A muscle spasm is a sudden, involuntary contraction of one or more muscles. A spasm results from an abnormally sustained muscle contraction and is often painful. Various muscles may develop spasms, including the small intrinsic hand muscles of a musician to the larger “charley horse” calf muscles of a runner. Muscle spasms may involve the skeletal muscles of the limbs and spine, responsible for locomotion and upright posture, or the smooth muscles lining the hollow, tubular internal organs of our body, such as the muscles lining the colon or bladder. Skeletal and smooth muscles have different embryological origins, functions, innervations, and physiologies.
Acute skeletal muscle spasms may be the result of muscle injury or overuse. They may occur, for instance, when an athlete has not warmed up or stretched prior to vigorous anaerobic exercise, such as sprinting or jumping. They may also occur during endurance training when, for example, a marathoner has not maintained proper fluid and electrolyte balance, and muscles with increased metabolic demand are depleted of nutrients. These types of spasms resolve with rest, hydration, and gentle stretching.
Recurrent, widespread, or chronic muscle spasms may signify a more significant underlying medical condition related to toxic-metabolic, nutritional, vascular, or hormonal problems. In peripheral artery disease, for instance, there is a lack of blood supply and oxygen to affected muscles, which cause the spasms of “vascular claudication.” These spasms, or cramps, usually involve the lower extremities and become worse with exertion and better with rest. In kidney or liver disease, there may be volume depletion and/ or rapid body fluid and electrolyte abnormalities responsible for chronic muscle cramps. Similarly, conditions which cause excessive vomiting, diarrhea, or insufficient nutritional intake may result in skeletal muscle cramps.
A muscle twitch or fasciculation is the involuntary, uncontrolled fine movement of a small segment of muscle. It can be seen under the skin and involves a few individual muscle fibers. Common muscles prone to benign fasciculations are the eyelid, thumb, calf, and thigh. These tiny muscle twitches may be related to fatigue, stress, or anxiety (i.e, the so-called “benign fasciculation syndrome”), as well as exogenous substances including: caffeine, pseudoephedrine, albuterol, and Adderall. In some cases, fasciculations are attributable to low magnesium or other nutritional deficiencies. Rarer associations are small fiber neuropathy or gluten neuropathy. Generally, the prognosis for benign fasciculation syndrome is very good and can be managed with nutritional supplementation, elimination of the offending related substance, stress management, or in some cases, pharmacotherapy such as anticonvulsants or beta blockers.
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