International Polio Network SAINT LOUIS, MISSOURIUSA Winter 2003 .Vol. 19, No. 1 Porro NEWORKNEWS Straight Answers to Your "Cramped" Questions Holly H. Wise, P7; PhD, and Kerri A. Kolehma, MS, MD, Coastal Post-Polio Clinic, Charleston, South Carolina Tired in the morning? Is it diffi- Cramps can occur throughout origins anywhere in the central cult to get comfortable for a good the day but more often occur at and peripheral nervous systems night of sleep? A complaint often night or when a person is resting. and may explain the wide range reported at the Coastal Post-Polio Although it is not known exactly of conditions in which the Clinic in Charleston, South why cramps happen mostly at cramping occurs (Bentley, 1996). Carolina, is the inability to get these times, it is thought that to sleep at night due to leg pain, the resting muscle is not being Seeking Answers twitching, or cramping. stretched and is therefore more A thorough history and possibly easily excited. Muscle cramping is a relatively a referral for screening labs will common, painful, and bother- The basis for the theory that help determine the causes for some complaint among generally I cramps occur more at rest, due to I leg pain and cramping. Polio healthy adults, and is more com- I the muscle not being stretched, I survivors can provide a descrip- mon in women than men. Some I is that passive stretching can I tion of their muscle cramps, studies estimate as many as 50- 1 relieve muscle cramping. Pain I identification of the time and 70% of older adults may experi- I associated with cramping is likely I place when they occur, and an ence nocturnal leg and foot I caused by the demand of the I activity log of the 24-48 hours cramps (Abdulla, et. al., 1999). Al- overactive muscle exceeding its preceding the episode(s). For though, leg cramps are a com- metabolic supply. This excessive example, if after a vigorous mon complaint in older adults, demand results in ischemia, or exercise session or a particularly they must be taken seriously when diminished blood flow, to the long walk, a polio survivor's the individual is a polio survivor. muscles, and the accumulation muscles are noticeably twitch- of metabolites (waste products). ing, aching, or painful, then the WhaC is a muscle cramp? activity probably exceeded the AKA "stitch," "spasm, " "knot, " Causes of Leg Cramps strength of the muscle. "Charley- horse, " or "twitch." Twitching and cramping can be In addition, the physical exami- Muscle cramping involves a caused by over-activity of nerves nation should include: physiological disturbance of and muscles from faulty posture, + Observation of edema, or muscle that produces an invol- shortened muscle length, and swelling in the legs, and an untary and painful contraction. excessive activity or exercise. examination of the circulation, Cramps typically occur in the calf Other known causes of muscle or vascular supply, to the legs. muscle and are accompanied cramping include diabetes mellitus, Occasionally, a diagnostic ultra- by sudden excruciating pain and kidney failure, thyroid or neurol- sound test (a Doppler) will also persistent muscle contraction. ogical disorders, and poor blood Occasionally, both legs may be CONTINUED ON PACE 2 flow or peripheral vascular dis- affected by cramping simultane- ease. In addition, certain medi- ously. Although cramps often cations and occupational routines resolve spontaneously within can precipitate muscle cramping. minutes of onset, the episodes Bracing Options . .4-5 may continue for hours or days Recurrent cramps without a with no apparent pattern of known cause are called idiopathic Ocular Health and Pulmonary frequency or duration. cramps. These cramps are sus- Assist Machines . 6 pected to be the result of disrup- Treatment Approach Options . 9 I tions or imbalances of unknown Hdly H. wise, PT, PhD, and Kenl ~d founders and team members of the Coastal Post-Polio Clinic, 354 Folly Road in Charleston, South Carolina, established in 2000, along with jenny Adams, CPO. be performed to determine the adequacy of blood flow in the legs. Dr. Kolehma ic a physiatrist who is board-certifted by the American Academy of Physical Medicine and Rehabilitation. In addition to her private practice, + Baseline measurements of Coastal Pain & Rehabilitation Center, PA, Dr. Kolehma is also Clinical Associate joint and range of motion Professor of Neurology at the Medical University of South Carolina. to establish if there are shortened muscle lengths and limited motion Dr. Wise is a physical therapist and has worked with polio survivors since contributing to the cramping. 1984'. In 1994, she co-founded the University of Miami Post-Pdio clinic with Carol Vandenakker, MD, where she worked until 1997 when she + Manual muscle tests (MMT) of relocated to Charleston. Dr. Wise is currently an Assistant Professor in the the arms, legs, and trunk muscles Physical Therapy Educational Program, Department of Rehabilitation Sciences, to identify which muscles, if any, College of Health Professions, Medical University of South Carolina. are at risk for Overuse and sub- The authors mybe contacted at [email protected] wisehhOmusc.edu. sequent cramping. In general, muscles with a strength grade less than a 3 on a 5-point scale muscle twitching, cramping, include the reduction in the are at risk for overuse. and pain. intensity of cramping episodes, + Posture, gait, and/or a mobility As with the general population, number of cramps per episode, assessment complements the nocturnal muscle cramping in and/or in the number of nights information gathered from the polio survivors may also be free of cramps. MMT. Faulty posture is associat- idiopathic in nature and not just ed with cramping and particular related to overuse of muscles What about quinine? attention should be given to affected by polio or the other Any new treatments? inefficient patterns of movement known causes listed above. The The standard pharmacological due to muscle weakness. first line of treatment is to stretch treatment that has been used for the leg muscles before sleep, over 50 years is 300 mg quinine Prevention and avoid caffeine in the evening, taken at night. The outcomes Treatment of Leg Cramps and eat foods high in potassium are substandard with about 40% The treatment approach for (bananas, orange juice, etc.). of individuals getting relief (Diener, et. al., 2002). The medicine must non-idiopathic cramps - cramps To accomplish self-stretching, in which the underlying cause polio survivors can put their foot be taken for one month to truly is known - is to treat the under- flat on the floor and slowly put tell if it is going to work, and lying cause. The only proven weight on the foot. This action does have side effects: ringing strategy for the prevention and stretches out the calf muscle, in the ear (tinnitus), dizziness, treatment of exercise-induced which can also be done in bed blurry vision, and headaches. muscle cramps is the avoidance by "pointing your toes towards Newer treatments include vitamin or reduction of activities that your nose" until the cramping E or calcium gluconate, both of cause cramping. stops. Applying heat and massag- which are available over the coun- Strategies to reduce muscle over- ing the cramped muscles can ter. The beneficial effects of these use may include lifestyle changes, provide relief, as can wearing non-prescription treatments on such as weight reduction, use night splints that help prevent nocturnal cramping have not of assistive and orthotic devices, muscle shortening. Individualized been studied in detail. rn and the adoption of energy intervention sessions with a conservation techniques. Other physical therapist and/or referral strategies include advice from to a certified orthotist are usually a physical therapist to create required to correct muscle REFERENCESAND RESOURCES efficient mobility patterns and imbalance and faulty posture. Abdulla, A.J.J., Jones, P.w., & Pearce, V.R. (1 999). Leg cramps in the elderly: Prevalence, to intentionally pace day-to- Although no treatment is con- drug and disease associations. International day physical activities. These clusively effective, many people lournal of ~linicalPractice, 53, 494-496. approaches are designed to achieve temporary relief of Bentley, S. (1 996). Exercise induced muscle allow for sufficient rest of over- symptoms with one or more of cramp - Proposed mechanisms and manage- used muscles and to eliminate these treatments. Success would ment. Sports Medicine, 21 (6))409-420. 2 POLIO NETWORKNEWS WINTER2003, VOL. 19, NO. 1 It happened again. I received We want you to continue living another phone call from a life, and our mission is to offer reporter who wanted to know you information and options. International Polio Network "what polio survivors think." As an organization, we consider (IPN),coordinated by Gazette He wanted to know what polio the generous contributions you survivors thought about the cre- International Networking Institute sent as a stamp of approval for ation of the poliovirus at SUNY (GINI), has received a grant from the work we are doing. Although SPIN, a charitable organization at Stony Brook last year. I held you are not listed on page 8, in Chicago, Illinois. The grant that some polio survivors were those you chose to honor are. for $3,000 was awarded to help surprised, a few were angry, We thank you for your financial individuals purchase a scooter. but that the majority was silent support and for letting us know on the topic. I further explained "what you think." In order to assist the greatest that in my experience, polio survivors and their opinions are -Joan L. Headley, MS number of individuals, IPN will Executive Director, GIN1 provide up to $500 per appli- representative of the population cant. If you are a polio survivor in general.