Insurance revisited and cramped muscles: No easy solution


Like many things in life, you never forget your first “Charley Horse.” The first time I had one, the contraction in my left calf muscle had me writhing in bed, at 4 am, with had no idea what to do. After breathing for a few minutes, like I saw my mom do in Lamaze class, the cramp released, but the leg still felt bruised for several days. Clients often ask how to treat or prevent Charley Horses, considering 60% of the adult population has reported having them, I thought finding an answer would be easy, but that is not the case (1). This article will cover the current thought on what to do if you find your muscles cramping in the night, but first would like to respond to several questions and comments from last month’s article on insurance reimbursement.

The first simply acknowledges the person did not realize there was massage therapy legislation. I did not know much about legislation until recently either, massage therapists are licensed professionals in Kentucky, which means the Kentucky legislature has passed a bill requiring licensure for massage therapist and a licensing board passes regulations we are obligated to follow. In my new role as president of AMTA-Kentucky I am getting a crash course in how legislation works and how to stay current on developments in the law. The next comment addressed an oversight of the March article.

I forgot to mention clients who have a Health Savings Account (HSA) as part of their insurance policy could charge this to Apex. There are limits based on your particular plan and sometimes some plans will require receipts, but this was a great catch and if you have an HSA account we would be happy for you to use it. The next question dealt with “In-Network” versus “Out-of-Network” coverage and this is something I do not know much about, I assume this would be part of the hassle for massage providers since every insurance provider requires an agreement, with varying requirements, to be “in” their network. One option someone related to this would be for the client to bill their insurance themselves much like many mental healthcare professionals offer, this would be pass the option onto the client I’m assuming as long as it was a covered therapy.

Related to this would be questions about what the insurance would cover, preventative or rehabilitative. I assume this will depend on what the cost benefit analysis of long-term partnerships between medical professionals reveal. Insurance would more than likely cover clients who have a prescription for treatment, much like personal injury claims (PIP) now work, and various accepted treatments would be covered, i.e. deep tissue, myofascial release, or trigger point work. My opinion on this is mostly an educated guess based on what I see currently with PIP claims and what I have read from other state’s regulations. I hope to learn more about this at the next National Board of Directors’ meeting in May. As cited above there is not much information on “Charley Horses” despite their high prevalence, first I will cover some of the ideas about the origin of the phrase.

I think Charley Horse is such a weird term for a cramp, so I did some research and there are many ideas about where it coined, but no clear origination. A few sources say it comes from an early 20th century baseball league that used a lame horse named Charley to pull a wagon around the field before a game, thus if you were injured you were called a Charley Horse. It sounds likely, but the good folks at Grammarphobia, a blog dedicated to language, have found dictionary references to Charley Horse much older than this story. Despite the prevalence and long history of the term, science does not have a great understanding of why they happen or how to prevent them.

The technical term for a Charley Horse is idiopathic nocturnal leg cramp or roughly translated a leg cramp you get at night without a clear cause (1). That’s right, barring a disease process, most nighttime leg cramps happen without a discernable reason or pattern, but there are a few aggravating conditions and some things you can do if you have them.
The exact cause is unknown, but one theory is the muscle contraction happens from the muscle being in the same position for a prolonged period. One solution I’ve read on several blogs is to make sure your sheets are not tucked tightly at the base of the bed so your legs can move freely. Charley Horses are most common among the elderly, pregnant women, certain medications, and some diseases. Often people ask if they should increase their hydration or eat more bananas, proper hydration and nutrition are important, but if you have cramps frequently you should probably talk to your doctor to rule out a more serious medical condition. What should you do if you get a muscle cramp?

First, breathing helps, if nothing else it might help you relax and form a plan, because it can be very painful. Next, try to contract the opposite set of muscles, if the cramp is in your calf try to flex the muscles of your shin. Your body cannot contract antagonistic muscles at the same time, so, flexing your shin can help ease the cramp and then you can slowly start to stretch the cramped muscle. Self-massage can help and ice or heat will help with the residual pain afterwards. When you schedule your next massage let us know if the muscles are still sore and we can ease into your session, I find massage feels really good following a cramp!

There have been many changes in the last month. When I wrote last month’s article there was still the threat of ice and I was preparing for the spring conference, now there are blooms on the trees and I am our AMTA Chapter President. Things are exciting right now for massage therapy and there are some great things also going on locally. You might have heard about Louisville referred to as the “Compassionate City” next month’s article will cover the Compassion Charter and let you know how you or an organization or business you care about could join. Until then, if you have any questions or comments before then email me,


Allen RE and Kirby KA. (2012). Nocturnal leg cramps. American Family Physician, 86,

350-355. Retrieved fromĀ

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