May 28, 2024
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Plague of the Night: Those Awful Calf Cramps

After having one of the snowiest and coldest winters on record, we are now finishing up a pretty hot summer, especially these past few weeks. Maybe the beach crowd loves the heat, but the rest of us might be noticing the difficulties associated with this long stretch of high heat.

During the past couple of weeks, at least five people have commented to me about getting calf cramps—especially in the middle of the night. Minding their own business and fast asleep, people describe being startled awake by searing pain in one of their calfs (not calves). Having experienced this type of cramp myself many times over many years, I know exactly how very intense the pain can be. In a seemingly unprovoked act of revenge, the muscle seizes up and we are left shocked by the intensity of the pain and bewildered by most efforts to squelch it.

Many of us know someone, or are someone, who has experienced this. Certain populations are more vulnerable than others, and pregnant women frequently complain of these cramps, starting especially during the fifth gestational month when blood volume is increasing significantly, but minerals and electrolytes have not yet adjusted.

The balanced presence of these minerals and electrolytes are essential to normal heart and muscular activity. This knowledge was the springboard to the invention of Gatorade and similar “sports drinks.” Salt (sodium chloride), potassium, magnesium and other essential minerals are needed to assure the neurochemical function required for healthy maintenance of heart and muscular function. Too much, or too little (more common), can upset the homeostasis (physiological balance) and wreak havoc in the body. When an imbalance occurs, the body has a few distinctive ways of letting us know—muscle cramps being one of them. Often these cramps are the result of repeated or extended exposure to hot (and sometimes humid) conditions. We don’t realize the toll that high heat takes, and often respond too late, or not at all, to heat exposure. Other causes of calf cramps can include circulatory issues, medication side-effects, neurological conditions alone or secondary to diabetes and other conditions.

To ward off calf cramps and other complications associated with the stress of hot weather, it makes sense to take some simple and important precautions, the most important being to avoid it if possible. If you don’t have to be out, stay in. If you have to be out, limit the time and exposure. The more vulnerable populations are young children, older adults, and workers, children and athletes who spend extended time outdoors in the heat and especially in the sun.

Here are some tips to stay ahead of the heat:

1. Pre-hydrate and stay hydrated. Prepare for exposure to the heat, and rehydrate abundantly and often. (TIP: Before a fast day, hydrate extra, drinking almost twice as much as you normally would.)

2. In hot conditions, here is the rule: if you are thirsty, it’s already too late. Drink enough to avoid thirst. Eat well, including foods that are known to be high in fluid content.

3. If there’s any question about a person’s status with heat illness: force fluids, even if they feel nauseated. With heat illness, the nausea is due to dehydration. Rehydrating will relieve it rather than increase it. Expect a protest and be insistent. Immediately contact emergency medical services and, if possible, retreat to a cool place. Heat illness is a medical emergency!

Now, back to the calf cramps. For successful relief, there are a couple of things that will effectively “shut off” the neurological signal to the calf muscle and also quickly counter the cramping activity.

1. In a sitting position on the bed: flex the foot, or pull the foot “toes towards the nose.” This maneuver might briefly increase pain, but is very effective. In the case of an overpowering cramp, this maneuver might be ineffective. Don’t give up; just do it anyway.

2. Along with the foot-flex maneuver, place a belt, strap, rope or similar item across the bottom of your foot, just around the base of the toes. Grasp the open ends of the strap, gently, firmly and steadily (not a jerk or violent motion) pulling the foot up simultaneously as you are pulling/flexing with your own leg muscle power.

Continue pulling the foot up and with the strap until the cramp releases—usually less than five seconds. Gently and gradually release the strap and relax your foot. If the cramp returns, repeat the process. Whatever you do: don’t point your toe! If you do that, the cramp will probably immediately return.

3. If you don’t have a strap: stand at a wall placing both palms flat on the wall. Move the cramping leg behind, keeping the knee straight and press the heel down into the floor. Shift all of your weight to the other leg, keeping that knee bent. Use this position to stretch the calf slowly by keeping the heel down and maintaining the stretch gently but firmly. Usually 5-10 seconds makes the essential difference.

Myths:

1. “Walk it out.” Eventually the cramp might stop, but not due to your walking! Walking actually perpetuates the nerve activity that maintains the calf cramp and is often counter-productive.

2. Massage. It often irritates the nerves, and the juncture where nerves and muscles meet, perpetuating the cramp process.

Remedies:

1. Rehydrate and stay hydrated. In hot weather, often 95 percent of us are walking around 75 percent hydrated.

2. Add a moderate amount of salt to your diet in hot weather, unless restricted by your doctor.

3. Use electrolyte drinks, unless instructed not to do so by your medical professional. While these drinks are high in electrolytes, they also contain sugar. Replenish fluids and electrolytes following an incident of muscle cramping.

4. Some doctors recommend drinking quinine water (tonic) to relieve leg cramps. While there aren’t many good studies to substantiate this claim, people do substantiate it to some extent. You decide.

Ellie Wolf, MS, BCB, Fellow BCIA, currently a Biofeedback Specialist, holds a master’s degree in Sports Medicine and Kinesiotherapy from the University of Illinois and spent more than 25 years as a Licensed Athletic Trainer/ATR working with scholastic, collegiate, professional and U.S. and Israeli Olympic athletes in conditioning and injury rehabilitation in the U.S. and Israel. She has worked with athletes from every professional team in Chicago and many others across the country, including football, basketball, hockey, soccer, volleyball, gymnastics, track and field, swimming, wrestling, tennis and golf.

By Ellie Wolf

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