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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35467
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I'm having severe cramping in my right leg and arm several

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I'm having severe cramping in my right leg and arm several times a day. It happens when I get up from sitting or sometimes if I'm in bed and stretch. The cramping is so severe that my toes are rigid and my fingers go stiff and I have to sit on my hand. The seizures last less than a minute and are incredibly painful. Sometimes an additional symptom is that I will feel a very warm sensation running from my left buttocks down to my left ankle as the cramping is subsiding on the right side. My brain MRI was normal as were my electrolytes. Suggestions as to what this might be and how to stop it? It started suddenly mid-April of this year and I've had at least one episode every day since, sometimes up to 8 of them in one day.


The exact cause of cramps is not well understood, but there are some risk factors that are thought to contribute to this condition:

1) Muscle fatigue,

2) Heavy exercising,

3) Dehydration,

4) Over weight

5) Electrolyte imbalances,

6) Vitamin deficiency,

7) Age above 50.

The medical causes related to the disease process are;

1) Calcium and phosphorus imbalances can cause cramping.

2) Low potassium or sodium (salt) levels.

3) Deficiencies of a nutrient called hesperidin, an antioxidant flavonoid found in oranges and other citrus fruits, have also been linked to nocturnal leg cramps.

4) Overexertion, standing on concrete for long periods, or prolonged sitting (especially with the legs contorted) may contribute to nighttime cramps.

5) Having structural disorders in the legs or feet (such as flat feet) may increase the risk for cramps.

6) Among the many medical causes of muscle cramping include hypothyroidism, Addison's disease, uremia, hypoglycemia, anemia, and certain medications. An hormonal evaluation, if not yet done, in your case may point to any causative.

Electrolyte imbalances is generally considered the most common main cause. A repeat blood electrolyte level may also help. Some researchers believe inadequate stretching and muscle fatigue leads to abnormalities in mechanisms that control muscle contraction. Other factors may also be involved, including exercising or working in intense heat and dehydration.

Prevention of the cramps is the best cure; for that following measures should be employed:

1) Drink water at regular intervals, even whey you are not thirsty.

2) Drink more than what you require.

3) Drink fruit juice or a sports beverage if the working conditions are hot and one sweats a lot.

4) If cramps occur frequently, stretching exercises help. Muscle relaxant like chlorzoxazone can also help (you are already taking them).

5) Following exercise may help you before you go to bed; Stand about 30 inches from a wall and, keeping the heels flat on the floor, lean forward and slowly move the hands up the wall to achieve a comfortable stretch.

6) A few minutes on a stationary bicycle at bedtime may also help.

7) While in bed, loose covers should be used to prevent the toes and feet from pointing, which causes calf muscles to contract and cramp easily.

8) Propping up the feet up than the rest of the body may also help.

9) During the week, swimming and water exercises are a good way to keep muscles stretched, and wearing supportive footwear is also important.

10) Eating more nuts, seeds, seafood and low-fat dairy would help.

Also, take Calcium and vitamin D with a supplement of magnesium and zinc a day. Gatorade, can help as it contain electrolytes. If still no change, then do follow up with your doctor for a blood test to check the electrolytes and hormones like thyroid, adrenal and parathyroid. Read the resource which tells you specifically about the night cramps;

Once a cramp starts, do the following measures so it is arrested immediately;

1) Straighten the leg, flex the foot upward toward the knee, or grab the toes and pull them toward the knee.

2) Walking or shaking the affected leg, then elevating it, may also help.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Dr. Arun

Customer: replied 6 years ago.

This began initially when my doctor put me on 30mg of Cymbalta. I was in my 2nd week of dosage and had begun to take the 60mg dosage (day two) about the time this started. My doc did not see a correlation initially but then found an uncommon side effect from Cymbalta is muscle cramping so she took me off of it. Shortly after this, I saw a different doctor who started me on Levothyroxin (she claims that there is no "normal" for thyroid levels and that my thyroid is underactive) and she said that this Levothyroxin would also help eradicate the remaining Cymbalta in my system. I haven't noticed a real change in that; the only real change I found was having a deep tissue massage and I only had one episode per day for the two days following that. My legs feel weak all the time now and my right arm is constantly sore as if bruised.

As far as straightening my leg during a cramp, it is impossible for me to do so, but my husband will hold my leg straight for me and I will lay on my hand (or he holds that, too) until it abates. I drink water all day (but interestingly enough, the day this started was following a weekend where I was not drinking water because we were out of town) and if I try to force a stretch it brings on an episode of severe cramping.

The thing that my physician and chiropractor and neurologist find so odd is that it is ONLY the right side of my body that cramps. When the cramping is particularly severe, I can also feel it in my right side along my ribs. I will follow up with my physician for more testing re: calcium, magnesium, phosphorous, potassium, et al. My appointment is next week - anything else I should request from her?


The causes of cramping can be mainly related to three;

1) electrolytes

2) hormones

3) neurological.

Ask for the thyroid, parathyroid and adrenal function tests, if not done earlier. If all these are normal, you may ask for MRI with gadolinium contract and MRI of neck (since predominantly they occur only on one side).

It is privilege assisting you.

Dr. Arun

Customer: replied 6 years ago.
One more thing: The same doc who prescribed the Levothyroxin also gave me Phentermine and I thought I noticed a lessening in the severity of the spasms while I was taking it. But the neurologist I saw told me not to take it so I stopped. Doesn't Phentermine affect the adrenals? If so, perhaps the idea that I was feeling better while taking it may point to the underlying issue here (the adrenal gland?)?


Phentermine can affect the adrenal. But feeling better during taking it may not be conclusively pointer to adrenal gland disorder. Blood work abnormalities for the adrenal gland are needed to substantiate it. So while all these give clues; a detailed work up, as we discussed is warranted to pin point the issue for your significant symptoms.

Dr. Arun

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