Cramps Research Articles

A Case Report on the Management of Asthikshaya (Nutritional Rickets) by Ayurveda and Yoga

Rickets is a disorder of growing bone due to abnormal mineralisation of bone. It affects longer bones, leading to poor bone growth and bony deformities such as bow legs and knock-knees in children. No direct description of such disease has been found in Ayurveda; the clinical manifestations due to Asthikshaya (deficient bony tissue) can be considered as rickets. Despite conventional treatment of supplementation of deficient nutrients, many children do not show satisfactory response to the treatment. This is a case report of nutritional rickets in a 3.5-year-old boy who presented with leg pain, cramps and frequent falls due to knocking of knees for the last four months. He was treated with the combined principles of Ayurveda and Yoga. The patient was treated with oral drugs like Ashwagandhadi Churna, Kukkutandatwaka Bhasma, Godanti Bhasma, Muktashukti Bhasma, Lakshadi guggulu, Gandha Tail, Tiktaksheer Basti (medicated enema), Sthanika Snehan-Swedana (local oleation and sudation), Gatravestana (bandaging), knee braces, and practice of Yogasana like Tadasana (standing pose), Vrikshasana (tree pose), Utkatasana (chair pose), and Bhadrasana (butterfly pose). The symptoms were relieved, the biochemical parameters were improved and no further bending of lower limbs was observed. Thus, the patient of nutritional rickets was treated with Ayurveda and Yoga.

A Study to Assess the Effectiveness of Intradialytic Exercises on Prevention and Reduction of Muscle Cramps among Patients undergoing Hemodialysis in a Selected Tertiary Care Hospital of Western Maharashtra

A Study to Assess the Effectiveness of Intradialytic Exercises on Prevention and Reduction of Muscle Cramps among Patients undergoing Hemodialysis in a Selected Tertiary Care Hospital of Western Maharashtra

Antenatal Care: A Comparative Review of Guidelines.

Antenatal care plays a crucial role in safely monitoring and ensuring the well-being of both the mother and the fetus during pregnancy, ultimately leading to the best possible perinatal outcomes. The aim of this study was to review and compare the most recently published guidelines on antenatal care. A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Public Health Agency of Canada, the World Health Organization, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists regarding antenatal care was conducted. There is a consensus among the reviewed guidelines regarding the necessary appointments during the antenatal period, the proper timing for induction of labor, the number and frequency of laboratory examinations for the assessment of mother's well-being, and management strategies for common physiological problems during pregnancy, such as nausea and vomiting, heartburn, pelvic pain, leg cramps, and symptomatic vaginal discharge. In addition, special consideration should be given for mental health issues and timely referral to a specialist, reassurance of complete maternal vaccination, counseling for safe use of medical agents, and advice for cessation of substance, alcohol, and tobacco use during pregnancy. Controversy surrounds clinical evaluation during the antenatal period, particularly when it comes to the routine use of an oral glucose tolerance test and symphysis-fundal height measurement for assessing fetal growth, whereas routine cardiotocography and fetal movement counting are suggested practices only by Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Of note, recommendations on nutritional interventions and supplementation are offered only by Public Health Agency of Canada and World Health Organization, with some minor discrepancies in the optimal dosage. Antenatal care remains a critical factor in achieving positive outcomes, but there are variations depending on the socioeconomic status of each country. Therefore, the establishment of consistent international protocols for optimal antenatal care is of utmost importance. This can help provide safe guidance for healthcare providers and, consequently, improve both maternal and fetal outcomes.

Arthroscopic Biceps Tenodesis With Interference Screw Fixation: A Technique Video

Background: Management of long head of the biceps tendon (LHBT) pathology is accomplished through a biceps tenotomy or tenodesis. While both modalities provide beneficial outcomes, a biceps tenodesis may confer improved cosmesis, functional outcomes, and decreased muscle cramping postoperatively. Many procedural considerations are undertaken prior to a tenodesis, such as the surgical approach and fixation device. While similar clinical outcomes are achieved between an open subpectoral and arthroscopic suprapectoral biceps tenodesis (ASPBT) with interference screw (IS) fixation, the latter technique offers a minimally invasive modality. Indications: The primary indications for an ASPBT include superior labrum anterior posterior (SLAP) tears, LHBT tears, biceps instability, bicipital tunnel disease, biceps pulley lesions, and biceps tenosynovitis. Contraindications to the arthroscopic approach include a distal lesion of the biceps tendon below the pectoralis major tendon (PMT). The IS may be used to create a biomechanically stiffer construct. Technique Description: With the arthroscope in the lateral portal, the distal aspect of the bicipital groove proximal to the superior border of the PMT is identified and opened. The LHBT is subsequently mobilized and released. An anterosuperolateral portal is localized with a spinal needle positioned perpendicular to the bicipital tunnel, 1.5 cm proximal to the superior border of the PMT. The biceps is then removed ex vivo and whip-stitches are sewn beginning 1 cm proximal to the myotendinous junction of the LHBT. After firmly associating the LHBT with the tip of the IS, a guidewire is placed 1.5 cm superior to the superior border of the PMT, perpendicular to the humerus, and a reamer is used to prepare a 6-, 7-, or 8-mm diameter socket. The tendon is inserted through the accessory portal into the tunnel, followed by screw fixation. Suture tails are tied with 5 alternating half hitches, each secured via an arthroscopic knot pusher. Results: ASPBT with IS fixation provides significant pain relief, improves range of motion (ROM), and enhances quality of life. Discussion: ASPBT with IS fixation provides significant improvements in patient-reported and functional outcomes and thus can be an acceptable treatment for LHBT pathology. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Efficacy of Acupuncture on Pain Severity and Frequency of Calf Cramps in Dialysis Patients: a Randomized Clinical Trial.

Patients with chronic kidney disease, as a common disorder, usually necessitate the implementation of hemodialysis. Muscle cramps are one of the most disabling complications affecting their quality of life. We aimed to investigate the efficacy of acupuncture as a safe alternative to the management of pain severity and frequency of calf cramps in dialysis patients compared to a control group. Fifty dialysis patients experiencing calf cramps who met the eligibility criteria were randomly allocated to two groups. Group A received routine management, including analgesic consumption, stretching exercises, and nine acupuncture sessions, including acupoints BL57, GV26, CV4, CV6, LV3, KI 1, LU7, LU9, and GB34. Group B underwent sham acupuncture therapy at locations other than the primary acupoints in addition to following the specified routine management. The pain severity was measured using the visual analog scale (VAS), and the daily frequency of calf cramps was evaluated at baseline and one month after treatment completion. VAS scores and the frequency of calf cramps were improved one month after treatment completion in both groups. However, the improvement was significant in group A (p < 0.001), while it was not statistically significant in group B (p > 0.05). There was also a significant difference between both groups regarding reducing pain and the frequency of calf cramps, which showed the efficacy of acupuncture compared to the control group (p < 0.0001). Acupuncture can decrease pain and frequency of calf cramps in dialysis patients.

Anti-IgLON5 disease as a differential diagnosis of multiple system atrophy

IntroductionAnti-immunoglobulin-like cell adhesion molecule 5 (IgLON5) disease is a rare autoimmune encephalitis that can mimic progressive supranuclear palsy or corticobasal syndrome. Moreover, anti-IgLON5 disease can present with symptoms characteristic of multiple system atrophy (MSA), such as cerebellar ataxia and autonomic dysfunction. However, the clinical features of anti-IgLON5 disease resembling MSA have not been well established. MethodsWe enrolled 35 patients with suspected MSA for whom anti-IgLON5 antibody tests were requested. We evaluated immunoglobulin G (IgG) against IgLON5 using cell-based assays. We also summarized the clinical characteristics of patients who were positive for anti-IgLON5 antibodies. ResultsWe identified serum and cerebrospinal fluid anti-IgLON5 antibodies in three patients. These patients had many clinical features characteristic of MSA, including parkinsonism, cerebellar ataxia, severe orthostatic hypotension, acute respiratory failure, sleep parasomnia, vocal cord paralysis, and pyramidal tract signs. Clinical features atypical for MSA were myorhythmia, horizontal eye movement restriction, fasciculations, and painful muscle cramps. ConclusionAnti-IgLON5 disease may be an important differential diagnosis of MSA. A comprehensive physical examination, including assessments of eye movement, lower motor neuron signs, and atypical involuntary movements, is important to avoid misdiagnosis.

Injury Incidence in Traineras: Analysis of Traditional Rowing by Competitive Level and Gender

The growing interest in “Traineras”, a traditional competitive rowing modality prevalent in Northern Spain, underscores the need for a comprehensive analysis of the injury incidence associated with this sporting practice. Despite rowing’s significance in the international sports arena and its inclusion since the beginnings of the modern Olympic Games, research into injuries in this sport, especially in traditional modalities such as Traineras, has been limited. This study aimed to identify and describe the predominant injuries among Traineras rowers, analyzing their epidemiology, characteristics, affected body regions, and diagnoses, further differentiated by competitive level and gender. A retrospective survey completed by 773 rowers (24% women, 76% men) participating in various leagues (ACT, ARC1, ARC2, LGT1, LGT2, ETE, and LGT-F) during the season revealed that 68.2% suffered from at least one injury, predominantly due to overuse (91.1% in men, 83.1% in women). The most affected regions were the lower back and shoulders, with the main diagnoses being muscle cramps and tendinitis, showing statistically significant differences between sexes. The findings of this study not only provide a deeper understanding of the etiology and origin of injuries in this sport but also lay the groundwork for developing specific injury prevention plans, thereby contributing to the safety and optimal performance of athletes.

Kandungan Fitokimia Daun Asam Jawa dan Potensinya sebagai Bioagen Antibakteri untuk Pengobatan Alami

Indonesia is known as a country that is abundant in various biological riches and their potential as medicines, so a review of natural antidiarrheal treatment methods using tamarind leaves was carried out. Diarrhea is a digestive disorder with a high prevalence rate, especially in developing countries. Diarrhea is a digestive system disorder characterized by stomach cramps, a liquid stool consistency, and an increase in the frequency of defecation more than 3 times in 24 hours. The research method used is to use literature review through online publications based on the Web, ResearchGate, Google Scholar and Scopus. The research sample used in this literature review was 22 articles. The research results show that the phytochemical content of tamarind consists of tannins, flavonoids, saponins, alkaloids, phenols and triterpenoids. The results of the analysis in the literature review show that tamarind leaves are an alternative natural treatment and are effective in inhibiting the growth of bacteria, for example the Escherichia coli bacteria that causes diarrhea.

Role of Serum Electrolytes and Serum Vitamin D in Cirrhotic Patients with Muscle Cramps

Role of Serum Electrolytes and Serum Vitamin D in Cirrhotic Patients with Muscle Cramps

Effectiveness Of Clittoria Ternatea And Zingibers Officinale Concoction On The Reduction Of Dysmenorrhea In Adolescent Girls

Dysmenorrhea or menstrual pain is abdominal pain originating from uterine abdominal cramps, occurring during menstruation due to sloughing of the endometrial layer. The prevalence of dysmenorrhea varies widely in various countries, ranging from 16-91%; the incidence in Indonesia ranges from 45-95%, while in the Special Region of Yogyakarta, as much as 52%, and in Sleman district, as much as 88.64%. The purpose of the study was to determine the effectiveness of steeping butterfly pea (Clitoria Ternatea) and ginger concoction(Zingibers Officinale) on reducing menstrual pain (dysmenorrhea) in adolescent girls. The research method used was Quasi Experiment Two Group Pretest-Posttest design. The subjects in this study were 90 respondents who experienced menstrual pain and met the criteria. Data analysis using the Wilcoxon test and Mann-Whitney test. The results of this study showed that the average menstrual pain before being given butterfly pea brew was 5.97. After being given Butterfly Pea Brew, the average menstrual pain was 0.51 with a P-Value 0.000 less than 0.05, meaning that there was a difference in menstrual pain felt before and after being given Butterfly Pea Brew. The mean value of menstrual pain before being given a ginger concoction is 6.02. After being given a ginger concoction, it decreased to 0.44 with a P-Value of 0.000 less than 0.05, meaning that there is a difference in menstrual pain felt before and after a ginger concoction. This study concludes that butterfly pea brew and ginger concoction effectively reduce menstrual pain (dysmenorrhea).

Intradialytic massage for leg cramps among hemodialysis patients: A single-center, randomized crossover trial

Background: Leg cramps are commonly experienced by hemodialysis patients, and its persistence may lead to treatment noncompliance. Limited studies are available examining the efficacy of intradialytic massage on reducing leg cramps. Objectives: To determine the efficacy of intradialytic leg massage on reducing leg cramps among patients undergoing maintenance hemodialysis at the East Avenue Medical Center. Methodology: This is a single-center, randomized crossover trial. A total of 44 adult patients were randomized in a 1:1 ratio into two groups—Group A (intradialytic massage followed by control) and Group B (control followed by intradialytic massage). Each patient underwent the first assigned intervention for 2 weeks, followed by a washout period of 4 weeks, then the second intervention was performed for another 2 weeks. The primary outcomes were the change in frequency, duration, and intensity of cramps. The secondary outcome was patient quality of life. Results: A higher proportion of patients during the intervention period did not experience cramps post-intervention than during the control period; however, the results were not statistically significant (p=0.2059). The median change in frequency, duration, and intensity of leg cramps did not significantly differ between intervention and control (p&gt;0.05). Moreover, quality of life measures were not significantly different between the two groups (p&gt;0.05). Conclusion: Intradialytic massage alone is not efficacious in reducing leg cramp frequency, duration, and intensity. Moreover, intradialytic massage failed to improve the quality of life of patients undergoing hemodialysis treatment. Underlying factors that lead to leg cramps should be addressed through comprehensive and individualized interventions.

1223 REM-related Leg Cramps

1223 REM-related Leg Cramps

Sports-Related Gastrointestinal Disorders: From the Microbiota to the Possible Role of Nutraceuticals, a Narrative Analysis.

Intense physical exercise can be related to a significant incidence of gastrointestinal symptoms, with a prevalence documented in the literature above 80%, especially for more intense forms such as running. This is in an initial phase due to the distancing of the flow of blood from the digestive system to the skeletal muscle and thermoregulatory systems, and secondarily to sympathetic nervous activation and hormonal response with alteration of intestinal motility, transit, and nutrient absorption capacity. The sum of these effects results in a localized inflammatory process with disruption of the intestinal microbiota and, in the long term, systemic inflammation. The most frequent early symptoms include abdominal cramps, flatulence, the urge to defecate, rectal bleeding, diarrhea, nausea, vomiting, regurgitation, chest pain, heartburn, and belching. Promoting the stability of the microbiota can contribute to the maintenance of correct intestinal permeability and functionality, with better control of these symptoms. The literature documents various acute and chronic alterations of the microbiota following the practice of different types of activities. Several nutraceuticals can have functional effects on the control of inflammatory dynamics and the stability of the microbiota, exerting both nutraceutical and prebiotic effects. In particular, curcumin, green tea catechins, boswellia, berberine, and cranberry PACs can show functional characteristics in the management of these situations. This narrative review will describe its application potential.

Selecting first-line advanced therapy for ulcerative colitis: A clinical application of personalized medicine.

Ulcerative colitis (UC) is a chronic autoimmune inflammatory disease that affects the colon, leading to symptoms of bloody diarrhea, abdominal cramps, and urgency. The treatment of UC has evolved over the past few decades from locally active anti-inflammatory compounds to more selective therapies that target specific arrays of the immune system. The challenge of selecting the first advanced therapy became apparent in this rapidly expanding landscape of medications. No current investigational tools, such as genetic, immunologic, or biological markers, can guide the identification of the safest and most effective therapeutic option for each patient. Hence, physicians must carefully assess patient/disease characteristics and match them with the most suitable drug through a clinically driven assessment. In this paper, we outline patient and drug characteristics that play a role in selecting first-line advanced therapies for UC and propose an algorithm for selection.

Public Health Implications of Cholera- a Water Sanitation and Hygiene (WASH) Related Infectious Disease in the Era of Climate Change: The Nigeria Experience

Water, sanitation and hygiene (WASH) play key roles in management of infectious diseases like cholera and other waterborne diseases; given that millions of people globally have no access to safe water. This cross-sectional study, conducted in 7 communities of Ogoni region (Khana, Gokana, Tai and Eleme LGAs), Orashi region (Abua/Odual, Ahoada West, Ahoada East and Ogba-Egbema-Ndoni LGAs) and Obolo region (Andoni LGA) all in Rivers State, Nigeria, enrolled 274 inhabitants comprising 164 females and 110 males. These included persons passing watery stools accompanied with vomiting, abdominal cramps and those with such prehistory. Questionnaires were used to obtain socio-demographic data. A total of 274 faecal samples were collected and transported in Cary-Blair stool culture transport medium to Rivers State University Teaching Hospital laboratory; and inoculated on Thiosulphate sulphate citrate bile salt-sucrose agar. Gram staining and biochemical tests were performed using standard procedures. Among the 274 subjects, 40 were infected giving a prevalence rate of 14.6%, including 26(15.9%) females and 14(12.7%) males though this was statistically insignificant, (U=8738.000, p=0.474). On educational levels, those who attended secondary schools had the highest prevalence rate (26.3%), compared with others and it was statistically significant, (p=0.00). WASH perceived predisposing factor showed the prevalence rate among those without access to safe water was 33(21.6%) against those with access to safe water 7(5.8%) and was statistically significant, (p=0.00). Subjects engaged in routine environmental sanitation and hygiene practices had lower prevalence 7(7.6%) than their counterparts, 33(18.1%), p=0.02. Respondents who think climate change had a positive impact on cholera transmission had prevalence of 34(23.3%) against those who disagreed, 6(4.7%), which was statistically significant. The study deduced that unavailability of safe drinking water, climate change, and unhygienic practices were major predisposing factors to cholera infection. Provision of safe water is advocated as greater percentage of the communities lacked access to safe drinking water. Routine environmental sanitation exercise should be revisited and enforced.

Pathogenic TNNI1 variants disrupt sarcomere contractility resulting in hypo- and hypercontractile muscle disease.

Troponin I (TnI) regulates thin filament activation and muscle contraction. Two isoforms, TnI-fast (TNNI2) and TnI-slow (TNNI1), are predominantly expressed in fast- and slow-twitch myofibers, respectively. TNNI2 variants are a rare cause of arthrogryposis, whereas TNNI1 variants have not been conclusively established to cause skeletal myopathy. We identified recessive loss-of-function TNNI1 variants as well as dominant gain-of-function TNNI1 variants as a cause of muscle disease, each with distinct physiological consequences and disease mechanisms. We identified three families with biallelic TNNI1 variants (F1: p.R14H/c.190-9G>A, F2 and F3: homozygous p.R14C), resulting in loss of function, manifesting with early-onset progressive muscle weakness and rod formation on histology. We also identified two families with a dominantly acting heterozygous TNNI1 variant (F4: p.R174Q and F5: p.K176del), resulting in gain of function, manifesting with muscle cramping, myalgias, and rod formation in F5. In zebrafish, TnI proteins with either of the missense variants (p.R14H; p.R174Q) incorporated into thin filaments. Molecular dynamics simulations suggested that the loss-of-function p.R14H variant decouples TnI from TnC, which was supported by functional studies showing a reduced force response of sarcomeres to submaximal [Ca2+] in patient myofibers. This contractile deficit could be reversed by a slow skeletal muscle troponin activator. In contrast, patient myofibers with the gain-of-function p.R174Q variant showed an increased force to submaximal [Ca2+], which was reversed by the small-molecule drug mavacamten. Our findings demonstrated that TNNI1 variants can cause muscle disease with variant-specific pathomechanisms, manifesting as either a hypo- or a hypercontractile phenotype, suggesting rational therapeutic strategies for each mechanism.

Assessing the Influence of Unstable Footwear on Lower Limb Lymphedema

Introduction: Unstable shoes may benefit lower limb lymphedema patients by reducing foot volume and relieving symptoms. Objective: The objective of this study was to evaluate and compare the effectiveness of unstable shoes versus conventional sports shoes in managing lower limb lymphedema, focusing on changes in foot volume, circumference, and symptom relief. Methods: We conducted an 8-week clinical trial, recruiting patients with lower limb lymphedema. Participants were divided into 2 groups: one using unstable shoes and the other using conventional sports shoes. Measurements of foot volume and circumference were taken at the beginning and end of the trial. Additionally, participants were asked to report any changes in leg cramps and paraesthesia during the study period. Results: The results indicated a nonstatistically significant tendency toward a decrease in foot volume and circumference in the intervention group using unstable shoes. In contrast, the control group using conventional sports shoes showed a tendency toward an increase in foot volume and a statistically significant increase in foot circumference. Moreover, participants in the unstable shoes group reported a decrease in leg cramps and paraesthesia, indicating potential symptom relief. Conclusions: This study suggests that unstable shoes have the potential to offer benefits to individuals with lower limb lymphedema, particularly in terms of foot volume reduction and symptom relief. The use of unstable shoes may be suitable for activities such as walking and extended periods of standing. However, further research is necessary to explore their full potential and effectiveness in managing lymphedema symptoms comprehensively.

Management of Colorectal Cancer Using Nanocarriers-based Drug Delivery for Herbal Bioactives: Current and Emerging Approaches.

Colorectal cancer (CRC) is a complex and multifactorial disorder in middle-aged people. Several modern medicines are available for treating and preventing it. However, their therapeutic uses are limited due to drawbacks, such as gastric perforation, diarrhea, intestinal bleeding, abdominal cramps, hair loss, nausea, vomiting, weight loss, and adverse reactions. Hence, there is a continuous quest for safe and effective medicines to manage human health problems, like CRC. In this context, herbal medicines are considered an alternative disease control system. It has become popular in countries, like American, European, and Asian, due to its safety and effectiveness, which has been practiced for 1000 years. During the last few decades, herbal medicines have been widely explored through multidisciplinary fields for getting active compounds against human diseases. Several herbal bioactives, like curcumin, glycyrrhizin, paclitaxel, chlorogenic acid, gallic acid, catechin, berberine, ursolic acid, betulinic acid, chrysin, resveratrol, quercetin, etc., have been found to be effective against CRC. However, their pharmacological applications are limited due to low bioavailability and therapeutic efficacy apart from their several health benefits. An effective delivery system is required to increase their bioavailability and efficacy. Therefore, targeted novel drug delivery approaches are promising for improving these substances' solubility, bioavailability, and therapeutic effects. Novel carrier systems, such as liposomes, nanoparticles, micelles, microspheres, dendrimers, microbeads, and hydrogels, are promising for delivering poorly soluble drugs to the target site, i.e., the colon. Thus, the present review is focused on the pathophysiology, molecular pathways, and diagnostic and treatment approaches for CRC. Moreover, an emphasis has been laid especially on herbal bioactive-based novel delivery systems and their clinical updates.

Management of Artavakshaya along with Dhatukshaya in lean adolescent girls: a narration

Abstract Background: Artavakshaya (~scanty menstruation/hypomenorrhea/oligomenorrhea) is one of the most prevalent reproductive disorders among adolescent girls now. Irregular, delayed and scanty menstruation, abdominal cramping, and lower back pain are the major symptoms of Artavakshaya. The condition can be correlated with oligomenorrhea along with hypomenorrhea based on similar symptomatology. Poor nutrition, stress, hormonal disturbance, and unhealthy lifestyle are the major causes of oligomenorrhea along with hypomenorrhea particularly in lean adolescent girls. Aim and Objective: This study aims to evaluate the efficacy of Ayurveda protocol in the management of Artavakshaya in adolescent girls. The rationale behind this study was only to prevent further gynecological morbidities and cure the current condition. Materials and Methods: An unmarried female patient of 14 years of age came to the outpatient department of Prasuti Tantra and Stree Roga of Sumandeep Ayurved Medical College &amp; Hospital with chief complaints of irregular, delayed, and scanty menstruation associated with weakness and white discharge per vagina for one and half year. The patient was assessed and diagnosed with subjective criteria for menstrual abnormalities, a pictorial chart for assessment of menstrual blood, and a Visual Analog Scale. The condition was managed with Rasapachaka syrup and Saptamrita Mishrana along with lifestyle modification and Rajaswala Paricharya (~do’s and don’ts during menstrual days). The treatment lasted for 3 months and the patient was followed up for the next 1 month. Results: The findings revealed satisfactory improvement after treatment. Conclusion: The findings revealed that Artavakshaya in lean adolescent girls could be managed effectively with these Ayurveda regimens and other modern interventions avoided.

Leg Cramp Treatments: Self-Reported Leg Cramp Management and Efficacy

Leg Cramp Treatments: Self-Reported Leg Cramp Management and Efficacy