Back Pain Doctor
Muscle Cramps
A muscle cramp is an involuntary contraction of a muscle that comes on suddenly and does not relax. The calf, hamstrings and quadriceps are the muscles most often affected, though cramps in the feet, hands, arms, abdomen and along the rib cage are also common. The exact cause is usually not identified. Inadequate stretching and muscle fatigue are thought to disturb the mechanisms controlling muscle contraction, and poor conditioning, exercising in heat, dehydration and depletion of salt and minerals all contribute. Endurance athletes and older adults doing strenuous activity are the two groups most often affected — the latter partly because muscle loss begins in the mid-40s and because the sense of thirst and the ability to respond to heat both decline with age.
Assessment focuses on separating ordinary exertional or nocturnal cramping from the small number of cases with an identifiable underlying cause. History and examination do most of the work here: the pattern and timing of the cramps, exercise and heat exposure, a full medication review, and directed examination of the pulses, spine and neurological system. Targeted blood tests — electrolytes, renal, thyroid and liver function, glucose, creatine kinase — are worthwhile where the history suggests a systemic cause rather than as a routine screen. Imaging is reserved for suspected nerve compression.
First-line care is straightforward: gentle stretching and massage during the cramp itself, then better overall conditioning, regular calf, hamstring and quadriceps flexibility work after warming up, and sensible fluid and electrolyte replacement around exercise in the heat. Magnesium supplements are widely used but the evidence in adults with idiopathic cramps is weak. Quinine is not recommended for routine use because of the risk of serious blood disorders. Cramps that are severe, frequent, unexplained or accompanied by numbness, weakness or exercise-related calf pain warrant review rather than repeated self-treatment.
Common symptoms
- Sudden, intense tightening of a calf, hamstring or thigh muscle
- A muscle that feels hard to touch or visibly distorted
- Cramps lasting seconds to fifteen minutes, often recurring
- Cramping during or hours after prolonged exercise, or at night
Commonly seen in
Thirteen options we can consider for muscle cramps, and where each one fits.
We work through these in order. Most people improve with the first two or three stages, and the later options exist for problems that are still there after that. Listing a treatment here does not mean it is right for you — the evidence, likely benefit, risks, cost and alternatives are all weighed against your diagnosis at consultation.
Start here — getting the diagnosis and the plan right
Nothing further along the pathway works as well without this, and for many people it is enough on its own.
Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Core care
What it involves
Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan — with weight management where that is clinically relevant.
What the evidence shows
Therapeutic exercise and education are recommended as core osteoarthritis treatments across major guidelines.
Where it fits for you
Runs alongside everything below. Activity does not wear the joint out.
Settling pain enough to rehabilitate
Short-term pain control, used to open a window for the loading work rather than as a treatment in its own right.
Dry needling and trigger point therapy A fine needle into a tender band of muscle, with nothing injected. Only if relevant
What it involves
A fine needle is placed into a tender band of muscle, with nothing injected. Often done in the same visit as your assessment.
What the evidence shows
Dry needling does not treat osteoarthritis itself.
Where it fits for you
Relevant only where focal myofascial pain around the joint is a clear separate contributor.
Wet needling (trigger point injection) The same target as dry needling, with a small volume of dilute dextrose solution injected. Only if relevant
What it involves
The needle is placed into the tender muscle band and a small volume of 5% dextrose with 0.04% lignocaine is injected. Often more comfortable than dry needling, and usable where the tender area sits deeper.
What the evidence shows
Trials comparing wet and dry needling are small and mixed; evidence quality is low.
Where it fits for you
Considered where a specific tender muscle is reproducing part of your pain.
Ultrasound-guided injections Guidance means we can see the needle reach the target. What goes into the needle depends on the diagnosis. Short-term relief
What it involves
The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis — and corticosteroid is used sparingly, for the reasons set out below.
What the evidence shows
Guidelines support corticosteroid injection for short-term symptom relief in selected osteoarthritis presentations, with benefit usually measured in weeks to a few months.
Where it fits for you
Most useful when pain is preventing rehabilitation. Used sparingly — see the note on cortisone.
V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Only if relevant
What it involves
A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.
What the evidence shows
Local vibration therapy has a modest, low-certainty evidence base in myofascial pain. It is not a shockwave and should not be described as one.
Where it fits for you
For the tender muscle around an arthritic joint — quadriceps, gluteals, calf. Not a treatment for the joint.
Energy-based treatment — no needles, no downtime
Delivered in the clinic over a short course of sessions. Often the next step when rehabilitation has stalled.
Radial or focused shockwave? Read the overviewRadial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Only if relevant
What it involves
A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue — including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.
What the evidence shows
Trials in osteoarthritis are mostly small and heterogeneous, and a radial pressure wave is not directed into the joint.
Where it fits for you
For the tender muscle and fascia around an arthritic joint, which is often a real part of the pain. Not a treatment for the joint itself.
Focused shockwave (ESWT) A true shock wave converging at depth — for tendon, joint, ligament and bone. Worth discussing
What it involves
A focused system generates an acoustic shock wave that converges at a focal point set at a defined depth, concentrating the energy where the target is. This is the form we use for tendon, joint, ligament and bone. Typically four to six sessions about a week apart, no anaesthetic and no formal downtime.
What the evidence shows
AAOS states ESWT may improve pain and function in knee osteoarthritis, though the recommendation is limited because the evidence is inconsistent.
Where it fits for you
The form used where the joint itself is the target, since the energy has to converge at depth. An adjunct aiming to reduce pain and improve function — not a cartilage regeneration treatment.
EMTT (magnetotransduction therapy) High-energy magnetic pulses applied over the area. Painless, no contact. Evidence mixed
What it involves
You sit with the applicator positioned over the area for a short session. Painless, no gel or contact required, and usually delivered as a course — commonly alongside shockwave.
What the evidence shows
Major osteoarthritis guidelines do not establish EMTT as a core treatment, and the studies that exist are mostly small.
Where it fits for you
Offered as an adjunct with the uncertainty stated plainly.
Injection options where pain persists
All ultrasound-guided. Each carries a real cost and a genuinely uncertain benefit, so we go through the numbers with you before you decide.
Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Worth discussing
What it involves
Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.
What the evidence shows
Osteoarthritis is one of the better-studied indications for PRP and some trials report meaningful improvement, but AAOS downgraded its recommendation because results are inconsistent.
Where it fits for you
Reasonable to consider after a conversation about uncertainty, cost, time course and alternatives.
Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. Evidence mixed
What it involves
Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.
What the evidence shows
Randomised trials in knee osteoarthritis report improvement in pain, stiffness and function sustained over a year, but the trials are small and certainty remains low.
Where it fits for you
Considered where pain persists after core care, particularly when the surrounding attachments are tender too.
Viscosupplementation (hyaluronic acid) A gel-like injection into an arthritic joint. Widely used, and genuinely contested. Evidence mixed
What it involves
One or a short series of hyaluronic acid injections into the joint under ultrasound guidance.
What the evidence shows
Guideline bodies disagree: some conclude the average benefit over placebo injection is small and advise against routine use, others allow it in selected patients.
Where it fits for you
May be discussed where corticosteroid is unsuitable or has been used repeatedly.
If the nerves are part of the picture
Burning pain, hypersensitive skin, or pain that does not behave like joint or tendon pain. Relevant for a minority of people, and worth checking for.
Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. Only if relevant
What it involves
Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.
What the evidence shows
Supported mainly by case series and training material, so evidence quality is low to very low.
Where it fits for you
Considered where tender, hypersensitive skin territories are found rather than joint-line pain alone.
Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Only if relevant
What it involves
Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.
What the evidence shows
Hydrodissection is a nerve treatment, not an osteoarthritis treatment.
Where it fits for you
Only if assessment suggests a separate nerve entrapment alongside the arthritis.
This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
Corticosteroid injection is not a stage of this pathway.
Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. Evidence in tendon problems suggests early relief can be followed by worse outcomes at a year than exercise alone, and repeated injections into a joint have been associated with cartilage loss. It does not repair anything.
So we do not build treatment plans around it. Where an injection is the right call, we discuss what is being injected and why, keep the number low, and pair it with the loading work that changes the longer-term course.
When we would still consider it
- Pain severe enough to block rehabilitation
- A clear inflammatory or bursal target on imaging
- A specific short-term goal — a trip, a procedure, a return to work
- Diagnostic use, where the response tells us where the pain is coming from
Frequently asked questions
What should I do when a cramp strikes?
Can my medications be causing cramps?
When do cramps need investigating?
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Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.
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