You had a great day being extra active — you did your usual morning walk with a strength training session and managed to squeeze in a bike ride with friends. Or maybe it was the opposite — you were stuck in back-to-back meetings all day and barely had time to get up and move. But suddenly, you wake up in the middle of the night with an intense charley horse in your calf that has you hobbling around your bedroom for relief. What gives?

Welcome to the world of muscle spasms (or muscle cramps). Most of us have experienced them at one time or another because muscle cramps are very common. “Muscle spasms are involuntary contractions of the muscle,” explains Lori Walter, PT, DPT, a physical therapist at Hinge Health. 

Your muscles are stimulated by electrical signals from your nerves. But sometimes, that signal can become overexcited. “Instead of your muscle contracting and then relaxing, your muscle just keeps on firing,” says Dr. Walter. These spasms can occur in any muscle, but they often affect the calf (aka the infamous charley horse). They’re also common in the hamstrings, feet, and hands, adds Dr. Walter.

While there’s no need to worry about occasional muscle spasms, you likely want to know what to do if they do occur and how you can decrease the chances of them occurring in the future. Here’s more about what causes muscle spasms and some simple steps that physical therapists recommend to help you avoid them so you can stay active.

What Causes Muscle Spasms? 

Most muscle spasms are “idiopathic,” which means there’s no obvious cause. But there are situations where you may be more likely to get muscle cramps, points out Dr. Walter. These include:

• Dehydration. When you don’t get enough fluid, your muscles can become more sensitive and spasm, says Dr. Walter. It’s important to drink enough liquids, especially when you’re exercising or going on a long plane ride.

• Low electrolytes. If you’ve had an intense workout or gone through a bad bout of diarrhea and/or vomiting, you may have lower electrolyte levels in your body. These are salts and minerals like potassium, magnesium, and calcium. “They help your muscles work properly, so electrolyte imbalances may trigger cramping,” explains Dr. Walter.

• Muscle fatigue. You may notice more muscle spasms with repeated, intense activity, especially without enough conditioning or stretching. Muscle spasms from fatigue are not dangerous and as you continue to exercise, your body can adjust to the challenges so cramps become less likely. 

• Stress. “When you’re under stress, your nervous system can become overexcited and cause more muscle spasms,” says Dr. Walter. 

• Certain medications. Drugs like diuretics (often used to treat high blood pressure) and cholesterol-lowering drugs known as statins have been linked to muscle cramps, especially nighttime leg cramps. This may be because they encourage increased urination, which can impact electrolyte levels.

• Pregnancy. About half of all pregnant women experience muscle cramps, especially during the last trimester. It’s probably due to a combination of weight gain, nerve compression, and more work for your lower limb muscles. They should resolve once you give birth.

• Staying in the same position for a while. Whether it’s looking up at your computer for several hours, or being stuck on a long plane ride, staying in the same position for long stretches may cause muscle spasms, explains Dr. Walter.

How Long Do Muscle Spasms Usually Last?

If you’re smack in the middle of one, you may wonder how long muscle spasms last. They can persist anywhere from just a few seconds to half an hour, says Dr. Walter. 

What Does a Muscle Spasm Feel Like? 

A classic spasm feels like a cramp that contracts and releases. The sensation can range from minor discomfort and stiffness to sudden, tight, intense pain. You may also see visible muscle knots, or notice twitching where the muscle contracts. The muscle may also feel hard when you touch it. After the muscle spasm subsides, the area may feel sore and tender.

While it may seem alarming to experience a muscle spasm (especially if it wakes you up at night) it’s important to remember that the pain will get better on its own (and usually very quickly). But if you notice spasms frequently, or they last for minutes at a time, let your doctor know. Some underlying medical conditions, such as fibromyalgia or type 2 diabetes, can trigger muscle spasms.

How Do You Stop Muscle Spasms? Physical Therapist Tips

Oftentimes, just as quickly as it appeared, the muscle spasm will resolve. But there are some things you can do to help it go away faster and lessen your discomfort: 

• Change your position. “Just getting out of the offending position can directly improve the spasm,” says Dr. Walter.

• Stretch. This relaxes the muscle and helps relieve the contractions. The “best” stretch depends on where the muscle spasm is. For a charley horse in your calf, you can do a calf wall stretch to stretch out the cramped muscle. If it’s a hamstring cramp in the back of your thigh, sit on the floor with your legs extended, then slide your hands down until you feel the stretch in your cramped muscle. For back cramps, try the yoga move “child’s pose.”

• Take some deep breaths. Since stress can trigger muscle spasms — and make them worse — Dr. Walter recommends that you practice a form of breathing known as diaphragmatic breathing. “It helps to engage the parasympathetic nervous system, which is the part of your nervous system that helps calm you,” she explains. Breathe in through your nose, allowing your stomach to rise as air enters. Count to three, pause, then exhale to the count of three. Repeat several times.

• Use cold/heat therapy. Some people will find ice relieves muscle spasms, while others swear by heat. “Cold will decrease electrical signals from your nerves, so the effects can be instantaneous, while heat will enhance blood supply to the muscle,” says Dr. Walter. You can try a combination of both ice and heat: apply ice for five minutes, followed by heat, and repeat several times.

• Use self-massage. Massage the affected area with your hands or with a foam roller. Research suggests this may be especially effective if your muscle cramp is due to intense exercise, as massage can help speed up muscle healing by reducing inflammation.

• Drink fluids. If you suspect your muscle spasms may be due to being dehydrated, sip water to help stay hydrated. 

If your muscle still feels sore after the spasm has disappeared, you can take an over-the-counter pain reliever such as ibuprofen (Advil, Motrin), naproxen (Aleve), or acetaminophen (Tylenol). It’s important to make sure that you are safely able to take these medications, based on your medical history.

How to Prevent Muscle Spasms

Muscle spasms can be tough to avoid because they’re unpredictable. But there are some steps you can take toward warding them off, especially if you experience them frequently. 

• Stay hydrated. After periods of intense exercise or working out during extreme heat, drink plenty of fluids. An electrolyte enhanced beverage may be even better than water. A 2021 study published in the Journal of the International Society of Sports Nutrition found that those who drank electrolyte enhanced water right before and after exercise were less likely to get muscle cramps than those who just guzzled plain H20.

• Fuel up on nutrients. Foods rich in magnesium (like leafy greens) and potassium (like bananas or avocado) may help prevent muscle spasms. 

• Wear comfy shoes. If you know that you’ll be standing for a long period of time, Dr. Walter recommends that you wear supportive shoes like sneakers to help ward off muscle cramps. 

• Stretch frequently. You can use dynamic stretches like walking lunges to warm up muscles before exercise, advises Dr. Walter. Static stretches — where you hold a stretch for 30 seconds or so — can help keep muscles limber after exercise and before bed.

• Adjust your sleep position. If you are prone to nighttime spasms, particularly calf spasms, tweaking how you sleep may help. If you sleep on your back, for example, you can try using pillows to keep your toes pointed upward. If you’re a stomach sleeper, maybe hang your feet over the end of the bed. 

• Stay active during the day. Taking frequent movement breaks throughout the day can help keep muscles from stiffening up, which may help prevent spasms, says Dr. Walter.

• Try physical therapy. If you experience muscle spasms frequently, and there’s no underlying medical cause, a physical therapist may be able to show you stretching and strengthening exercises for the muscle or muscles. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

PT Tip: Stretch Into Your Spasm 

“It’s counterintuitive, but sometimes a muscle spasm can feel better when the muscle is shortened — that means moving more into the slack position, rather than stretching away from it,” explains Dr. Walter. “It shortens the muscle, which in turn reboots your nervous system — kind of like turning a computer off and back on again.” Bending your knee when your hamstring is in spasm or pointing your foot down like pushing on a gas pedal when the calf is in spasm can help release the tension and allow you to move with more ease.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.  

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Bordoni, B., Sugumar, K., & Varacallo, M. (2020). Muscle Cramps. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499895/

2. Garrison, S. R. (2012). Nocturnal Leg Cramps and Prescription Use That Precedes Them. Archives of Internal Medicine, 172(2), 120. doi:10.1001/archinternmed.2011.1029

3. Crane, J. D., Ogborn, D. I., Cupido, C., Melov, S., Hubbard, A., Bourgeois, J. M., & Tarnopolsky, M. A. (2012). Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Science Translational Medicine, 4(119), 119ra13. doi:10.1126/scitranslmed.3002882

4. Lau, W. Y., Kato, H., & Nosaka, K. (2021). Effect of oral rehydration solution versus spring water intake during exercise in the heat on muscle cramp susceptibility of young men. Journal of the International Society of Sports Nutrition, 18(1). doi:10.1186/s12970-021-00414-8

5. Herzberg, J., & Stevermer, J. (2017). Treatments for Nocturnal Leg Cramps. American Family Physician, 96(7). 

6. Alaia, M. J., & Wilkerson, R. (2022, October). Muscle Cramps. OrthoInfo — American Academy of Orthopedic Surgeons.https://orthoinfo.aaos.org/en/diseases--conditions/muscle-cramps