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Muscle cramps and contractures: causes and treatment
  1. Jildou N. Dijkstra1,
  2. Eline Boon1,
  3. Nick Kruijt1,
  4. Esther Brusse2,
  5. Sithara Ramdas3,4,
  6. Heinz Jungbluth5,6,
  7. Baziel G.M. van Engelen1,
  8. Jon Walters7,
  9. Nicol C. Voermans1
  1. 1 Department of Neurology, Radboud Universiteit, Nijmegen, The Netherlands
  2. 2 Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
  3. 3 MDUK Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, UK
  4. 4 Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
  5. 5 Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's and St Thomas' Hospitals NHS Trust, London, UK
  6. 6 Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, UK
  7. 7 Department of Neurology, Morriston Hospital, Swansea, UK
  1. Correspondence to Nicol C. Voermans, Department of Neurology, Radboudumc, Nijmegen, Gelderland, Netherlands; Nicol.voermans{at}


Muscle cramps are painful, sudden, involuntary muscle contractions that are generally self-limiting. They are often part of the spectrum of normal human physiology and can be associated with a wide range of acquired and inherited causes. Cramps are only infrequently due to progressive systemic or neuromuscular diseases. Contractures can mimic cramps and are defined as shortenings of the muscle resulting in an inability of the muscle to relax normally, and are generally myogenic. General practitioners and neurologists frequently encounter patients with muscle cramps but more rarely those with contractures. The main questions for clinicians are: (1) Is this a muscle cramp, a contracture or a mimic? (2) Are the cramps exercise induced, idiopathic or symptomatic? (3) What is/are the presumed cause(s) of symptomatic muscle cramps or contractures? (4) What should be the diagnostic approach? and (5) How should we advise and treat patients with muscle cramps or contractures? We consider these questions and present a practical approach to muscle cramps and contractures, including their causes, pathophysiology and treatment options.

  • muscle disease
  • neuromuscular

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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  • JND and EB are joint first authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned. Externally peer reviewed by James Lilleker, Manchester, UK.

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