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What causes a muscle spasm?

There are a variety of causes of muscle spasms, and each cause depends on certain

predisposing factors and anatomic areas of involvement.

Spasms may occur when a muscle is overused and tired, particularly if it is overstretched or

if it has been held in the same position for a prolonged period of time. In effect, the muscle

cell runs out of energy and fluid and becomes hyperexcitable and then develops a forceful

contraction. This spasm may involve part of a muscle, the whole muscle, or even adjacent

muscles.

Overuse as a cause of skeletal muscle spasm is often seen in athletes who are doing

strenuousexercisein ahot environment.This is also an occupational issue with construction

workers. Usually, thespasmswill occur in the large muscles that are being asked to do the

work.

Writer's cramps are similarly caused by prolonged use of the small muscles in the hand.

It is commonly thought thatdehydrationand depletion ofelectrolyteswill lead to muscle

spasm and cramping. Muscle cells require enough water,glucose,sodium, potassium,calcium, and magnesium to allow the proteins within them to interact and develop an

organized contraction. Abnormal supply of these elements can cause the muscle to become

irritable and go into spasm.

Atherosclerosis or narrowing of the arteries (peripheral artery disease) may also lead to

muscle spasm andcramps,again because adequate blood supply and nutrients are not able

to be delivered to the appropriate muscle.

Leg spasms are often seen related to exercise, but cramps may also be seen at night

involving calf and toe muscles. Nocturnal leg cramps and restless legs syndrome are

considered a type ofsleepdisturbance.

Systemic illnesses likediabetes,anemia(low red blood cell count), kidney disease andthyroid and other hormone issues are also potential causes of muscle spasms.

Diseases of the nervous system, such asmultiple sclerosisor spinal cord injury, can be

associated with muscle spasm.

Smooth muscle can also develop spasm. When a hollow structure filled with air or fluid is

squeezed by the muscle spasm, significant pain can occur since the fluid or air cannot be

compressed. For example, smooth muscle in the intestinal wall can go into spasm, causing

waves of pain called colic. Colicky pain which tends to be rhythmic (coming and going) may

also occur within the bile duct that empties the gallbladder and may develop after eating.

Should akidney stoneattempt to pass, the smooth muscles that are in the walls of the

ureter may spasm and cause significant pain. Often this type of pain may be associated withnausea and vomiting.Colicky pain is often associated withdiarrhea,where the muscles

within the colon wall go into spasm just before the watery bowel movement.

Dystonias are movement disorders where groups of muscles forcefully contract causing

twisting and repetitive movements or the inability to have a normal posture as a result of

muscle spasm and cramping. The symptoms may be very mild initially but gradually progress

to become more frequent and aggressive. Occasionally, there is no progression. Examples of

this type of muscle spasm includetorticollis(where the neck muscles spasm and cause the

head to turn to one side),blepharospasm(where there is uncontrolled blinking of the eyes),

and laryngealdystoniathat affects the muscles that control speech. Dystonias may be

caused by abnormally functioning neurotransmitter chemicals in the part of the brain calledthe basal ganglia. These chemicals (serotonin, dopamine, acetylcholine, and GABA) are

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required to properly send messages that begin muscle contraction. Dystonia symptoms may

occur as a complication ofstroke.

The Cause of Joint Stiffness

Joint stiffness is caused byinflammation in the synovium,the lining of the joint. Theabnormal synovial lining is the cause of manytypes of arthritis.The only physical expression

of synovial involvement may bejoint pain,or there may beswelling,redness, and warmth

associated with the affected joint.

Other medical conditions can also cause joint stiffness, including bone diseases, cancer, joint

trauma, or overuse of the joint.

What is Joint Stiffness?

Joint stiffness is defined as discomfort after a period of inactivity (such as waking up in the

morning or sitting for an extended period of time), decreasedrange of motionor a loss of

range of motion in a joint.Withosteoarthritis,joint stiffness after waking may last up to 30 minutes. With

inflammatory types of arthritis such asrheumatoid arthritisorsystemic lupus

erythematosus,the stiffness typically lasts more than 45 minutes.

Treating Joint Stiffness

With propertreatment of arthritis(such asdisease-modifying anti-rheumatic drugsor

biologicsfor rheumatoid arthritis), the synovial inflammation and subsequent joint stiffness

may significantly improve or completely resolve. Ifmorning stiffnessis a big problem, some

patients will wake up early to take theirarthritis medicationsand then go back to sleep.

Others may take a long-actinganti-inflammatory medicationorpain medicationlater in theevening so that they will feel better when they wake up.

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