Patient: I get really bad cramps in my right knee at night, usually before I go to bed. The pain is so bad sometimes that it hurts more to move it. I try sports creams, but they usually do nothing to lessen the pain. Sometimes the cramps occur during the day, but they more often occur at night. Do you have any idea what could be causing this?
Doctor: Thank you for writing to Ask The Doctor.Muscle cramps are extremely common, and nearly everyone experiences a cramp at some time in their life. Cramps are common in adults and become increasingly frequent with aging. However, children also experience cramps. Any of the muscles that are under our voluntary control (skeletal muscles) can cramp. Cramps of the extremities, especially the legs and feet, and most particularly the calf (the classic charley horse), are very common. Muscle cramps are felt to be caused by excessively excited nerves that stimulate the muscles. This can occur particularly after injury to nerve and/or muscle; dehydration with low blood levels of calcium, magnesium, or potassium; from certain medications; and even at rest.The pain that is associated with muscle cramps that are caused by poor circulation to the legs that worsens with walking is referred to as claudication. Deficiencies of certain vitamins or minerals, including iron deficiency, thiamine (B1), pantothenic acid (B5), and pyridoxine(B6), can also cause muscle cramps.Muscle cramps usually cause a temporary nuisance and typically resolve on their own without treatment. When muscle cramps continually recur, it is time to seek an evaluation by a physician. The primary treatment of muscle cramps involves methods to relax the affected muscle. This typically involves stretching, massage, and heat application.Other treatments are directed toward the underlying cause of the muscle cramps and can include rehydration, electrolyte repletion, hormone treatment, calcium supplementation. Most cramps can be stopped if the involved muscle can be stretched. For many cramps of the feet and legs, this stretching can often be accomplished by standing up and walking around. For a calf muscle cramp, the person can stand about 2-2.5 feet from a wall (possibly farther for a tall person) and lean into the wall to place the forearms against the wall with the knees and back straight and the heels in contact with the floor. Another technique involves flexing the ankle by pulling the toes up toward the head while still lying in bed with the leg as straight as possible.For writer’s cramp (contractures in the hand), pressing the hand on a wall with the fingers facing down will stretch the cramping finger flexor muscles. Gently massaging the muscle will often help it to relax, as will applying warmth from a heating pad or hot soak. If the cramp is associated with fluid loss, as is often the case with vigorous physical activity, fluid and electrolyte (especially sodium and potassium) replacement is essential. Medicines are not generally needed to treat an ordinary cramp that is active since most cramps subside spontaneously before enough medicine would be absorbed to even have an effect.I hope this helps you. Please reply if you have further queries and we will help you.