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5th June 2015
Port Life
Electrolyte imbalance likely to blame for charley
horses
Making Sense of Medicine
Bob Keller
At last, after being on your feet all day long, you finally get into a well-deserved night of sound sleep. Until
— and it seems as though you’ve barely been asleep — the muscles in the back of your calf twist
themselves into a rock-solid knot, waking you suddenly and with excruciating pain. And not only that, it
won’t go away no matter how you move or anguish.
Finally, after possibly many minutes that seem like hours, the cramp begins to subside, but not without
leaving some residual pain and the horrifying feeling that it may recur at any moment.
You’ve just had a charley horse!
Why this event should be called a charley horse is uncertain except that it seems to come from baseball
jargon in the 1880s. It is attributed sometimes to a lame horse named Charley who dragged the dust
brush around the Chicago White Sox’s baseball diamond, and sometimes to a pitcher named Charley
“Old Hoss” Radbourne, who frequently suffered such cramps during a game. There are other tales, as
well, and your guess is as good as any, and just as unsubstantiated.
A charley horse is usually associated with cramps in your calf, but whatever you call it, any of the muscles
in your thigh or leg or foot can cramp, and frequently, you may experience cramps in more than one
muscle simultaneously.
What is a muscle?
The muscles that connect one bone of your skeleton to another are called “skeletal,” or sometimes
“striated,” and for our purposes, contracting the muscle causes one or both of the bones to move. These
muscles are usually under your conscious control.
There are other muscles, called “smooth,” which you don’t control consciously.
They form the tissue supporting blood vessels and internal organs such as your stomach and bladder.
There is a third type of muscle called “cardiac” that occurs only in your heart and is also not voluntarily
controlled.
We are concerned with skeletal muscles. Each muscle has a “belly” containing the filaments that move
past one another to shorten the muscle during contraction.
The belly is wrapped with a tough protein called collagen, which merges at either end of the belly to form
the tendons that connect to bones. In addition, each muscle is hard-wired to your brain through one or
more nerves and contains an assortment of blood vessels.
And contraction?
In a muscle contraction, nothing actually changes length except the overall muscle. Rather, within the
belly is a large set of parallel thick (myosin) and thin (actin) filaments that slide past one another when a
nerve impulse signals the need for contraction. That is, when relaxed, the myosin and actin filaments are
end to end. When a contraction is signaled, microscopic bridges are formed, allowing the myosin to pull
the actin filaments toward them until they are almost side by side, thus shortening the overall muscle.
When you relax the contraction, the actin filaments slide back and the muscle is restored to its relaxed
length.
What happens with a cramp?
A cramp or spasm occurs when muscles contract without your conscious control. A lot is unknown about
cramping, but during a cramp, there is an abnormally high rate of nerve firing, a much greater rate than
occurs during your maximum voluntary contraction.
The specific cause of this is probably related to an imbalance in electrolytes.
That is, the normal cycle of contraction and relaxation depends heavily upon a delicate balance of four of
the mineral electrolytes in the fluid surrounding the muscles and nerves: sodium, calcium, potassium and
magnesium.
For example, sodium constricts and potassium relaxes muscle, with calcium and magnesium initiating
each phase of the action. If your potassium is low, then that alone can be enough for a cramp to happen.
That is, a deficiency of potassium can leave any muscle in a locked position. On the other hand, too much
potassium can override sodium’s normal influence on contraction, leading to the inability of any muscle to
contract, including the heart. This is why lethal injections contain a very high concentration of potassium.
What causes electrolyte imbalance?
Under normal circumstances, electrolyte imbalance can result from over exercise in many forms, including
just standing, and from dehydration. Especially during periods of heat and humidity, drink lots of water, not
beer or diet soda.
If you would usually drink half your body weight in ounces of water every day, then you might consider
almost doubling that during hot temperatures. Although drinking much too much water can be
problematic, as well, your body can deal better with over hydration than dehydration.
Imbalance may result also from more serious conditions such as kidney diseases and poor circulation.
Cramps may result also from many medications, including statins and those for Alzheimer’s, Parkinson’s,
asthma and osteoporosis.
Signs of imbalance
There are many signs of electrolyte imbalance that are easy to spot. Dark urine, for example, may indicate
dehydration.
Fatigue and lethargy are possible indicators, as are an irregular heartbeat, diarrhea or constipation, and
abdominal or any other cramping. Changes in mood, such as irritability, confusion or depression, may
also suggest an electrolyte imbalance.
What can you do?
If you’re having a cramp, there are some things you can try. For some people, correcting the imbalance by
taking a potassium supplement can render quick relief, but you should do this only with advice from your
doctor. There are also some leg cramp creams that seem to help. Massaging the area, putting ice or heat
on it, or taking a bath with Epsom salts may help, as well, although it’s a bit hard to imagine taking time to
draw a bath when you are in the agony of a cramp.
Most effective, however, is to stretch the area that is cramping. This may seem counterintuitive, but what
the stretch does is voluntarily activate the muscle that is the opposite of the cramping muscle; these two
muscles are antagonists.
The stretch works because we know for sure that when a muscle is contracted voluntarily, its antagonist
cannot contract, and so the spasm relaxes.
If you are having periodic leg cramps, please see your doctor, if for no other reason than to get a check on
your electrolyte balance. Your doctor can also check for other conditions or medications that may be
causing your cramps.
In my practice, I use treatments designed to balance your nervous system.
These may help to avoid future cramps.
Bob Keller is a certified pain relief practitioner and medical massage therapist in Newburyport. He can be
reached at 978-465-5111 or [email protected].