Cramp bark’s name shows it is a herb that is a specific relaxant for muscular tension and spasm. This action works on smooth muscle found in the visceral organs (internal organs). It can be used to relax where there is tension or cramping in the muscles such as with neck tension.

It is also an excellent reliever of menstrual cramps as it relaxes the uterine muscles. It can be used for bronchial spasm that can sometimes occur with an enduring post viral cough. By the same action cramp bark can also be used to relieve hiccups.

Cramp bark is sometimes used for colic or irritable bowel syndrome as it reduces pain and cramping caused by infection or indigestion in the gastrointestinal tract.

According to the energetics of Western herbal medicine cramp bark may be best applied in constrictive or spasmodic tissue states. Tension may be due to either emotional or physical causes. The tissues may be in a state of spasm, and cramp bark acts as a relaxant in this situation and works as both nervine and antispasmodic (13). Sometimes migraines are caused by constriction in the cerebral microcirculation. Some examples of emotional manifestations of tension will be stress, anxiety- perhaps hyperactivity and a feeling of being ‘highly strung’.

This constrictive tissue state is often indicated in those who have experienced an acutely traumatic situation or where prolonged overexposure to stress hormones has led to a heightened state. The nervous system is left in a state of tension and over reactivity. There will often be gastrointestinal symptoms associated stress and tension such as colic, irritable bowel syndrome and intestinal spasms. There may also be a heightened state of alertness and anxiety along with tense breathing, palpitations and an accelerated heart rate. Cramp bark can work well where symptoms of both physical and emotional tension present together.

Almost all of the great antispasmodics used in traditional western herbal medicine are acrid and cramp bark falls into this category of acrid relaxants. Acrid herbs are often used for constrictive tissue states. Cramp bark best lends its therapeutic actions for conditions that present with constricted and tense tissue states. These may present throughout the body in almost any organ system (13).

Cramp bark has a long history of use as a spasmolytic during pregnancy, especially for threatened miscarriage. The herb is native to Europe and Russia and is held in high esteem in the Russian and Ukrainian folklore. This use dates back well over a hundred years by Western herbalists and by native American tribes.

The Meskwaki tribe of Wisconsin used cramp bark to treat menstrual cramps and other painful conditions such as arthritis and back pain. Whilst the Penobscot people of Maine used the herb to counter swollen lymph glands and gout. It is also believed that the Iroquois specifically used cramp bark to treat a prolapsed uterus post-childbirth (11).

Cramp bark was also listed in the United States Pharmacopeia from 1894-1916, and in the National Formulary from 1916-1960 as a sedative and antispasmodic.

Much of cramp barks therapeutic activity is via its effects on the smooth muscle tissue throughout the body. Smooth muscle is found in many vital organs such as; the stomach, intestines, bladder and uterus. Some of the compounds found to be responsible for these actions are viburnin which has been shown to exert antispasmodic actions on uterine smooth muscle (12). Also, phenolic compounds proanthocyanidins and flavanol monomers initiate antioxidant processes and produce spasmolytic actions in the body. Due to this broad action cramp bark has applications in almost all body systems to promote tissue relaxation and cellular regeneration.

Genito-urinary system

Cramp barks long history of use for threatened miscarriage and miscarriage prevention (1,9) is understood to be as a result of its powerful relaxant action upon the uterine smooth muscle. It is used specifically where uterine cramping is the likely cause. Cramp barks relaxant and antispasmodic action reduces spasm and calms uterine contractions or tension (12). 

This may be of use throughout pregnancy however it is also recommended to take it at more acute doses for threatened miscarriage. It can be given in repeated doses every 15 minutes at between 2 to 3ml over a 2- to 3-hour period. This should yield a demonstrable reduction in uterine irritability (3). For situations like this, it is important to see a clinical herbalist, which you can find on our resources section.

Cramp bark is also used in preparation in endometriosis and dysmenorrhea and works via a similar mechanism (1). Many of its applications for conditions in the reproductive system stem from its powerful spasmolytic action (5, 12).

Cramp bark may also be used for spasmodic tissues states in the bladder. This is particularly useful for ureteral stones. The smooth muscle contraction that often occurs in this condition is relaxed by cramp bark which facilitates the passage of ureteral stones (2). It is also sometimes used for enuresis (bedwetting) in children (9).

There are at least four active substances, including scopoletin and aesculetin, which have been identified as having uterine spasmolytic activity (3) as well as viburnin (12).

Neuro-muscular system

Cramp bark is often used for muscular cramping or tension. This is specific for nerve pain that is caused by muscle spasm- where a patient may complain of a trapped nerve. This type of muscular tension in the shoulders and neck often comes with headaches that radiate upward from the nape of the neck into the head. Cramp bark can offer relief from this type of headache. It is also specific for muscular tensions in the lower back or glute area which may also be associated with pain radiating into the thighs (5, 8). 

One of the primary uses for cramp bark is for muscular cramping or tension (9). It is specific for pain that is related to nerve compression caused by muscle spasm or constriction. Patients may complain of stiffness, shooting pains or a ’trapped nerve’. 

This type of muscular tension in the shoulders and neck can often be accompanied by a headache that radiates upward from the nape of the neck into the head. Cramp bark can offer relief from this type of pain. It is also specific for muscular tensions in the lower back and that of the glute area which often causes pain radiating into the thighs (5, 8). 

Cramp bark has a strong thread of reference for use by herbalists as an autonomic nervous system (ANS) balancer (8). The ANS is a component of the peripheral nervous system that regulates involuntary or automatic physiological processes such as; heart rate, blood pressure, respiration and digestion. Many of the systems that cramp bark affects and which are discussed in this monograph are innovated by the ANS. 

There are two branches of the ANS- parasympathetic and sympathetic. The parasympathetic nervous system (PSNS) regulates the ‘rest and digest’ functions such as sleep, digestion, slowing down the heart and breath rate. Whereas the sympathetic nervous system (SNS) essentially controls the stress response i.e. the fight or flight- such as to increase strength and power – elevating blood pressure and speeding up the heart and breath rate. 

Cramp bark is parasympathomimetic – meaning that is it activates the PSNS, whilst it is also sympatholytic- reducing overactivity of the SNS (10). Imbalance in the ANS often defaults to excess in the SNS (fight or flight) due to prolonged exposure to high stress hormones. A herbalist will often address the ANS with use of adaptogens or ANS balancers due to the prevalence of high stress hormones in our modern culture.

By the same mechanism- cramp bark is also sometimes used for anxiety or panic. Particularly where the breathing is affected and a patient experiences a sensation of chest tightness. Note that the sensation of tightness in the chest (that is not related to known anxiety conditions) should be urgently investigated. 

Cramp bark is rich in valeric acid which is a compound found in valerian. This may be a link for cramp barks relaxant, anti-anxiety and mildly sedative effects (8). 

Digestive system

Cramp bark is used for tension or spasmodic tissue states throughout the digestive system. This may be applied for conditions such as constipation, diverticular disease, gallstone disease, peptic ulcer and irritable bowel syndrome (1).

Cramp bark regulates tension throughout the gastrointestinal tract -reducing tension and spasticity and allowing for relaxed and proper peristaltic function. Cramp bark also nourishes and strengthens the mucosal lining due to its high tannin content. Some understanding of the mechanism of action may be understood by the findings of one specific group of compounds derived from cramp bark called proanthocyanidins. These phenolic compounds exert a potent gastroduodenoprotective effect (3).

Studies have found that these phenolic compounds also promote endogenous nitric oxide (NO) generation (4). Endogenous NO is also a mediator of smooth muscle relaxation- playing a major role in skeletal and smooth muscle (7). These combined pharmacological actions clearly demonstrate how herbal medicines work in diverse ways to produce a therapeutic effect.

Cellular

Cramp bark has potent antioxidant and cellular protective properties. Antioxidants scavenge free radicals from the cells – preventing or reducing the damage caused by oxidation. As a result of optimising cellular health – antioxidants have wide spread benefits throughout the body improving overall systemic health and physiological function. 

This antioxidant action is understood to be partly resulting from phenolic compounds in cramp bark. These cause suppression of lipid peroxidation (oxidative degradation of lipids that leads to cell damage) and mobilisation of antioxidant activity (3). Phenolic compounds in cramp bark are the most active against free radicals, especially proanthocyanidins and flavanol monomers (6).

The mechanism of this action may be in part due to a potent protective action of proanthocyanadins via elevating endogenous nitric oxide (NO) generation (4). Nitric oxide also functions as a neuro-modulator mediating aspects of learning and memory (7).

These complexities in herbal pharmacology lend an explanation to how they can work in the body in such dynamic ways and also how appropriate they are for the treatment of tissue abnormalities rather than isolated symptoms. 

Cardiovascular system

Smooth muscle is found throughout the cardiovascular system so it is no surprise that cramp bark also has an important place in the treatment of a number of tension related cardiovascular conditions. It may be used as part of a herbal approach for support of conditions such as angina, intermittent claudication, high blood pressure and arteritis. It works via a relaxant vasodilating action on the capillary walls (1, 8).

Cramp bark should be combined with other herbs to address inflammation and to improve structural and functional health within the cardiovascular system. Other herbs to combine to consider using in combination with cramp bark may be yarrow, hawthorn or motherwort.

Respiratory system

Cramp bark is often used as an antispasmodic for the lungs. It is referenced for use in whooping cough (1) and also asthma (8). It is antispasmodic and works best to relax the airways in bronchial spasms. Note that for asthma it should be used alongside other medications for maintenance and preventative but should not be relied on as a sole treatment for asthma attacks. 

For the treatment of chronic bronchial spasm or recurrent coughs it should be used alongside other herbs to sooth irritated or inflamed tissues such as marshmallow or mullein. It is always important to identify and treat the root of the cause, therefore it is recommended to seek help of a medical herbalist for chronic conditions. A recurrent cough that continues for more than 3 weeks should always be investigated by a medical professional.

A review of phytochemistry and biological effects

A review of studies carried out on the effects of cramp bark and its phytochemistry analysed the available data of its biological effects. On analysis, the review suggests that many of cramp barks therapeutic effects are associated with antioxidant activity, which has been demonstrated in both in vitro and in vivo studies. Some of the active compounds identified and studied included phenolic compounds, vitamin C, carotenoids, iridoids, and essential oils, which are all well-known antioxidants in support of cellular health.

The results of in vitro studies show the antimicrobial potential of cramp bark, especially against Gram-positive bacteria. Cramp bark demonstrated anti-inflammatory, anti-obesity, anti-diabetic, osteogenic, cardio-protective, and cytoprotective properties in cell-based studies. The review discusses study findings that substantiate the use of cramp bark in the treatment of urinary tract diseases, endometriosis, and as a possible adjunctive for some cancers (4).

Urinary system

A study was carried out to evaluate the efficacy of cramp bark extract in the medical expulsive treatment of distal ureteral stones. 103 subjects with a mean age of 45.8± 14.5 years were included in the study. Patients were divided into two groups: those given cramp bark at 1000 mg peroral 3×2 and diclofenac 50 mg peroral on-demand and those given only diclofenac sodium 50 mg peroral on-demand. Urethral stone expulsion rates were compared as well as the need for additional treatment and complication rates. The rate of stone expulsion was significantly higher in the group that had cramp bark, and the time needed for the stone to pass was significantly shorter. The need for additional treatment was lower in the cramp bark group with only 9.4% needing it compared to 20% in the other groups. Additionally, the need for painkillers was lower in the cramp bark group with only 20% needing them compared to 44% in the other groups. The study concludes that cramp bark is an effective treatment alternative that facilitates the passage of ureteral stones smaller than 10 mm in size (2).

Cramp bark has a long history of folklore in Ukraine and Russia with references found in Ukrainian poems, songs, art and embroidery. Its symbolism in Ukrainian culture can be traced to Slavic Paganism, dating back at least 1,000 years. 

The berries symbolise native land, blood and family roots in Ukraine. The red colour of the berries represents beauty and the bitter taste of the berries represents the separation of loved ones in Russian folklore. These plant lores make cramp bark a national symbol in Russia.

Cramp bark is native to the woodlands of the European deciduous forest in Russian Asia and Europe including Britain and Ireland. It is freely naturalised in the United States. It is typically found growing near swamps, wetland margins, coastline and hedgerows and roadsides.

According to the IUCN Red List of Threatened Plants Status cramp bark is classified as ‘least concern’ due to its widespread distribution, stable populations and no major threats.

Habitat loss and over harvesting from the wild are two of the biggest threats faced by medicinal plant species. There are an increasing number of well known herbal medicines at risk of extinction. We must therefore ensure that we source our medicines with sustainability in mind. 

The herb supplement industry is growing at a rapid rate and until recent years a vast majority of medicinal plant produce in global trade was of unknown origin. There are some very real and urgent issues surrounding sustainability in the herb industry. These include environmental factors that effect the medicinal viability of herbs, the safety of the habitats that they are taken from, as well as the welfare of workers in the trade.

The botanical supply chain efforts for improved visibility (transparency and traceability) into verifiably sustainable production sites around the world is now certificated through the emergence of credible international voluntary sustainability standards (VSS). Read our article on sustainable sourcing of herbs to learn more about what to look for and questions to ask suppliers about sustainability.

Cramp bark is often adulterated with the closely related black haw (Viburnum prunifolium). While black haw is used in a similar manner to cramp bark, it is much less expensive than cramp bark (14). There is also many references that suggest cramp bark was adulterated by mountain maple (Acer spicatum) , although the latter is not mentioned in current publications such as the American Herbal Pharmacopoeia.

Herbal Medicines are often extremely safe to take, however it is important to buy herbal medicines from a reputed supplier. Sometimes herbs bought from unreputable sources are contaminated, adulterated or substituted with incorrect plant matter.

Some important markers for quality to look for would be to look for certified organic labelling, ensuring that the correct scientific/botanical name is used and that suppliers can provide information about the source of ingredients used in the product.

A supplier should be able to tell you where the herbs have come from. There is more space for contamination and adulteration when the supply chain is unknown.

Cramp bark will grow in most locations in moist but well-drained soil. It can tolerate full sun to full shade. 

• Cramp bark can be propagated by seed, however it is most often grown from softwood or hard wood cuttings. 
• Softwood cuttings are taken from the tender new growth of the season in spring or early summer. 
• Collect non-flowering shoots early in the day when it is full of water. Taking up to 10cm of shoot, cutting off neatly above a bud on the parent plant. Using a sharp knife trim below a node to make a cutting about 5-10cm. Remove the lower leaves. An organic rooting solution is often used to stimulate growth.
• Planting the cuttings into fine compost they should be placed in good light but not direct, scorching sunlight. Once rooted, harden off the cuttings for about two weeks and pot them on individually.
• Keep them watered whilst they develop their roots over a period of 2- 4 weeks.
• If potted by mid-summer they will most likely develop sufficient roots to survive the winter. Otherwise pot up in the following spring. 
• Once the cuttings are well established plant out directly into the garden. Cramp bark grows well as part of a hedgerow, shrub border or woodland garden. 
• Once established it will need little or no pruning.

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