Sunday, August 14, 2016

Muscle Cramps in athletes a form of nervous tic

I recently came across an article "Spicy End to Muscle Cramps" (Tuesday, July 12, 2016) in Wall Street Journal about a problem that athletes unexpectedly develop and which, because of crippling pain and stiffness, forces them to withdraw from the competition, ruining years of their efforts in matter of seconds.
The article describes how two neurobiologists with excellent credentials - one of them, Rod Mackinon, a Nobel prize-winner in Chemistry and the other, Bruce Bean, from Harvard - have finally put to rest the standard thinking on the matter, which was universally accepted by sports doctors and other experts, that muscles go into spasm because of some problem in the muscle cells like dehydration, electrolyte imbalance, microtears in its fibers, or simply fatigue.
The standard thinking had flaws. For one thing, athletes developed muscle cramps out of the blue, sometimes at the very beginning of a marathon, when they are adequately hydrated and their electrolytes were in good shape, and sometimes they did it while in bed, resting, where there can be no question of fatigue, microtears and dehydration. So the neurobiologists reasoned that the culprit may be the nerves that control the muscles rather than the muscles themselves.  
The article states that the two scientists hypothesized that the problem lies in the misfiring of the nervous system. While the article does not state it explicitly, I assume what they mean is that something happens in the nervous system which sends signals to the muscles to contract in such a rapid fashion that it locks them in a continuous contraction (tetany), preventing them from doing their job in a coordinated manner.
As to why the nervous system starts misfiring they have a curious explanation. They think the misfiring - which really should be excessive firing - has no advantage to the organism. Nothing like the pain that makes us pull away from a hot stove, and the phenomenon has not evolved to prevent injury and help us survive, but it happens because the human body isn't perfectly advanced machine. In short there is no rhyme and reason to this unnecessary muscle cramps happening other than to ruin an Olympian's chance of getting the gold medal.
But does it not sound weird, especially coming from a Nobel Laureate in science, that a phenomenon has no cause, but is just a freak imperfection of human body!
Their error lies in an inability to look beyond the physical, as opposed to the mental, when it comes looking for etiology of human problems. Granted they went a step above the pure physical in recognizing that it is not some form of gross malady like muscle tear, dehydration or fatigue that results in spasm but nerves, but they did not take the next logical step of examining what causes the nerves to go into that disadvantageous mode, simply chalking it to the imperfection of evolutionary process. 

Now we know that anxiety causes causes muscle spasms. In Anxiety Neurosis (Generalized Anxiety Disorder) the whole body stays in a state of tension, all the muscles getting geared up into  minispasms. Perhaps much of the diseases of arthritis, back pain, even autoimmune disorders where chronic muscle tension causes break down of muscle components (mini rhabdomyolysis) which are treated by the immune system as foreign bodies,  may owe their existence to chronic anxiety.
An observation whose worth we will soon see is that muscle tension in anxiety is not always uniformly distributed. In somatic anxiety it may appear in patchwork, as isolated neck or back spasm, or stomach cramps, or in lower intestines as various manifestations of colitis, or in the respiratory tract as asthmatic attacks, or in the detrusor  muscles as in urinary frequency. In extreme anxiety the spasm may get so uncoordinated that the whole skeletal system becomes a firework of fasciculations.
Could sudden appearance of muscle cramps (spasms) in athletes be a manifestation of somatic anxiety?
It goes without saying that sports are a venue for discharge of surplus aggression. What humans - a highly aggressive species - cannot discharge upon each other for fear of causing actual injury, which will trigger retaliation, they do so in play and in sports. But even in play and sports there is always surplus aggression left, generated by extreme competitiveness, that cannot be discharged upon the opponent and in the game, but must come out in obsessive rituals. Obsessive rituals themselves being nothing but acts of symbolic aggression followed by symbolic undoing of it; the two motor acts - aggression and its reversal - blended together. This explains why so many athletes suffer from obsessive-compulsive traits, many of them compelled to do their obsessive rituals, including superstitious acts and magical mental mantras, before the start of the game. If they do not discharge that excessive aggression in obsessive rituals then they would not have the optimal level of aggression in the game. For a good game requires just the right degree of "killer instinct". Too much or too little of it, instead of killing the opponents game, will defeat one's own game.  
But it is not always we can bind all our aggression with obsessions. Some of it can still exist in form of raw anxiety which can lead to tensing up of the muscles. It is really an attempt to make a fight or flight with whatever is oppressing one's being. And then we see a whole range of pathological muscle activities which are variants of obsessions and compulsions: tics, throat clearing, spitting, Tourette-like use of foul language, and what is dreaded by the athletes, a crippling muscle spasm.
So it is the anxiety over confrontation - for sports are nothing but an organized way of confronting the competition to show who is better - that gives rise to muscle spasms, whose purpose, self-defeating of course, is to take one out of the game. It is kind of disqualifying oneself to avoid confrontation.
How does one explain then people who while swimming in isolation suddenly go into muscle spasms and die unable to swim? They are not in competition therefore it cannot be unleashing of some great aggression that translates into locking up of the muscles to produce one's own death? Or can it be? Often we discharge aggression not at the site where it was occasioned for it would be inexpedient there, but at some other venue totally unrelated. In our bedroom, when relaxing, and when it is safe to do so, or in our dream where the danger is imagined and not real, and perhaps in water when the lure to submerge oneself in that intrauterine like state forever, away from the strife of existence, may feel so tempting.
The two scientists cure for muscle spasms is interesting and throws light upon the etiology. They overload the sensory system of mouth and stomach by pungent tasting food or drink. They think "the strong sensory input causes inhibition of the motor output." And they proved the correctness of the hypothesis by showing that pungent food like juices from pickles, beets or sour berries, made it harder to induce spasms with electric impulses.
But does an increase in sharp sensory input really numb the motor response? Or if we recall our physiology from college days, does it actually increase it? Now we know that sensory input because of the reflex arc causes the motor response not suppresses it. When we go to sleep we deliberately put a block on all sensory input in order to get the body into total quiescence, with no motor output, so we can into the immobility of sleep.  
So if pungent food increases the motor activity why does it lessen the skeletal muscle spasms?
Perhaps what happens is that the pungent food causes a spike in gastrocolic reflex with the reflex motor output getting directed to the intestinal muscles. The excessive aggression then finds discharge in involuntary muscles, sparing the discharge upon the skeletal. Both are controlled by acetylcholine, the neurotransmitter that causes the muscles to contract and is undoubtedly the main conduit for the discharge of aggressive instinct.  Release of aggression (acetylcholine mediated neurotransmission) through non-skeletal muscles upon one's own self frees the person to have a more modulated competitiveness towards one's sport rivals. The process is perhaps not too dissimilar as to how vagal nerve stimulation in depressed patients unfreezes their brain from acetylcholine's straitjacketing. Discharge of aggression at one point lessens it at another. Causing pain and irritation in the esophagus and stomach with the resulting spasms in the intestinal tract, unfreezes the spasm in the skeletal muscles.