Cramp, The Midnight Dance!

If you are under 60 you probably haven’t yet experienced it, but 33 per cent of people over 60 get cramps, particularly at night,and over 80s, often up to three times a week.

It is one  of those things you discuss with wry grins. We have all been there.  The daytime attack: ridiculous grimace, sudden clutching and having to jump up from  a restaurant table  or theatre seat gabbling inane apologies. Then the contortions as you try to stretch it out…

And the hilarious evening when it interrupts the lingering romantic clinch. Leap from loving arms, knock over wine and candles whilst yelling  Not quite the expected reaction to a caress!

The surreal dance is when you emerge from a deep sleep, start to turn over and, wham! Total, instantaneous, screaming cramp.  Legs in all directions searching for the one position which will stretch it out. You try climbing out of bed and attempt to stand.  One foot forward, one foot back, twist left , twist right  until “Ah”. Gone. Simple calf or foot cramp you can manage, cramp in one leg isnt too difficult to cope with. You make yourself  balance, walk, move on it until it gives. A sort of hopping dance around the bed.

But cramp in two legs and  it is truly a nightmare, almost impossible to stretch one without triggering more in the other. If it is in the inner thigh area it can be painful to the point of fainting and if you are alone, terrifying.

We know that it will go of its own accord – usually after about 10 minutes. But those 10 minutes or so are scary. And frequently it returns. The fear and sleep disturbance are distressing. If the cramp is severe, you are left limping the next day from sore muscles.  That type of cramp is not funny.

 

For older people, in the dark, it is not a dance. It is a seriously  dodgy experience.  So you seek help.

Try looking for help on the net, Google the cause and treatment of cramp. I mean it – do try! I have never seen so many ‘might be’ causes and ‘maybe useful’ treatments. No one seems to have a clue. Medical sites are delighted to assure you that it is harmless. Even the NHS site!  Though I suspect, it doesnt really care. In their view it is not a medical problem, it doesn’t block beds.

GPs provide reassuring platitudes and maybe pills. Chemists will sell you expensive ones. They are usually based on Calcium , magnesium* or quinine type substance and are taken as a preventative, in case you get cramp, though often with side effects.  However few medications truly prevent cramp or provide relief.

In the various references you will see that the nocturnal cramp of later years  is labelled idiopathic. ie. of unknown cause. However they provide you with plenty of suggestions. Apart from exercise it lists, temperature, liver problems, poor circulation, tight bed sheets, lack of calcium and dehydration….a long varied list like this is sure sign they havent a clue!

Why am I writing this? 

Because this is another of those things you only understand when you are actually old, by having experienced it!

We need to ask, ‘Why is no one doing any significant research about cramp in older people?’

The answer is money.   Research costs, big Pharm needs profits and whilst the NHS does not see it as a significant problem, there will not be any.

Nor is it properly understood.* All published research on cramp relates to sport and athletics. Research institutions don’t seem to be aware of older people’s cramp as a different problem. People under retirement age haven’t experienced our kind of cramp. Understandably they link our complaints to the cramp they do know about, the kind you get from sport and exercise.

Wrong! Cramp for most older people is not linked to exercise, possibly it is the opposite. First, it happens after you have been lying very still, or sitting, playing cards or watching a film. No older person has ever told me about this type of cramp coming on after exercise. Second, it does not – as most of medical websites seem to think – wake you up. It commonly happens as you first move, that initial stirring, from deep sleep.

Are there any answers?

Those who get cramp will know the pattern.  That starting a movement triggers an abnormal  convulsive total contraction, usually in just one muscle or muscle group.

Many articles on cramp recommend you to massage it. Try, of course, but mostly it doesnt help or you are in too much agony to do it or tell someone where.

Absolutely the best answer is to stretch it out. Reset the muscle fibres to their relaxed state. Painful as that seems, it works.  Contracting the opposite muscle if you can will do it . Otherwise find a way to put body weight on it so it stretches.  It is possible to get someone to do it for you, but hard because you cant easily explain right then just what is needed

Being a Physio, I can identify just which muscle is in spasm. Because  of that I know exactly how to stretch it quickly. Most people don’t know the action of individual muscles and struggle longer.

If you do get cramp regularly, a Physio could probably show you the best techniques for stretching those muscles most commonly affected.

Until they find the cause it may be that the best treatment for nocturnal cramp is a quick course in anatomy and stretch techniques! For you and your partner? 

Some answers on the internet are lovely, such as put a tablet of soap under your bottom sheet. Most are anecdotal and rarely have they any real evidence. However, there is one which has a proper research basis.  And that is to drink the juice of cucumber pickles immediately ie. as soon as you get cramp! Experients showed that it does reduce the attack significantly and quicker.  Not perhaps the ideal answer for that cramp which dramatically intrudes on an early morning cuddle…

 Maybe it is up to us? Cramp must no longer be ignored.   It isnt harmless!  It is nasty,   dangerous and another reason for loss of confidence  in older people.

The NHS should take it seriously and we need to push for answers.

* Causes are still unknown. One team exploring muscle spasm , Minetto et al were I think, on the right track. They were looking at spinal inhibition failure, nerve conduction problems and changed muscle stimulation thresholds, all of which seems to fit. Most studies on Ageing bodies suggest that there is a gradual diminution of reflex controls as we age. We all know about bladder and balance….So the explanation may lie in that direction.    Journal of Muscle and Nerve ,Vol 40 Issue 4 Oct 2009

**https://www.nps.org.au/medical-info/clinical-topics/news/magnesium-a-treatment-for-leg-cramps.    This independent research review confirms the present state of uncertainty about the cause of night cramp and how to treat it. Please read it.