Causes (and Remedies) for Nocturnal Leg Cramps

Do you wake up in the middle of the night feeling as if your lower legs are paralyzed and cramped? Do your lower leg muscles feel as if they are hard to the touch and tight? If you experience these symptoms, you may have nocturnal leg cramps.

What are Nocturnal Leg Cramps?

Nocturnal leg cramps (leg cramps at night), also called Charley horses, are involuntary contractions or spasms of the muscles in the legs that usually occur during the night. These leg cramps often involve the posterior calf muscles, but can also involve the feet or thigh muscles. Because the muscles are tightened and knotted, nocturnal leg cramps are extremely painful sensation. Symptoms of straining, tightening, cramping, and knotting may last up to 10 minutes per episode.¹ Since leg cramps can last for a while, the patient may experience muscle tenderness and soreness for up to a day after symptoms are gone. Nocturnal leg cramps are more common in women and in adults over the age of 50.¹ Laboratory evaluation and specialized testing are usually not necessary to confirm diagnosis.

Nocturnal Leg Cramps: Not the Same as Restless Leg Syndrome

Nocturnal leg cramps are not the same as RLS (Restless Leg Syndrome).

Nocturnal Leg Cramps	Restless Leg Syndrome
Usually occurs at night or at rest	Usually occurs at night or at rest
Cause pain and cramping	Cause discomfort and crawling sensation
Stretching the muscle relieves pain	Moving the legs relieves discomfort

Causes of Nocturnal Leg Cramps

The exact cause of nocturnal leg cramps is often unknown. However, there are several factors that may increase your risk of leg cramps:

• Sedentary lifestyle
• Over-exertion of the muscles from exercise
• Standing for long periods of time
• Improper sitting position, like crossing your legs¹

The following medical conditions are also known to cause nocturnal leg cramps:

• Pregnancy
• Endocrine disorders (diabetes, hypothyroidism)
• Structural issues (flat feet, spinal stenosis)
• Neurodegenerative disorders (Parkinson’s disease)
• Neuromuscular disorders (myopathy, peripheral neuropathy)
• Medications (diuretics, intravenous iron sucrose, raloxifene, statins, naproxen, conjugated estrogens, beta agonists)
• Dehydration/electrolyte imbalances²

Management and Treatment of Leg Cramps

1. Stretch: The best method to relive pain and cramps is to stretch the affected muscle and hold the stretch for one minute.
2. Exercise: Walking around sends a signal to the muscle that it needs to relax after contracting, which will help ease the leg muscle.
3. Massage: Kneading, rubbing, and massaging the affected muscle can also relieve the cramps.
4. Apply heat: Other methods that have shown some benefit include taking warm baths and showers, and applying a hot towel or pad to the affected area to relax the tight muscles.²
5. Over the counter medications: No current medications have shown safe and effective results in patients with nocturnal leg cramps. However, calcium channel blockers (diltiazem), vitamin B12 complex, carisoprodol (Soma) have some good evidence and may be considered in some patients.³ Magnesium have some benefit in pregnant patients and mixed results in non-pregnant patients with leg cramps. No evidence supports the use of nonsteroidal anti-inflammatory drugs (naproxen), potassium, or calcium.³

Prevention and Self-Care Strategies:

1. Hydration: Drink lots of water and fluids every day to keep your body hydrated and help your muscles contract and relax more. Men should drink 15.5 cups (3.7 liters) of fluids and women should drink 11.5 cups (2.7 liters) of fluids a day.
2. Stretch before bed: If you experience nocturnal leg cramps, stretch your calf muscles for a few minutes before bed.
3. Doing light exercise: Walking around your neighborhood or house before bedtime may help prevent leg cramps at night.
4. Wearing comfortable shoes: Wearing shoes that support your feet can help prevent leg spasms.
5. Un-tucking the covers: Loosening the bed covers at the foot of the bed will give your legs more space to move and prevent cramps.¹

The next time you experience nocturnal leg cramps, identify the cause. Then, try one of the treatment methods to relieve your leg cramps. After resolving your leg cramps, use the self-care strategies to help prevent future leg cramps. However, if your leg cramps persist for long periods of time and occur every day, talk to your physician to determine whether or not you have leg cramps or other alternative medications that are appropriate.

Resources:

1. Leg Cramps at Night. https://my.clevelandclinic.org/health/diseases/14170-leg-cramps-at-night. Accessed January 10, 2019.
2. American Academy of Family Physicians. Nocturnal Leg Cramps. Accessed January 10, 2019.
3. Abdulla AJ, Jones PW, Pearce VR. Leg cramps in the elderly: prevalence, drug and disease associations. Int J Clin Pract. 1999;53(7):494–496.