More and more people are suffering from cramps, tension and muscle-related pain. Medicines are often taken against it – even without medical advice. Pain expert Michael Überall explains why this can be dangerous and what helps instead.
What role does muscle-related pain play?
Michael Überall: Muscle cramps without prior physical exertion are reported by around a third of the population in cross-sectional surveys – mainly in the evening or at night. In fact, nocturnal cramps at rest, especially in the calf area, are such a common symptom that hardly anyone is spared from them over the course of their entire life. 9 out of 10 young adults report isolated muscle cramps, women statistically more often than men. The level of involvement increases with age and from the age of 65 onwards, a third to half of all people suffer from regular muscle cramps at least once a week, with 4 out of 10 affected people experiencing three or more resting cramps per week.
Michael A. Überall has been Vice President of the German Society for Pain Medicine (DGS) e.V. since 2003 and President of the German Pain League (DSL) e.V. since 2012 as well as honorary laureate of the German Pain Prize 2011.
A characteristic of muscle cramp is the temporary and extremely painful involuntary contraction of a part of a muscle, the entirety of a muscle or a circumscribed group of functionally related muscles, which is accompanied by a palpable, sometimes also visible hardening, the duration of the rest cramp usually being varies between one and ten minutes.
While the calves are most affected by muscle cramps – we are talking here about a sudden, temporary, unintentional and often very painful tension of a muscle or a muscle group – muscular tension – that is, sudden and often movement-induced, strong to moderate, depending on stress and movement, also very severe muscle pain with restricted mobility – among the primary symptoms in the area of the small of the back and back. In contrast to muscle cramps, with muscle tension the muscle tone is permanently increased over a longer period of time, usually days to weeks, possibly even months.
According to studies, patients differentiate between the more acute, severe cramps you mentioned on the one hand and the more chronic, moderate tension on the other. In your experience, which sufferers are more likely to seek help?
Everywhere: Due to the time-limited course and the manifestation primarily in the evening and night hours, leg cramps are one of the health problems rarely or often incidentally reported by patients during a doctor’s visit. Unfortunately, nocturnal cramps are often not taken seriously by doctors and are often dismissed as a trivial symptom. As a result, those affected sometimes endure their symptoms for several years without addressing this issue, which is why years and therefore valuable time for rational countermeasures often pass between the first occurrence and the first medically useful examinations.
Interrupting nighttime sleep can significantly affect the quality of life of those affected. In clinical studies, around a third of patients complained about sleep disorders and increased daytime sleepiness due to the frequent, cramp-related, abrupt pain attacks. One in five suffers from nervousness, difficulty concentrating and stress. In addition, there is a risk of developing further illnesses due to the cramps and the lack of sleep they cause or of increasing the burden of symptoms of pre-existing illnesses, such as obesity, metabolic syndrome, depression and high blood pressure. There is also a risk of falling, daytime tiredness and a loss of performance in everyday life.
In contrast to cramps at rest, those affected with lower back and back pain seek and receive medical help much earlier – probably mainly due to the fear of serious structural damage to the spine, which is ultimately the cause of the symptoms in only 3 to 5 percent of all those affected are largely responsible.
In what form are they looking for help?
Everywhere: First and foremost, people with muscle-related pain as a result of cramps at rest at night are looking for an explanation for the severe and unpredictably occurring symptoms. From a medical point of view, it is not only important to rule out symptomatic muscle cramps – i.e. cramps for which a defined illness, an organic disorder or a specific medication is causally responsible – but, above all, to educate those affected and teach them health-promoting behavior.
Unfortunately, our healthcare system in Germany is not primarily geared towards prevention and avoidance, but primarily towards therapy and curation, which is why the remuneration paid for such consulting services is so low that doctors often ask questions about its cost-effectiveness. This, in conjunction with the increasing frequency of nocturnal rest cramps depending on age, explains why other health problems of those affected, for example those affecting the cardiovascular system, respiratory tract or metabolism, are given much more intensive attention during medical consultations than leg cramps – which go beyond that A relevant illness rating is often agreed upon across the board.
Among the tensions and cramps in the skeletal muscles, painful nighttime calf cramps are probably a little more well-known by now. What makes them so special in your opinion?
Everywhere: Muscles are anatomically one of the most complex functional units in the human organism. The striated or somatic skeletal muscles are an often underestimated wonder of nature. It is responsible for the movement and stabilization of the skeleton and its limbs and can – for example, in contrast to the smooth muscles of the internal organs – be consciously controlled, but at the same time it also contains parts that are unconsciously controlled and activated – for example to ensure an upright posture . It can be stimulated and trained directly, can cramp, tire – and grow.
Skeletal muscles are of particular importance in terms of developmental history, as they were largely responsible for ensuring that humans are not inferior in the confrontation with other living beings, who were sometimes much better equipped to survive in the wild. Being fast, strong and agile was therefore non-negotiable in the early days of humanity – it was simply necessary for survival. Nothing has changed in this regard for thousands of years – until today. While at the beginning of the 1920s the average walking distance of a person in Western Europe was between 17 and 20 kilometers per day, today it is just a sobering 1,000 meters. At the same time, however, people are getting older and older – so they live in a tension between an increasingly urgent need for the ability to move and, on the one hand, an ever-increasing lack of training in the muscles required for this.
Muscle pain, especially in the muscles that we use most frequently every day – such as the calf muscles, which we use when walking, running, jumping and climbing stairs – are one of the typical consequences of a condition characterized by aging, declining physical activity and social transformation Life in the 21st century. In the area of tension between a lack of training, increased resting tone and insufficient relaxation, a vicious circle develops that ultimately results in repeated resting cramps.
In addition, the calf muscles are particularly stressed by the increasing number of sedentary activities. In the sitting position, the calf muscle is tensed and fixed to a shorter setting due to the usually longer sitting phases. If this happens every day over long periods of time without compensation through stretching, lengthening or muscular relaxation exercises, not only the muscular tissue of the calf muscles changes, but also the surrounding connective tissue. The natural flexibility of the fascia decreases, they harden and worsen the incorrect contraction and reduced blood flow to the muscles.
What is particularly dramatic in this regard is that most people even “sit” at night or while sleeping by sleeping with their legs bent. This allows them to advance the process described even faster.
How do you assess the further development of cramps and tensions within society?
Everywhere: All signs point to the fact that the frequency of muscle-related complaints and pain in the posture and movement system will increase even more in the future. This rather pessimistic assessment is based on demographic change and the significantly increasing number of older people of both sexes as well as socio-demographic and social changes. On the one hand, these lead to the muscular system becoming increasingly poorly cared for or trained and thus more stress-resistant, while at the same time it is exposed to increasingly strong psychosocial risk factors such as stress, but also fears and depression, which somatically manifests itself in tone disorders of the increasingly weakly developed autochthonous system back muscles as well as the tormented calf muscles.
Many studies have shown that the resting muscle tone is essentially defined by the endogenous stress level, which clearly explains why the frequency of muscle-related pain syndromes is increasing in an age of ever-decreasing physical exertion. Whereas in the past, for example after real physical work, the de facto stressed muscles had the chance to relax and thus also to prepare themselves functionally for the new stresses of the next day, today it is mainly psychosocial risk factors that put a strain on the basal resting muscle tone through their 24/7 presence without any real opportunity for recovery.
All of this, in conjunction with the increasingly frequent and long-term sedentary activities, the increased life expectancy and the inadequate preventive or treatment activities of those affected, will likely lead to rest cramps – especially in the calves – becoming a real widespread disease.
Is there any advice you would like to give to those affected?
Everywhere: Even if it sounds a bit bold: regular exercise, stretching and relaxation are among the most effective, least side-effects and cost-effective measures in both the prevention and the specific treatment of muscular cramps, muscular tension and muscle-related pain. They only require one thing: personal initiative and self-motivation – and that explains why they are so rarely used. Breaking old habits, reducing sedentary activities, avoiding shortening, implementing new movements and, above all, regularly relaxing stressed muscles again through appropriate exercise therapies. These include, for example, post-isometric relaxation exercises – a neuromuscular technique that can be used by those affected to loosen and stretch tense and functionally shortened muscles in order to counteract their willingness to engage in spastic muscle contractions. These are all highly effective measures that people with recurrent resting cramps and painful muscle tension should or can learn and use at any time – regardless of age and gender.
Medications to pharmacologically reduce muscle tone are an important therapeutic option, but cannot really replace a lack of personal activity. The drugs recommended for the prevention of rest cramps and muscular tension reduce neurogenic activity and offer the opportunity to decouple the vicious circle of muscular shortening, incorrect signals from muscular stretch receptors and reactive activation of spinal motor neurons.
Information about the causes and background is therefore the be-all and end-all of education, which is why medical advice – especially when clarifying possible other causes, for example drug-related or illness-related causes – is so important and should be obtained at the latest when the need arises. to treat yourself with medication. In principle, as is often the case in medicine, prevention is better than cure and those affected should therefore proactively seek a conversation with their doctor.
In addition and independently of this, the German Pain League – Germany’s largest umbrella organization for people with chronic pain – is also happy to help those affected – for example by advising those affected via the DSL pain telephone, through its numerous self-help groups and the many regular patient forums in various regions of Germany key activities carried out.