Wednesday, August 20, 2014

I hate you Charley, and the horse you rode in on

Sunday is the one chance I get to wake without an alarm, but the sweet dream of sleeping in often alludes me. Sunday at 4:00 am is when bombastic thunderstorms like to roll over my house.  Or one of the kids has the worst nightmare ever. Or some bird decides to whistle the most obnoxious symphony right outside my window. But even if I manage to dodge all these premature wake up calls, a Charley Horse rides into town looking for a fight.

We’ve all experienced this neuromuscular hell at one time or another. Mine come totally unprovoked. I’m just sleeping for crying out loud, and then I’m crying out loud - wide awake and trying to twist my leg off in order to stop the excruciating pain.

A Charley Horse basically feels like someone has twisted the muscles in your leg in the opposite direction of how they are supposed to run. The sensation is due to a spasm in those muscles, which usually subsides fairly quickly, although it feels like you could watch all the Harry Potter movies before the pain ends.

“Quick, Hermione, what is the spell that cures a Charley Horse?”

Known in some circles as “nocturnal leg cramps”, and in other circles as “just amputate my @&*$# leg!”, the Charley Horse is poorly understood. We don’t even know why we call it a Charley Horse. The reference first appears in the 1880s, believed to have its origins in baseball. According to this article, “the earliest known use of the term is from the Boston Globe, 17 July 1886:  Several years ago, says the Chicago Tribune, Joe Quest, now of the Athletics, gave the name of “Charley horse” to a peculiar contraction and hardening of the muscles and tendons of the thigh, to which baseball players are especially liable from the sudden starting and stopping in chasing balls, as well as the frequent slides in base running.”

But who is this Charley? Some say it was a ball player who owned a lame horse, but others say it was an actual lame horse, possibly the one that pulled the roller at the White Sox ballpark in Chicago at the time. But in 1907, according to World Wide Words, the American Dialect Society claimed that the phrase referred to the pitcher Charley Radbourne, nicknamed Old Hoss, who suffered leg cramps during a ball game. So it is possible that the original reference did not involve horses at all. 

“Charley Hoss, Charley Horse. Pretty close, especially in Boston.”
Obviously, people were getting these involuntary leg cramps long before we decided to hitch them to a Charley or a horse. The leading school of thought is that the muscles get all bent out of shape because of dehydration or an electrolyte imbalance. But before you go swimming in Gatorade, let’s review what a muscle is and why the minerals sodium, potassium, and calcium are important to function.

So a Charley Horse is basically a locked muscle contraction. For some reason, the muscles are “high strung” and won’t relax as quickly as they should. If you need another argument against intelligent design, the Charley Horse has legs.

Some have speculated that these satanic cramps can be prevented with dietary supplements. Magnesium is commonly touted as a solution to prevent Charley Horses but don’t giddy-up to your local GNC just yet. A Cochrane study performed in 2012 concluded that, “It is unlikely that magnesium supplementation provides clinically meaningful cramp prophylaxis to older adults experiencing skeletal muscle cramps.”
"They’ll put a cramp in your wallet and you’ll still get cramps in your legs."

How about stretching your legs before bed? While stretching doesn’t do any harm, it unfortunately is not likely to keep Charley Horses in the stable. There has also been a Cochrane analysis for the use of quinine to treat muscle cramps. While quinine does show modest benefit, the risks of serious side effects do not outweigh the possible benefit.

Your doctor is likely to tell you to stay hydrated. However, the idea that dehydration is linked to leg cramps simply doesn’t hold water when researchers put it to the test. Interestingly, what does provide relief is…pickle juice! Yes, just say it three times fast and the cramps will go away…no, wait, that’s Beetlejuice.

Testing this old home remedy, scientists artificially induced muscle cramping with electricity and then administered pickle juice or water. The pickle juice, but not the water, resolved the cramps faster. But since the cramp subsided faster than electrolytes from the pickle juice could possibly be replenished, the mechanism behind the pickle juice remains unknown. The authors of the study speculate, “Something in the acidic juice, perhaps even a specific molecule of some kind, may be lighting up specialized nervous-system receptors in the throat or stomach…which, in turn, send out nerve signals that somehow disrupt the reflex melee in the muscles.”

I guess for now, the Charley Horse will remain a physiological mystery. I’m sure I’ll have time to contemplate it next Sunday at 5:00 in the morning.

Contributed by:  Bill Sullivan
Follow Bill on Twitter @wjsullivan

Garrison SR, Allan GM, Sekhon RK, Musini VM, & Khan KM (2012). Magnesium for skeletal muscle cramps. The Cochrane database of systematic reviews, 9 PMID: 22972143

Coppin RJ, Wicke DM, & Little PS (2005). Managing nocturnal leg cramps--calf-stretching exercises and cessation of quinine treatment: a factorial randomised controlled trial. The British journal of general practice : the journal of the Royal College of General Practitioners, 55 (512), 186-91 PMID: 15808033

El-Tawil S, Al Musa T, Valli H, Lunn MP, El-Tawil T, & Weber M (2010). Quinine for muscle cramps. The Cochrane database of systematic reviews (12) PMID: 21154358

Miller KC, Mack GW, Knight KL, Hopkins JT, Draper DO, Fields PJ, & Hunter I (2010). Three percent hypohydration does not affect threshold frequency of electrically induced cramps. Medicine and science in sports and exercise, 42 (11), 2056-63 PMID: 20351595

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