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Original ArticleOpen Access
The Relationship Between Myofascial Trigger Points of Gastrocnemius Muscle and Nocturnal Calf Cramps
Prateepavanich P 
,
Charoensak T
,
Charoensak T To support that myofascial pain syndrome (MPS) of gastrocnemius muscle is one cause of
nocturnal calf cramps, quantitative assessment of the efficacy of trigger point (TrP) injection compared
with oral quinine in the treatment of nocturnal calf cramps (NCC) associated with MPS of
gastrocnemius muscle was designed. Twenty four subjects with NCC and gastrocnemius TrPs were
randomly divided into two groups of twelve for each treatment. Patients in group I were treated
with xylocaine injection at the gastrocnemius TrP, and 300 mg of quinine sulfate p.o. was prescribed
for patients of group 2. The treatment period was four weeks with a follow-up 4 weeks later.
Cramps were assessed quantitatively (in terms of frequency, duration, pain intensity, cramp
index, and pain threshold of the gastrocnemius TrPs) before treatment, after treatment and at the
end of the follow-up respectively. The outcome of treatment in both groups showed a statistically
significant reduction in all quantitative aspects of cramps (95% confidence interval). Also the pain
threshold of the gastrocnemius TrP was significantly increased in group I only when comparing the
pre-treatment and at the end of follow-up. In comparing the two groups we found no statistical
difference during the period of treatment. The benefit of both strategies lasted up to four weeks
following cessation of the treatment but the outcome of all measures (except pain threshold) were
found to be significantly better in the group treated with TrP injection. The results of this study
support that gastrocnemius trigger point is one cause of NCC and show that the TrP injection
strategy for NCC associated with myofascial pain is not only as effective as oral quinine during
the treatment period but also better in the prolonged effect at follow-up.
Key word : Trigger Point, Cramp
nocturnal calf cramps, quantitative assessment of the efficacy of trigger point (TrP) injection compared
with oral quinine in the treatment of nocturnal calf cramps (NCC) associated with MPS of
gastrocnemius muscle was designed. Twenty four subjects with NCC and gastrocnemius TrPs were
randomly divided into two groups of twelve for each treatment. Patients in group I were treated
with xylocaine injection at the gastrocnemius TrP, and 300 mg of quinine sulfate p.o. was prescribed
for patients of group 2. The treatment period was four weeks with a follow-up 4 weeks later.
Cramps were assessed quantitatively (in terms of frequency, duration, pain intensity, cramp
index, and pain threshold of the gastrocnemius TrPs) before treatment, after treatment and at the
end of the follow-up respectively. The outcome of treatment in both groups showed a statistically
significant reduction in all quantitative aspects of cramps (95% confidence interval). Also the pain
threshold of the gastrocnemius TrP was significantly increased in group I only when comparing the
pre-treatment and at the end of follow-up. In comparing the two groups we found no statistical
difference during the period of treatment. The benefit of both strategies lasted up to four weeks
following cessation of the treatment but the outcome of all measures (except pain threshold) were
found to be significantly better in the group treated with TrP injection. The results of this study
support that gastrocnemius trigger point is one cause of NCC and show that the TrP injection
strategy for NCC associated with myofascial pain is not only as effective as oral quinine during
the treatment period but also better in the prolonged effect at follow-up.
Key word : Trigger Point, Cramp
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