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Understanding Cramps, Stopping and Preventing them, Updated Science

This article is a transcribed edited summary of a video Bob and Brad recorded June in of 2021. For the original video go to https://www.youtube.com/watch?v=x-gCo08Kjo8&t=404s


Brad: Today, Bob is on a little hiatus, he’s taking the day off.


Chris: Attaboy.


Brad: So, we are going to do this, Chris and I. You’ve seen Chris before. He has excellent information and presents himself well, much better than Bob or I. Today’s topic is “Understanding Cramps Stopping and Preventing Them.” We’ve got some updated science and we’ve got some good information on how you can stop cramps when they start and perhaps on how you can prevent them. Really interesting information. Pretty much everyone has experienced painful cramps, I think I’m safe in saying that. Some people more than others. Often times they are induced by exercise or excessive fatigue. Other times they come on for no apparent reason. So, Chris got his desk out and he commenced on researching this to the nth degree and we’re going to come up with what he has to tell us. I’m going to tell you some things I’ve worked with my patients on over the years, what’s been the best solution to prevent and stop them once they start. So, cramp: it’s when a muscle contracts into tetany; tetanus. That’s when a muscle contracts to maximum potential. Very painful.


Chris: It’s awful.


Brad: It’s not done volitionally. In other words, your brain isn’t telling that muscle to cramp. It just happens. Chris, can you explain a little more on that, technically?


Chris: Cramps are awful. We’ve all experienced them at one level or another. Young or old, you can get them, it doesn’t make a difference. What we do know, cramps are a by-product seemingly of fatigue and dehydration. These are probably the two most prominent causes that we are going to see.


Brad: So, not enough water.


Chris: Not enough water, not enough electrolytes. You could throw diet in there to a lesser degree probably. It can be age related; you’re going to see it. As we get older, we lose some muscle mass. So, if we were standing all day, working all day in the yard, we don’t have as much muscle mass to support our bodies so as a result it just creates more fatigue on the muscle. When you’re sitting in the chair at night, watching TV, reading a book or when you’re sleeping, all of a sudden, boom. You got that cramp and it’ll wake you up in the dead of night. It’s miserable.


Brad: You kind of holler a little bit.


Chris: Yeah, you might say some magical words. It’s different from magical thinking, but either way it’s not fun stuff. So, what do we do? It’s one of those things where there’s not a lot that really happens. There’s not a lot of preventative maintenance but what we can do is light stretching, maybe before bed.


Brad: So, really the bottom line is the research has no definitive answer.


Chris: No, it’s really a by-product of fatigue. It’s a by-product of hydration. There can be a couple other things, maybe some hypothyroidism.


Brad: Maybe eat a lot of bananas, get that potassium in your system.


Chris: Yes, potassium definitely seems to be something that’s beneficial. There are some correlative studies that talk about magnesium supplementation, because you’re going to have your electrolytes, sodium, potassium, magnesium, and calcium. They’re all part of the action potential of the muscle to make the muscles contract and relax, contract and relax. The muscle is just in a hyper contracted state when we get there. It seems like if we’re not getting enough fluids and maybe we have sweated out too much of our own salts or our electrolytes, it becomes an operative problem. If we can supplement that through our daily diets, and there’s a couple of things we’ll go through as we go further into this about what to do to prevent it as much as we can.


Brad: So, as far as my experience in the clinic, the biggest muscle groups that cramp are in the legs. The toe, the muscles in the toe and the bottom of the foot that make her toes curls is pretty common. The calf muscles and the hamstrings and the quads as well, but probably the hamstrings are more on the top of that list. We are going to focus more on those because I think we’re safe on saying that is covering the majority. What I’ve had with elderly people in particular, the people who come to me in the clinic and say, “I get these night cramps,” and say your calf cramps. What happens is, your toes are going to plantar flex or go down cause those muscles to cramp. When you get that, it’s very painful. The first thing you have to do is dorsiflex or pull that foot back up. Now, this is very awkward in bed to reach up, especially if you’re older, to reach your toe and pull back.


Chris: Especially when you're in the dead asleep.


Brad: Yeah, so, I suggest when you need to get out of bed safely; if your balance is off, have something there. If you have a walker possibly or the wall, would depend on your situation. Be safe but get up and put your body weight through that to stretch it. It seems to work the best. It’s easier than pulling on it and you’re going to stretch out. In other words, a foot from plantar flexion to the neutral position, the pain should start to lessen. Then you can bring your foot behind you. Hold onto the dresser or whatever to dorsiflex or bring the ankle up even further. You can push your knee forward to stretch it more. By that time, the pain should be gone. It may be painful, but you won’t have that severe cramp pain. You’re going to hold it there. Don’t let it go back and cramp right away. Try and hold it. Give it a stretch. Walk around a little bit before you go back to bed. And so, you’ve had it stretched.


Brad: One thing that can trigger a cramp is if you stretch and yawn in bed and you kind of like think you’re stretching your legs because it feels better. Those are times where you can get those quadriceps, those calf muscles and the toe cramp where your toes curl under. I’ll talk about toe cramps because they’re very painful. I usually get them swimming. When you push off the floor, not many people swim laps. Anyways, swimmers get them a lot. If you get them and your toes curl down, this is one of those things where it’s, I think it’s easiest. As long as you can get to your foot, if you can reach it, to get on those toes and just stretch them the opposite direction the best you can and work on that.

Brad: This includes a family member; anybody around can help you if they know what to do. I thought it interesting, I got certified in scuba diving last year. You have to learn how to stretch someone’s legs in the water with your gear on.


Chris: I bet that's kind of tricky.


Brad: It’s not so bad once you get used to it and how to work your BC but that’d be another video.


Chris: Maybe underwater filming.


Brad: Yeah. So, you need to stretch that. And the hamstrings; the tendency is it’s going to want to pull your knee up and flex it. You’ve got to do whatever you can. If you’ve got someone there to help if you can lay on your bed. On your stomach. So, if this cramp is pulling and if the person can lay on their stomach and someone else can go here and push, push, push this leg down. When you get this out to here (all the way straight), that cramp should relieve.


Brad: If you don’t have someone to help you, then you’re going to need to do what you can to straighten that leg. Can you lay on your back, Chris?


Chris: Yeah.


Brad: You get these don't you Chris? What do you do to relieve yours?


Chris: Scream, ha-ha. Actually, I try to stretch as quickly as I can.


Brad: What techniques do you do in bed?


Chris: Well, I get out of bed as quickly as I can. For me, whether it’s my calf or my hamstrings, those are my two most common cramping points. But, with my hamstring, actually what I’ve found is that I’ll get my foot up on my bed and then I’ll just lean into it. So, if you can imagine me standing, I’d have my foot on the bed and just gently stretch. Then I’ll walk.


Brad: So, if you’re doing this, just from my point of view, think about keeping your back straight and leaning forward. You’ll get a more aggressive stretch a little quicker as opposed to rounding. When you’re in this kind of pain, you’re probably not going to think about that. Just get over and stretch it out the best you can. Again, balance is an issue. If you’re not stable on your feet, this is not going to be an option. If you’re lying-in bed, go do this stretch where you go underneath and then straighten the knee. If you can do this and straighten that knee out and do the best you can and get that cramp relieved.


Brad: Is there anything else that you wanted to cover?


Chris: I think that one of the things is, we’re in summertime now so a lot of people are out there in the heat and enjoying exercising, being more active and certainly doing things. So, a lot of times one thing that is overlooked is hydration. We want to make sure we are drinking plenty of fluids.


Brad: Plenty of fluids.


Chris: Water is ideal but some people like sports drinks and it’s debatable about what’s best and what isn’t. I will tell you that many of them have lots and lots of sugar. Some of them use high fructose corn syrup which is a natural sweetener. It’s a natural carbohydrate source.


Brad: Can you give an example? I think we can mention that.


Chris: I mean, like Gatorade. I think actually their a better choice, if you can get to it, is the Gatorade Bolt that actually uses sea salt. I think it’s much better than the traditional Gatorade.


Brad: Because it has less sugar?


Chris: It’s considerably less sugar. I mean, you need the carbs, but you don’t need as much carbs as was in a traditional can or bottle of Gatorade. At that point, the powder Gatorade does use sugar for sweetener, but the bottle pre-made is always made out of high fructose corn syrup. I honestly think that natural sugar is something your body processes better. But the Bolts specifically use a sea salt and actually sweetener from watermelon specifically. It’s about as natural a sugar as you can get. The less calories but plenty of water in there because it’s a very watery drink but it gives you the sea salt and it gives you the other electrolytes. With those electrolytes in there, it’s going to help to minimize that. Further than that, from a drink, people don’t think of this, but you see a lot of marathoners and a lot of runners going to Pedialyte.


Brad: Pedialyte, which is for kids.


Chris: It’s for kids.


Brad: Babies.


Chris: Babies all the time when Mom and Dad come in and baby’s dehydrated, for whatever reason, it’s my go-to choice. There’s not a lot of excess sugar in there and it’s got all the good and none of the bad, so inexpensive stuff. It works very very effectively.


Brad: Pedialyte for the adult for electrolytes and hopefully they start marketing it towards adults and athletes now.


Chris: They’re just kind of starting to tap into that.


Brad: They better change the name.


Chris: Maybe they’re going to have to but nonetheless, it’s actually really affordable stuff. Sometimes you buy them in like cases of these sports drinks that can actually get expensive on the pocket books. So, you know, fruits and veggies. Honeydew, the melon actually works really well. It’s got a perfect blend of carbohydrates, potassium and sodium. It’s excellent.


Brad: And it tastes good.


Chris: Tastes great. It’s excellent, after a run or a workout.


Brad: You have to cut it up with a big knife and work out that way.


Chris: Or you just scoop up the seeds, get a spoon. It works great as a post exercise or post activity or even a snack in the middle of the day. Let’s say you’re at work and you’re working a construction site where you’re sweating because it’s hot, go for some melon. It works very effectively for you. And don’t forget the water.


Brad: Right, plenty of water. As far as preventing cramps from stretches, I’ll have a lot of people that cramp at night. I’ll do the exact same stretch as we talked about once you get a cramp, but you do them preventatively.


Chris: Right before bed.


Brad: Right. You could be laying or lying. I’m sorry. I’m sorry, Karen about that. Karen, she’s our English major. When you lay in bed, you can stretch out your hamstrings if standing. Doing the standing stretch on the bed isn’t good. Make sure you do pull your ankle back dorsiflex it. You should do that lying down with your knees straight. You’ll get a better stretch on those calf muscles there. That covers all of it.


Chris: That’s pretty much it.


Brad: There’s one thing I want to say. If you have a lot of calf cramps, get yourself an inclined board. If you do a lot of walking, a lot of running. It just makes calf stretches easier and it’s more effective, I think.


Chris: There’s a better balance to it.


Brad: This is about a 25 degree. You can buy them. 25 degrees is what I feel will fit most people. They’ll tell you what the degree is. You put your foot on there and boy does that work while you can just relax. You should do it with a shoe on, works a lot better, in my opinion; you get a better stretch. Hold that for 20-30 seconds once or twice before you go to bed or before you run or after you run or walk. Actually, I made this one. If you’re handy, you can make these.


Chris: Heck, you made me one.


Brad: Oh yeah. Made Bob one, my wife one, Bob’s son got one. They were Christmas gifts.


Chris: One thing I didn’t touch on with the supplements, salt tablets actually. There’s a variety of different ones. Hammer makes Thermotabs. There’s a variety of different ones that also work well. The key to making those work well is make sure you have plenty of hydration with it too, but they get rid all the sugars and things but they’re just putting the electrolytes in a tablet or capsule.


Brad: One thing that always kind of confused me about this and I think other people might wonder, what if there’s a little high blood pressure.


Chris: That’s an interesting point you bring up because you know, one of the other causes that people that maybe take diuretics so that which can make you lose fluid, and you lose electrolytes when you’re on a diuretic.


Brad: Water pills.


Chris: We have to be careful. Why don’t you check in with your doctor with just about anything just to make sure or talk with your pharmacist. If they know your profile to make sure that it’s going to be safe and effective for you. But with respect to a salt tablet, the number one, when you look at the studies, the by-product of cramping is usually lack of sodium but what do we say to people that have hypertension? “Don’t use salt.”


Brad: Yeah! So, it’s a double-edged sword.


Chris: So, I would say work with your physician to make sure that it’s appropriate for you to maybe use either a little bit of table salt on your food or let’s say you have a big yard work project that you’re going to get done and you’re going to be perspiring quite a bit. When we sweat, we lose a lot of our electrolytes. So, we want to make sure we’re keeping you safe. We still want you drinking water. If you can get most of your electrolytes for your diet, it’s certainly appropriate. Some people can certainly use the salt table or the sports drinks.


Brad: So, if they don’t have high blood pressure.


Chris: Yeah, no hypertension issues, it’s not going to be a big issue. If it’s well controlled and on certain medications, it can be appropriate in certain situations. Being more careful around diuretics, so the water pill, so to speak, and there’s several of those out there. It’s something to always work with your doctor, work with your pharmacist. Make sure it’s appropriate for you.


Brad: That always made sense to me once I thought about when you’re sweating a lot out in the heat and the sweat goes down your face. You can just taste the salt in it. Then it’s like, oh, yeah, maybe we should replace that.


Chris: There’s a balance with everything we do.


Brad: Alright, Chris, I think we pretty much hammered everything we needed to.


Chris: I think so. It’s a lot about cramping.


Brad: Don’t cramp your style, or my style. Whatever.


Chris: Thanks guys.


Brad: Take care, be careful.


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