal ganglia, with differences influenced by individuality and research tools. 

Cramp fasciculation syndrome (CFS) 

CFS is a peripheral syndrome characterized by muscular cramps, fasciculations, burning sensations, and numbness, often affecting potassium channels. 

End-stage renal disease 

50% of patients who are suffering from muscle cramps have chronic renal failure undergoing dialysis, mostly affecting the lower limbs. Onset of cramps may occur at home or during dialysis. Cramps in dialysis patients are associated with depression, sleep disorders, and reduced quality of life. The etiology of muscle cramps in hemodialysis patients is unknown yet. 

The initial evaluation involves palpation, where a strong tension is felt under the hand, which can affect the entire group of muscles or a localized node. 

 Electromyography is another method that can be used to analyze the discharge patterns of motor units, aiding in the diagnosis of neurological pathologies unrelated to the disease. Additionally, an echocardiograph can assess morphological anomalies that might trigger cramp phenomena. 

The simplest conservative treatments for both healthy individuals and patients include stretching the affected muscle or performing deep massages. 

For healthy individuals, prevention may involve proper warm-up exercises before physical activity and maintaining adequate hydration. For various pathologies associated with cramp occurrence, there are no universally accepted pharmacological guidelines applicable to any specific pathological state. 

Neurology

• Cyclobenzaprine: It is structurally linked to tricyclic antidepressants and a skeletal muscle relaxant that is centrally acting. 
• Methocarbamol: This is a skeletal muscle relaxant acting centrally and approved for the management of acute musculoskeletal pain.

Neurology

• Ibuprofen: It is an NSAID used in treating rheumatoid disorders, fever, osteoarthritis, and dysmenorrhea. 
• Naproxen: This is also an NSAID indicated to relieve from muscle aches, headaches, common cold, and arthritis. 

Neurology

Acetaminophen: It is an antipyretic and analgesic agent indicated in the treatment of mild to moderate pain. It is a non-opioid analgesic. 

Neurology

Dantrolene: This is a skeletal muscle relaxant that acts directly and used to relieve cramping, spasms, and muscle tightness due to stroke, cerebral palsy or multiple sclerosis. 

Neurology

Management of muscle spasm involves several phases. 

• Acute phase
  This includes relieving pain and reducing intensity, resting, using cold therapy, medications, and physical therapy. 
• Subacute phase:
  This takes into account restoration of normal function using heat therapy, stretching, and massage. 
• Rehabilitation phase:
  In this phase, strengthening of muscles, exercising, promoting good posture and learning of stress management techniques are involved. 
• Maintenance phase:
  Maintaining muscle health through regular exercise, proper hydration, a diet rich in essential minerals, and lifestyle adjustments.
  Following these phases can effectively manage muscle spasms and reduce their likelihood of recurrence.