Not Just a Vitamin Deficiency: Doctors Name Causes of Leg Cramps

There are times when your legs cramp up, and if it’s not from being in cold water, there can be many reasons. Journalist NGS.RU Maria Tishchenko found out from Novosibirsk doctors how this is related to vitamin deficiencies, how to distinguish such cramps from epileptic ones, and what treatment might be.

Difference from Epileptic Seizures

According to neurologist and expert doctor at the Gemotest laboratory, Ekaterina Demyanovskaya, sudden painful contractions of the calf muscles, often called cramps, are a local transient muscle hypertonicity and are not related to epilepsy. These conditions are fundamentally different in their mechanism of occurrence.

Epilepsy is the result of a sort of “short circuit” in the cerebral cortex, when many nerve cells activate simultaneously. This can lead to loss or decrease of consciousness with muscle contraction in a specific area (for example, neck or arm) or generalized contraction of skeletal muscles.

Contraction of the calf muscle, however, is a disruption at the level of the peripheral nervous system or in the muscle tissue itself without a change in consciousness. There can be several reasons: a failure in the transmission of the signal from the nerve to the muscle, disruption of muscle cell function, or an imbalance of substances necessary for proper contraction and relaxation of the fibers.

Causes of Cramps

The main cause of painful involuntary contractions of the calf muscles (called crampi) is considered to be an electrolyte imbalance: deficiency of magnesium, potassium, calcium, or vitamin D.

These micronutrients are critical for the process of muscle contraction and relaxation.

“Magnesium acts as a natural muscle relaxant and stabilizer of nervous excitability. Its deficiency leads to the muscle being unable to fully relax,” explained Ekaterina Demyanovskaya. “Significant losses of magnesium are possible with excessive sweating, diuretic use, pregnancy, or an unbalanced diet.”

Vera Semashko, a neurologist of the highest category at the Smitra clinic, also added that cramps can be a symptom of endocrine system diseases, namely the parathyroid glands, including after thyroid surgery. Sometimes cramps can also be psychosomatic in nature.

Another significant factor is muscle overload. When muscles work for a long time and actively, for example during a long walk, an unusual workout, or standing work, metabolic products, including lactic acid, accumulate in them.

Moreover, Ekaterina Demyanovskaya noted, the energy resources in the form of ATP molecules necessary for relaxation are depleted in the muscles, since that is also an energy-consuming process. Because of this, the muscle may remain in a clenched, tense state, which is felt as a cramp.

The condition of the peripheral nerves also plays an important role. For example, in polyneuropathy, which occurs in people with diabetes, the transmission of nerve impulses to the muscles is disrupted, which can manifest as painful spasms.

Ekaterina Demyanovskaya emphasized that the condition of the blood vessels cannot be ignored. Chronic venous insufficiency or atherosclerosis of the abdominal aorta, its branches, and arteries of the lower extremities impair venous outflow and blood supply to the leg muscles, which, accordingly, leads to the accumulation of metabolic products and reduced blood supply. This provokes painful spasms, especially at rest.

In some neurological diseases, such as multiple sclerosis or damage to the nerve roots in the lumbar region, the normal connection between motor neurons and muscles is disrupted. The nerve signals that control the muscles are intermittent. Because of this, the well-established cycle of muscle contraction and relaxation is thrown off, which can lead to sudden painful contractions of the calf muscles.

“It is important to distinguish simple crampi from symptoms of more serious conditions. For example, Parkinson’s disease, amyotrophic lateral sclerosis, or dystonic syndromes may also include muscle spasms, but they will be accompanied by other characteristic neurological symptoms: tremor, muscle weakness, changes in gait,” said Ekaterina Demyanovskaya.

She also noted that relatively well-known and more frequent causes of crampi — varicose veins, magnesium deficiency, carbohydrate metabolism disorders — can progress and lead to serious complications. Therefore, if painful contractions of the calf muscles become frequent, are not relieved by simple muscle stretching, or begin to affect other muscle groups, this is a strong reason to consult a doctor to find out the cause.

What to Do

If you are bothered by cramps, first of all you should see a general practitioner. The doctor will examine the patient, take a medical history, find out how often the cramps occur and what they are related to: whether the patient experiences high physical exertion, what kind of shoes they wear, whether there has been a sharp change in weight, and what other symptoms are present.

The doctor will order primary diagnostics for iron levels, thyroid hormones, and parathyroid hormone, and based on the results, will prescribe treatment or refer to a specialist — a neurologist or an endocrinologist.

“You should not independently take tests for vitamins, especially vitamin D,” emphasized Vera Semashko.

Tatyana Tartyunova, a neurologist at the network of family medicine centers Zdraвица, noted that if cramps have become the cause of impaired circulation, one should see a vascular surgeon.