A muscle spasm is an involuntary contraction of a muscle, and is frequently painful. T here are many different types of muscle spasms. Some can be addressed through medical means, improvement of diet or physical therapy. Other causes of a muscle spasm may be harder to find and treat.
Some causes of muscle spasm include straining of a muscle, dehydration, trauma, diseases like cerebral palsy or multiple sclerosis (MS), as well as a reaction to certain poisons like strychnine, and damage to nerves or to the spinal cord.
The contraction that occurs during a muscle spasm is involuntary; the brain sends signals to the muscle to contract, which are not willed by the body. When we exercise, we use voluntary contractions of muscles to perform work. In a muscle spasm, the brain sends a mixed signal to the muscle to contract that is not willed by the person.
A contraction can last for a few seconds, to several minutes or hours. The familiar charley horse, for example, may contract a muscle in the legs. The muscle does not simply relax by a person wishing it would. Deep breathing and relaxation exercises may help the muscle gradually relax. Often people actually contract other muscles in response to the pain of a charley horse, which can make the duration of the muscle spasm longer.
Muscle spasm results from inflammation that occurs when a muscle is overstretched or torn. It begins as a muscle strain, which does not sound like a serious injury, but it can cause severe low back pain. Many people go to the emergency room each year because of a muscle strain. In fact, most episodes of acute lower back pain are caused by damage to the muscles and/or ligaments in the low back.
Muscle strains are also known as a pulled muscle. When the muscles in the lower back are strained or torn, the area around the muscles can become inflamed. With inflammation, the muscles can spasm leading to severe low back pain and difficulty moving. Lower back pain from a muscle strain occurs most frequently after lifting a heavy object, lifting while twisting, or a sudden movement or fall. The pain is usually localized, meaning it does not radiate to the leg. The area may be sore to the touch, the patient usually feels better when resting.
In medicine a spasm is a sudden, involuntary contraction of a muscle, a group of muscles, or a hollow organ, or a similarly sudden contraction of an orifice. It is sometimes accompanied by a sudden burst of pain, but is usually harmless and ceases after a few minutes. Spasmodic muscle contraction may also be due to a large number of medical conditions, including the dystonias.
Hypertonic muscle spasms are caused by excessive muscle tone or residual tension in a resting muscle – the amount of contraction that remains when a muscle is not actively working. Hypertonia is beyond conscious control, it does not always produce direct awareness of its presence, and it surfaces in many ways not normally associated with muscle. What may appear as skeletal, circulatory, nerve, or inflammatory distress usually begins with hypertonic muscle spasm, a condition caused by the interruption of nerve feedback loops between muscle and brain.
True hypertonic spasm is caused by malfunctioning feedback nerves, is much more serious, and is permanent unless treated. Simply put, the hypertonic muscle is muscle tone run amok – the muscles are unable to relax.
By extension, a spasm is a temporary burst of energy, activity, emotion, stress, or anxiety.
A subtype of spasms is colic, an episodic pain due to spasms of smooth muscle in a particular organ (e.g. the bile duct). A characteristic of colic is the sensation of having to move about, and the pain may induce nausea or vomiting if severe. Series of spasms or permanent spasms are called spasms.
In very severe cases, the spasm can induce muscular contractions that are more forceful than the sufferer could generate under normal circumstances, which can cause tearing of tendons and ligaments.
Hysterical strength is argued to be a type of spasm induced by the brain under extreme circumstances.
Amongst causes of spasms are insufficient hydration, muscle overload, and absence of electrolytes.
If one frequently gets cramping of this sort, this may be the result of poor nutrition, or too much exercise. Frequently at the end of a marathon, runners may be seized with painful muscle spasms because their body is depleted of essential electrolytes. Excessive nausea and vomiting can also cause a muscle spasm.
The first consideration in treating frequent muscle spasms of the legs and feet is to address hydration concerns. People who do not maintain proper hydration are more likely to experience cramping. As well, some studies show that magnesium and calcium depletion may result in a muscle spasm. If cramps occur frequently, one might consider supplementing one’s diet with more calcium and magnesium loaded foods, or with mineral supplements.
Should this not end painful muscle spasms, one should see a doctor to evaluate other possible causes. Exposure to certain chemicals, like pesticides may cause poisoning, which can result in spasm. As well, severe muscle spasm may be linked to conditions like MS.
Another type of muscle spasm that may occur is cramping of the stomach. This may be associated by either a stomach flu illness, or with conditions like irritable bowel syndrome (IBS). This cramping is also quite painful, but gradual control of IBS can reduce frequent muscle spasm. Infants with colic often experience muscle spasm in the abdomen as well, hence the excessive crying. This is often a brain's immature response to digestion, which is why many children with colic improve as they age.
Angina is another type of muscle spasm, caused when the heart does not get enough blood. It is associated with atherosclerosis or hardening of the arteries. The muscle spasm angina causes is usually painful cramping that may be felt in the chest, and sometimes the neck, shoulders and jaw. Treatment usually involves treating the underlying conditions causing heart disease, and treating episodes of angina with medication.
Injured muscles may also improperly receive “work” signals from the brain, causing muscle spasm. Often as a muscle heals, such spasms become infrequent. Sometimes an injury can cause almost constant spasmodic action of the muscles, which may require muscle relaxants, as well as time, in order to heal such action.
The symptoms of muscle spasm depend upon the muscle involved and the circumstances leading up to the spasm.
Skeletal muscle spasm usually involves muscles that are being asked to do excessive work. There is acute onset of pain as the muscle contracts. A bulging muscle may be seen or felt underneath the skin where the muscle is located. Most often, the spasm resolves spontaneously after a few seconds though it may last many minutes or longer. Usually, the patient will feel the need to stretch the muscle involved, thus relieving the spasm and resolving the episode.
A muscle fasciculation or twitch may last just a few seconds or may be a recurrent event. Usually, it is just a momentary repetitive contraction of just a few muscle fibers in a localized area served by one nerve fiber usually involving the eye, calf, or thumb. They often come, go, and may be related to stress or anxiety. Ingestion of stimulants like caffeine and pseudoephedrine found in over-the-counter cold medications may also cause the twitch. Medications such as albuterol (Ventolin, Proventil, AccuNeb, VoSpire, ProAir) used for the treatment of asthma and medications used to treat attention deficit disorder may be associated with twitching. These twitches are considered benign fasciculation.
However, muscle twitching may also be associated with neurologic disorders such as muscular dystrophy, amyotrophic lateral sclerosis, and myopathy (a primary muscle illness). With these diagnoses, associated symptoms include weakness, muscle wasting with loss of muscle size, and change in sensation.
Smooth muscle spasm will cause colicky pain that comes and goes. The symptoms will depend upon the organ involved.
Prevention is the key to most skeletal muscle spasm episodes. Since they are often associated with dehydration and electrolyte disturbances, it is important to keep the body well hydrated. If the fluid loss is due to an illness with fever or vomiting and diarrhea, controlling the symptoms will help limit fluid loss and prevent spasms. Similarly, for those who work or exercise in a hot environment, drinking enough fluids to keep hydrated is very important.
Muscles should also be prepared for the activity that they are expected to do. Just as athletes stretch and warm up before the game, non-athletes should warm up before heavy labor, including jobs like raking, mowing, and shoveling snow.
Should a skeletal muscle go into spasm, the initial treatment is to gently stretch the muscle back to length to break the spasm cycle and resolve the acute situation.
Further treatment will depend upon the underlying cause of the muscle spasms. For muscles that have been damaged or strained, medications may be required for short-term pain relief, including anti-inflammatories (ibuprofen), narcotics, and muscle relaxants.
The treatment of smooth muscle spasm also depends upon the underlying cause. Often, pain control will occur simultaneously with the care provider's efforts to make the diagnosis.
There is no one effective treatment for the dystonias. Medication may used to try to restore balance to the brain's neurotransmitters. The decision as to which medication to use depends upon the patient's presentation. It may take trial and error to find the right medication in the right dose to control symptoms.
Anti-Parkinsonism drugs, like trihexyphenidyl HCl (Artane) andbenztropine mesylate (Cogentin) decrease acetylcholine levels. Muscle relaxants like diazepam (Valium) and baclofen (Lioresal) affect GABA receptors.
Levodopa (Sinemet) and reserpine (Harmonyl) affect dopamine levels.
Carbamazepine (Tegretol), a seizure-control drug, may be useful in some patients.
Botulinum toxin type A (Botox) may be injected into a specific muscle to paralyze it and relieve the muscle spasm. These were initially used for blepharospasms but are now able to be used where other muscles are involved.
Spasms may affect many different types of muscles in the body, leading to many different symptoms and presentations.
Spasms of skeletal muscles are most common and are often due to dehydration and electrolyte abnormalities. The spasm occurs abruptly, is very painful and usually short lived. It may be relieved by gently stretching the muscle.
If muscle spasms are especially painful, if they do not resolve or if they recur, medical care should be accessed to look for potential underlying causes.
Smooth muscles that are within the walls of hollow organs in the body can go into spasm, causing significant pain. Often this pain is colicky, meaning that it comes and goes. Examples include the pain associated with diarrhea, gallbladder pain, and kidney stone pain.
A special form of muscle spasms are the dystonias whereby an abnormality perhaps exists with the chemicals that help transmit signals within the brain. Examples include torticollis and blepharospasm. Treatment may include medications to help restore the neurotransmitter levels to normal and Botox injections to paralyze the affected muscle and relieve the spasm.
THC, CBD, CBME improve muscle spasm. Cited M. E. Albood, R. Pertwee “Cannabinoids”
THC has anti spasmodic properties. Cited GW Pharmaceuticals Great Britain.
Cannabinoids suppress muscle spasms. “ “ “ “ “ “
Cannabinoids in clinical practice.
Williamson EM, Evans FJ.
Centre for Pharmacognosy, The School of Pharmacy, University of London, England.
Cannabis has a potential for clinical use often obscured by unreliable and purely anecdotal reports. The most important natural cannabinoid is the psychoactive tetrahydrocannabinol (delta9-THC); others include cannabidiol (CBD) and cannabigerol (CBG). Not all the observed effects can be ascribed to THC, and the other constituents may also modulate its action; for example CBD reduces anxiety induced by THC. A standardized extract of the herb may therefore be more beneficial in practice and clinical trial protocols have been drawn up to assess this. The mechanism of action is still not fully understood, although cannabinoid receptors have been cloned and natural ligands identified. Cannabis is frequently used by patients with multiple sclerosis (MS) for muscle spasm and pain, and in an experimental model of MS low doses of cannabinoids alleviated tremor. Most of the controlled studies have been carried out with THC rather than the whole cannabis herb, and so do not mimic the usual clinical situation. Small clinical studies have confirmed the usefulness of THC as an analgesic; CBD and CBG also have analgesic and anti-inflammatory effects, indicating that there is scope for developing drugs that do not have the psychoactive properties of THC. Patients taking the synthetic derivative nabilone for neurogenic pain actually preferred cannabis herb and reported that it relieved not only pain but also the associated depression and anxiety. Cannabinoids are effective in chemotherapy-induced emesis and nabilone has been licensed for this use for several years. Currently, the synthetic cannabinoid HU211 is undergoing trials as a protective agent after brain trauma. Anecdotal reports of cannabis use include case studies in migraine and Tourette's syndrome, and as a treatment for asthma and glaucoma. Apart from the smoking aspect, the safety profile of cannabis is good. However, adverse reactions include panic or anxiety attacks, which are worse in the elderly and in women, and less likely in children. Although psychosis has been cited because of cannabis use, an examination of psychiatric hospital admissions found no evidence of this; however, it may exacerbate existing symptoms. The relatively slow elimination from the body of the cannabinoids has safety implications for cognitive tasks, especially driving and operating machinery; although driving impairment with cannabis is only moderate, there is a significant interaction with alcohol. Natural materials are highly variable and multiple components need to be standardized to ensure reproducible effects. Pure natural and synthetic compounds do not have these disadvantages but may not have the overall therapeutic effect of the herb.
Cannabinoids: their role in pain and palliation.
Department of Family Medicine, Kaiser Permanente, 752 N Broadway, Escondido, CA 92025, USA. Bill.H.Mccarberg@kp.org
Controversy is associated with the issue of cannabis and cannabinoids in clinical care in the United States. Recent research has demonstrated the underlying mechanisms of cannabinoid analgesia via endocannabinoids, an endogenous system of retrograde neuromodulatory messengers that work in tandem with endogenous opioids. Additional receptor and non-receptor mechanisms of cannabinoid drugs have pertinent activity, including anti-carcinogenesis and neuroprotection, which may be of key importance in aging and terminal patient populations. The results of clinical trials with synthetic and plant-based cannabinoids suggest that the role of formulation and delivery system is critical in optimizing the risk-benefit profile of cannabinoid products. Synergy between opioids and cannabinoids may produce opioid-sparing effects, as well as extend the duration of analgesia and reduce opioid tolerance and dependence. This article reviews the mechanism of action of cannabinoids, examines marketed agents and those in clinical trials, and addresses their role in treatment of chronic pain, cancer, neurodegenerative diseases, and HIV/ AIDS. The ability of cannabinoid medicines to treat pain, associated sleep disorders, appetite loss, muscle spasm and a wide variety of other symptoms suggests that such agents may in the future play an important role in palliative care.
Recommendation: Indica x Sativa hybrid
Maui Wowie, Green Poison, Tessa, Death Star, Blackberry Kush, Twilight Indica, Misty, White Berry, Sweet Blu, Purple OG Kush, Sweet Dreams, OG Kush, Black Vietnamese, Blue Fruit, Medicine W
Use a vaporizer, edibles, elixirs, tinctures, extracts. You want to choose strains with both high THC and CBD levels. They work together to provide their anti spasmodic properties.
Filho JAF, Pestronk A. Muscle pain and cramps. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds.Neurology in Clinical Practice. 15th ed. Philadelphia, Pa: Butterworth-Heinemann; 2008: chap 28.
Brinker MR, O'Connor DP, Almekinders LC, et al. Basic science and injury of muscle, tendon, and ligament. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009: chap 1.
Update Date: 7/23/2010
Bucholz, R.W., J.D. Heckman, and C.M. Court-Brown. Rockwood and Green's Fracture in Adults. 6th ed. Philadelphia: Lippincott, Williams & Wilkins, 2006.