What is the cause of muscle cramps?

What is the cause of muscle cramps?

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According to Wikipedia, muscle cramps are caused by the inability of myosin fibers to break free from the actin filaments during contraction, resulting in a prolonged contraction.

A lack of ATP would obviously produce cramping, as myosin requires ATP to become free from actin.

However, I have heard that potassium and sodium are useful for treating cramps and that their deficiencies can lead to cramping.

So, how does a deficiency in sodium or potassium result in the inability of myosin fibers to break free from the actin filaments during contraction?

The quick and simple answer:

Cramps of a hypokalemic origin are much more common than those of a hyponatremic origin because the Na-K pump is more effective at moving potassium in comparison to sodium. At the onset of a muscle contraction, the presence of calcium triggers the opening of the Na-K channels in the membrane. Potassium is a calcium inhibitor, so as the potassium flows out of the cell, it eventually reduces the presence of calcium. This causes the closure of the Na-K channel (negative feedback mechanism). In a hypokalemic state, the lack of sufficient K doesn't inhibit the calcium channel, and in turn doesn't properly terminate the muscle contraction at the cellular level.

The continued presence of calcium, which has a lot to do with nerve impulses, means that the nerves keep firing, and in some cases such as a 'charlie horse', these impulses fire fast and continuously. The body at this point is reaching a small local state of metabolic acidosis resulting from the extremely high oxygen consumption, increasing levels of CO₂ (the acidosis component) and reducing blood partial oxygen levels. Since the oxygen is no longer as abundant as it was, it inhibits the bodies ability to locally produce the ribose and phosphate necessary for ATP. Less ATP = more myosin that can't be disconnected from actin = continued muscle cramp.

Muscle contraction occurs when the brain tells the body to move. The brain then starts an action potential down the motor neurons, until it reaches the terminal bouton. At the terminal bouton, it releases the neurotransmitter, acetylcholine, which travels through the myoneural junction and into the myoneural cleft. ACH binds to the receptor, which causes an action potential in both directions along the cell membrane. The action potential repels the potassium, which travels down the cell membrane until it falls into a transverse tubule. K+ continues to fall into a transverse tubule and accumulates, which increases voltage (-70 to -50 mV). The voltage change causes the calcium gates to open and to diffuse the calcium. Calcium then binds to troponin, which in turn binds to tropomyosin and pulls it, exposing the g-actin binding site that allows myosin and actin to bind. The myosin head changes shape (called power or working stroke) and pulls the actin towards the M line, and the muscle contracts. Similar to a tug of war, the myosin heads (your hands) pull on the actin (the rope) to contract a muscle. Like team members in a tug of war, the myosin heads alternate between pulling and holding on to the actin; the only way that myosin will release actin is to add ATP, which forces the two apart and thus relaxes the muscle (as mentioned above).

Now, a lack of potassium, sodium, or calcium would prevent the muscle from contracting but won't relieve a muscle cramp. The common advice of eating a banana actually does help relieve cramps but not because of the potassium. Bananas also have sugar and fat, which are converted into ATP.

Muscle cramps are primarily caused by a lack of ATP in the body. ATP forces the myosin to release the actin; thus, the muscle relaxes and the cramp is relieved.

Another cause could be the lack of magnesium, which helps the ATPase sodium/potassium pump, which, in turn, returns the voltage to resting potential and relaxes the muscle.

One possible reason why low sodium levels induce cramps may lie in the cation selectivity of the nicotinic acetylcholine receptor (nAChR), which is an ion channel. When ACh binds to the receptor site on the nAChR protein, the protein changes shape to open a pore formed by the protein in the cell membrane. This pore allows the influx of both sodium and calcium ions, which induce depolarisation (a positive shift in the membrane voltage) to trigger the voltage-dependent ion channels responsible for action potentials. A reduction in sodium ions would mean more calcium is able to enter the cell through the nAChR. The calcium ion carries greater charge as it is formed by the loss of two electrons from its outer shell, while the sodium ion is formed by the loss of one electron. This means that, each time the nAChR channel opens, the cell undergoes greater depolarisation. The muscle response is harder and faster to the same neural stimulus, which results in a depletion of energy stores.

None of these answers makes sense, and there some minor errors in them. I know that action potentials may continue to fire down the axon. One reason may be because acetylcholinesterase is not coming to the rescue and cleaning up all the acetylcholine in the synaptic cleft. But that usually happens if there are drugs involved. So, in terms of natural muscle cramps, it really does not make any sense whatsoever.

A really good reason is mainly because of a lack of potassium. The function of potassium inside the muscle cell is to repolarize the membrane. However, if there is not enough potassium, the time it takes for it to repolarize is very slow. On the other hand, sodium is used to depolarize the membrane. As a result, since there is an unequal distribution of sodium to potassium, less potassium flows out the membrane while more sodium flows into the membrane, causing it to depolarize faster than it repolarizes. Since the inside of the cell is becoming more positive with the help of sodium, and since the outside of the cell is becoming negative with the help of potassium, the inside of the cell is pulling back the potassium. But, again, there is an unequal distribution of potassium compared to sodium, so it will never achieve that electrochemical equilubrium (resting membrane potential). Since electrochemical equilibrium can not be achieved, sodium is flowing inside the membrane, causing it to depolarize across the membrane and to form an unfused tentanus at a rapid rate.

The rate in which this is happening is so fast that it won't let the myosin head detach from actin for a long period, so it is continuously making the sacromere shorter, causing a pain receptor to travel toward the CNS. This is my hypothesis.

One of the things that I would like to point out is that ATP detached the myosin head but does not control the powerstroke! If there are no more ATP being produce, then rigor mortis results. You will just be really tense/sore because the myosin head is not being released, and it's staying contracted (perhaps a fused tentanus), but it does not make the sacromere shorter if ATP are no longer able to be produced. And if there are no more ATP being produce, it can't be hydrolyzed into ADP and inorganic phosphate (Pi). That would help to create the cross bridge. In addition, inorganic phosphate, not ATP, is the essential compound when you want the power stroke to happen.

A quote from Flex Pharma:

Most muscle cramps are not caused by dehydration, lactic acid, electrolyte imbalance, or muscle tightness. That is why popular remedies like sports drinks, bananas, magnesium tablets, and stretching are usually ineffective. New research has shown that cramps and spasms do not originate in the muscle itself, but are caused instead by a neural mechanism: excessive firing of the motor neurons in the spinal cord that control muscle contraction.

Activation of transient receptor potential (TRP; TRPV1 and TRPA1) ion channels reduces muscle cramps.

What to know about muscle cramps

A muscle cramp is a painful tightness in a muscle due to a sudden, involuntary contraction. Various factors may contribute to muscle cramping, but the underlying cause is often unclear.

Muscle cramps may occur almost anywhere in the body, but some common areas include the legs and feet. People with digestive issues or menstrual cramps may experience muscle cramps in the abdomen.

Muscle cramps are mostly temporary and go away on their own. Some home remedies may help longer lasting cramps pass or ease the symptoms.

However, anyone experiencing persistent cramping should speak with their doctor to get a diagnosis. In some cases, treatment may be necessary.

This article discusses muscle cramps in more detail, including their causes, treatment, and prevention. It also explains when to see a doctor about this issue.

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Muscle cramps are sudden contractions in one or more muscles. These contractions are involuntary, meaning that a person cannot control them.

These cramps can cause uncomfortable symptoms, but, for the most part, they are temporary. The duration of symptoms typically ranges from seconds to minutes.

When muscle cramps occur, the person may feel a sudden tightening in the muscle or muscles in the area. It may feel as though they have flexed their muscle, even if they are otherwise relaxed. This tightening often does not stop and leads to pain in the area as the muscle overcontracts.

The muscle may also seem to twitch or spasm.

In some cases, such as with muscles close to the skin, the person may be able to see the contraction in the muscle. A hard knot or lump of tissue may form in the affected muscle.

Much of the time, it is difficult to identify the exact cause of a muscle cramp. As one article notes, this is because what appears to be a simple cramp often involves the whole bodily system, affecting the person’s emotional and physical state.

Although there are many possible causes of a cramp, in many cases, the underlying cause is unknown. Some muscles may simply start cramping for a short time and then go back to normal.

Cramps may occur anywhere in the body, but they most commonly affect the legs — specifically, the calves. One article notes that about 80% of cramps occur in the calf muscles.

The reason for this may be that people use the calves throughout the day. However, the exact cause may vary in each case.

The authors of an article in Sports Medicine also note that cramps are hard to study because they are largely unpredictable.

Potential causes of temporary cramping

Temporary muscle cramps could have various causes. Issues that may lead to cramping include:

  • overusing a muscle
  • holding a certain position for a long period
  • minor dehydration
  • using a muscle without stretching it first

Muscle loss from aging

General muscle loss from aging, called sarcopenia, may play a role as well.

The American Academy of Orthopaedic Surgeons note that older people are more susceptible to muscle cramps due to normal muscle loss that begins around a person’s mid-40s.

Aging muscles do not work as hard or as quickly, and they may be more susceptible to overuse that could cause cramping.

Other underlying issues

In some cases, a muscle cramp may be a sign of an underlying issue in the body, such as:

  • lack of electrolytes or minerals in the body
  • compressed nerves
  • low blood supply
  • conditions in the thyroid
  • issues during pregnancy

Night cramps

Muscle cramps may occur at night as people sleep, typically in the legs. Research notes that about 37% of people over the age of 60 years in the United States experience nocturnal leg cramps.

Muscle cramps at night may be due to a person keeping the muscles in one position for a long period while sleeping, holding an awkward position in bed, or overusing the muscles throughout the day.

However, as with other types of cramps, cramps at night often do not have an identifiable cause.

Period cramps

People who menstruate often get period cramps before and during menstruation each month. The Office on Women’s Health note that pain is the most common symptom that people experience before or during a period.

The feeling may vary from heaviness in the abdomen to severe cramping in the abdomen and pelvic area.

Pain from period cramps occurs as the uterus contracts. In a period, the uterus contracts to help shed the uterine lining, which the body then expels through the vagina.

Many cramps are temporary and will simply come and go. Some home treatments may ease the symptoms or help the cramp pass.

Gently stretching the muscles in the area may help relieve the symptoms in some people. Applying pressure and performing deep tissue massage in the area may also lessen the symptoms.

Warm compresses may help by causing the muscles to relax a bit, reducing discomfort or pain. Some people may find that a warm shower or bath eases the cramp.

Over-the-counter (OTC) pain relief medications, such as acetaminophen (Tylenol) or ibuprofen (Advil), may help if the symptoms make it difficult to sleep or focus on other tasks.

Those with period cramps may also find that home remedies help. These may include placing warm water bottles or other warm compresses on the area and taking OTC pain relief medication or anti-inflammatory drugs to ease the symptoms.

A person may be able to reduce the chance of muscle cramps by avoiding some of their common causes. Some general prevention tips include:

  • staying hydrated by drinking plenty of water
  • replenishing electrolytes in the body, especially after working out
  • reducing alcohol intake
  • stretching before using the muscles
  • avoiding overexertion, especially when it involves the muscles that tend to cramp up

Even with these tips, some cramps may still occur. It is not always possible to avoid all cases of cramping.

Anyone taking medications that cause dehydration or muscle cramps may wish to speak with their doctor to discuss alternatives.

Many cases of muscle cramps are temporary, with the symptoms appearing and then going relatively quickly. However, in some cases, a person may need to see a doctor for treatment.

People experiencing severe pain from muscle cramps should see their doctor, especially if the pain does not go away. Those who experience other signs and symptoms alongside muscle cramps should also seek medical advice. These signs and symptoms may include:

  • muscle weakness in the cramping muscles
  • swelling in the area
  • numbness
  • skin changes, such as discoloration or rashes
  • cramps that happen frequently or become more common

Additionally, cramps that do not respond to home treatments may be a sign to see a doctor.

A doctor can diagnose any underlying issues and suggest ways to relieve the symptoms.

Although muscle cramps are common, the exact cause is often unknown. Some factors, such as improper stretching, muscle exertion, and electrolyte imbalances, may make cramps more likely.

Most cramps are temporary, with the symptoms going away on their own or with simple home remedies.

It is important to see a doctor for a diagnosis if cramps are severe, become regular, or do not go away with home treatment.

Muscle Cramping During Exercise: Causes, Solutions, and Questions Remaining

Muscle cramp is a temporary but intense and painful involuntary contraction of skeletal muscle that can occur in many different situations. The causes of, and cures for, the cramps that occur during or soon after exercise remain uncertain, although there is evidence that some cases may be associated with disturbances of water and salt balance, while others appear to involve sustained abnormal spinal reflex activity secondary to fatigue of the affected muscles. Evidence in favour of a role for dyshydration comes largely from medical records obtained in large industrial settings, although it is supported by one large-scale intervention trial and by field trials involving small numbers of athletes. Cramp is notoriously unpredictable, making laboratory studies difficult, but experimental models involving electrical stimulation or intense voluntary contractions of small muscles held in a shortened position can induce cramp in many, although not all, individuals. These studies show that dehydration has no effect on the stimulation frequency required to initiate cramping and confirm a role for spinal pathways, but their relevance to the spontaneous cramps that occur during exercise is questionable. There is a long history of folk remedies for treatment or prevention of cramps some may reduce the likelihood of some forms of cramping and reduce its intensity and duration, but none are consistently effective. It seems likely that there are different types of cramp that are initiated by different mechanisms if this is the case, the search for a single strategy for prevention or treatment is unlikely to succeed.

Conflict of interest statement

Ronald J. Maughan and Susan M. Shirreffs have no conflicts of interest relevant to the content of this article.


Postulated abnormal spinal control of…

Postulated abnormal spinal control of motor neuron function during exercise-associated muscle cramp. Based…

How to get rid of muscle cramps

Muscle cramps usually dissipate within seconds or a few minutes. But you don't always have to wait it out. Here's what you can do to ease the cramp and accompanying pain:

Stretch or massage the area

First, try gently massaging the body part that's experiencing a muscle cramp in order to help your tight, cramped muscle relax.

If the cramp is in your calf, this stretch can help relieve the contraction in the muscle, Badia says:

  1. While sitting, grasp the foot of your cramped leg with both hands.
  2. Make sure you keep your leg straight, and slowly pull the top of your foot toward your face. You should feel a slight stretch in your affected calf.

You can also ease calf cramps with this standing stretch:

  1. While standing, bring your opposite knee (not the cramped leg) slowly forward.
  2. Keep the heel of your cramped leg on the ground. You should feel a slight stretch in your affected calf.

As well as being a treatment for cramps, stretching can also help prevent them. Make sure you stretch the muscles you're using before and after workouts — a brief stretching warm-up before your workout, followed by a more thorough cool-down stretch afterwards, is especially helpful.

Foam rolling, in particular, can help prevent muscle cramps, and is also one of the best ways to get rid of sore muscles.

If you frequently get muscle cramps at night, try doing some simple stretches on those muscles before bedtime, suggests Badia.

Drink more fluids

Other strategies to prevent cramps include getting adequate fluids and electrolytes.

If you're working out, a sports drink, like Gatorade, may be helpful since it provides both hydration and electrolytes, says Badia.

Or, if you're worried about cramps in the middle of the night, drink a glass of water before going to sleep to make sure you're well hydrated.

Apply heat or ice

If a cramp occurs during a workout, or as a result of some other physical activity, the first thing you should do is stop the activity.

Then, you may want to try a heating pad, which helps the muscles relax and can provide pain relief. Additionally, you can try massaging it with ice, which may help relieve any soreness.

Measures to prevent cramps include the following:

Not exercising immediately after eating

Gently stretching the muscles before exercising or going to bed

Drinking plenty of fluids (particularly beverages that contain potassium) after exercise

Not consuming stimulants (eg, caffeine, nicotine , ephedrine, pseudoephedrine )

The runner’s stretch is most useful. A person stands with one leg forward and bent at the knee and the other leg behind and the knee straight―a lunge position. The hands can be placed on the wall for balance. Both heels remain on the floor. The knee of the front leg is bent further until a stretch is felt along the back of the other leg. The greater the distance between the two feet and the more the front knee is bent, the greater the stretch. The stretch is held for 30 sec and repeated 5 times. The set of stretches is repeated on the other side.

Most of the drugs often prescribed to prevent cramps (eg, calcium supplements, quinine , magnesium, benzodiazepines) are not recommended. Most have no demonstrated efficacy. Quinine has been effective in some trials but is no longer recommended because of occasional serious side effects (eg, arrhythmias, thrombocytopenia, thrombotic thrombocytopenic purpura [TTP] and hemolytic-uremic syndrome [HUS], severe allergic reactions). Mexiletine sometimes helps, but whether using it is worth the risk of adverse effects is unclear. These effects include nausea, vomiting, heartburn, dizziness, and tremor.

Some athletic coaches and physicians recommend pickle juice for muscle cramping, but data concerning its efficacy are insufficient.

What causes exercise cramps?

Muscle cramps during exercise can be debilitating, so it's hardly surprising that people go to great lengths to avoid them. The sports world is full of "secrets" for avoiding cramps, from Epsom salt baths to drinking pickle juice or mustard, most of which are ineffective.

So, what causes muscle cramps during or after exercise? Researchers have hypothesized that exercise cramps might be caused by electrolyte imbalance or dehydration, but that's primarily based on anecdotal evidence. Many experts agree that the strongest scientific evidence points to muscle cramps being caused by a miscommunication between the tendon that controls the muscle and the nervous system. According to a 2009 review by Dr. Martin Schwellnus, a professor and sports medicine physician at the University of Pretoria in South Africa, the miscommunication that causes exercise-associated muscle cramps (EAMC) is most likely the result of muscle fatigue.

Muscles constantly communicate with the nervous system, telling it whether they are stretched or contracted. When a muscle becomes fatigued, the signals between the tendon and the central nervous system essentially become confused. Instead of signaling for the muscle to contract, and then relax, the central nervous system sends more signals for the muscle to keep contracting. The signal to relax doesn't get through and the muscle cramps.

If you tend to get muscle cramps, you may have a genetic predisposition based on the type of collagen in your tendons, according to research by Malcolm Collins, a professor of exercise science and sports medicine at the University of Cape Town in South Africa. You're also more likely to suffer cramping during exercise if you've experienced it before, and if you've had injuries to the tendons or ligaments, according to Schwellnus' 2009 review.

The best way to relieve cramps? Forcefully stretch the cramping muscle. This stops the muscle from contracting and allows the relaxation signals to be received.

The simplest way to avoid cramps during and after exercise is to avoid overexertion. Several studies have found that athletes who cramped were often running faster than their normal speeds. Exercising in hot or humid conditions is more tiring and will cause muscles to fatigue faster. Staying hydrated and making sure your body is properly conditioned for exercise will also help stave off the fatigue that causes cramps.

What Causes Muscle Cramps All Over Your Body?

Some of the causes of muscle cramps all over the body include strains and sprains, peripheral neuropathy, and kidney failure. Other causes are rickets and low blood sodium, states Healthline. Muscle cramps are the involuntary and sudden contractions that affect the different muscles in the body.

Strains and sprains occur when a person engages in physical activity. They affect the muscles and mostly occur in the groin, calf or thigh and can be severe or mild, explains Healthline.

The peripheral nervous system links the nerves from the spinal cord and brain to other parts of the body such as legs, hands, face, arms and internal organs. If the nerves are destroyed or damaged, they malfunction, and peripheral neuropathy occurs, sometimes sending pain to parts of the body, according to Healthline.

The body has two kidneys with one on every side of the spine. They get rid of toxins from the body and send them to the bladder and also filter blood. Kidney failure happens when the kidneys fail to remove waste from the blood as they should, notes Healthline.

Rickets is as a result of phosphate, vitamin D or calcium deficiency. It makes the body have soft and weak bones. In severe cases, it can cause deformities in the skeleton, according to Healthline.

Sodium is an important electrolyte that controls the balance of water in the cells of the body. It contributes to the proper functioning of the nerves and muscles. If water and sodium are not in balance, low blood sodium occurs, and that prevents the nerves and muscles from functioning properly, explains Healthline.

Prevention of Muscle Cramps

Preventing cramps is the best approach. The following measures can help:

Not exercising immediately after eating

Gently stretching the muscles before exercising or going to bed

Drinking plenty of fluids (particularly sports beverages that contain potassium) after exercise

Not consuming caffeine (for example, in coffee or chocolate)

Avoiding drugs that are stimulants, such as ephedrine or pseudoephedrine (a decongestant contained in many products that do not require a prescription but are available only behind the pharmacy counter)

Stretching makes muscles and tendons more flexible and less likely to contract involuntarily. The runner's (gastrocnemius) stretch is the best stretch for preventing calf cramps. A person stands with one leg forward and bent at the knee and the other leg behind with the knee straight—a lunge position. The hands can be placed on the wall for balance. Both heels remain on the floor. The knee of the front leg is bent further until a stretch is felt along the back of the other leg. The greater the distance between the two feet and the more the front knee is bent, the greater the stretch. The stretch is held for 30 seconds and repeated 4 or 5 times. Then the set of stretches is repeated on the other side.

1. Stand facing or next to wall with hands on the wall for support.

2. Place uninvolved leg forward.

3. Keep rear leg straight with knees and toes pointing toward the wall, keep rear heel on the floor.

4. Bend knee on uninvolved leg and lean hips toward the wall to feel a stretch along the calf of the rear leg.

5. Hold stretch for 30 seconds.

6. Do 1 set of 4 repetitions, 3 times a day.

(It is important to maintain a straight back posture with the heel firmly planted [not lifted] during the stretch.)

Did You Know.

Stretching helps prevent cramps because it makes muscles less likely to contract involuntarily—without the person's intending it.

Related Information

Other Works Consulted

  • American Academy of Neurology (2010). AAN summary of evidence-based guideline for clinicians: Symptomatic treatment for muscle cramps. Available online:
  • American Academy of Neurology (2010). AAN summary of evidence-based guideline for patients and their families: Drug treatments for symptoms of muscle cramps. Available online:
  • Katzberg HD, et al. (2010). Assessment: Symptomatic treatment for muscle cramps (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 74(8): 691–696. Available online:
  • Young G (2014). Leg cramps. BMJ Clinical Evidence. Accessed April 14, 2016.

Maintaining Neuromuscular Performance

Some important clues have surfaced over the past few years that lend support to the notion that “calming” hyper-excited nerves will prevent muscle cramps. An initial finding is that cramp-prone subjects require less electrical stimulation to produce a cramp, suggesting that their neuromuscular systems are more sensitive to cramping 2 . This observation helps explain why some athletes are haunted by cramps, while others rarely have a problem.

There have been many proposed “cures” for muscle cramps, including eating mustard and drinking pickle juice. At first, the effectiveness of pickle juice baffled scientists, but laboratory studies confirmed its benefit, at least on small muscle groups in the foot that were electrically stimulated to cramp 3 . Those results led scientists to speculate that pickle juice might activate sensory fibers in the mouth and throat and send signals to the nervous system that calm down hyper-exitable motoneurons and reduce the duration of a cramp.

This mouth-to-spine-to-muscle connection is not as far-fetched as it may sound. We have all experienced how the nervous system reacts to icy-cold drinks, acidic solutions such as pickle juice, and hot spices. For example, “brain freeze” often occurs as a result of quickly drinking ice-cold beverages because of rapid cooling of the sphenopalatine ganglion, a cluster of nerves adjacent to the roof of the mouth. For similar reasons, certain spices and other natural ingredients may be good anti-cramp candidates because spices such as capsaicin in red peppers activate specific membrane channels in sensory nerves called TRP channels that are found in the oropharyngeal region (mouth and throat) and esophagus that project to the spinal cord and indirectly inhibit hyper-excited alpha motoneurons.

This theory came to MacKinnon, who is an endurance athlete and sea kayaker himself, after a bout of debilitating cramps on the open ocean. The experience reminded him that, aside from being a painful nuisance, muscle cramps could mean the difference between life and death in some situations. MacKinnon won the 2003 Nobel Prize in chemistry for his work in understanding how channels in cell membranes work to move ions such as potassium from one side of a membrane to the other. Building on this, he reasoned that the right combination of natural TRP channels activators could switch on nerves that could in turn inhibit the over-active alpha motoneurons that cause cramping.

MacKinnon’s original idea has triggered a wave of laboratory and field research, with recent results demonstrating that the frequency and duration of cramps can be reduced when subjects ingest a specially formulated spicy beverage before exercise.

As a result of this research, we are coming closer to the understanding the true cause of cramping. So, while electrolytes, hydration, and fitness certainly matter for performance, athletes should not be looking to those elements to cure their cramping issue. As we continue to learn more about the root cause of cramps, we will also begin to understand how we can prevent them.