• Nocturnal Leg Cramps

    (Muscle Cramps; Nocturnal Muscles Cramps; Age-Related Cramps)

    Definition

    Nocturnal leg cramps are sudden contractions of the lower leg and foot muscles. They often awaken you from sleep. The calf muscles are most often involved. The cramps are harmless. They do not mean that you have a serious disease.
    The Calf Muscles
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    Causes

    The specific cause of nocturnal leg cramps is unknown. These cramps may be related to imbalances in local muscle chemistry. Many activities and diseases are associated with nocturnal leg cramps:
    • Overexertion of the muscles
    • Standing on hard surfaces
    • Prolonged sitting
    • Certain leg positions while inactive
    • Dehydration
    • Diseases: Certain medications:
      • Blood pressure medicines
      • Statins (that lower cholesterol)
      • Morphine
      • Lithium

    Risk Factors

    The following factors increase your chance of developing nocturnal leg cramps:

    Symptoms

    • Sudden nighttime calf (or foot) cramps

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done.
    Tests may include the following:
    • Blood tests
    • Checking your foot pulses for good circulation

    Treatment

    Talk with your doctor about the best plan for you. If no specific cause can be found, treatment options include the following:
    • When cramps occur, pull against them with your leg muscles. Also, grab your foot (feet) and pull up.
    • Standing on the affected leg often stops the cramping.
    • Massage and hot or cold treatments help the muscles relax.

    Medications

    None of these medicines has earned full approval for either safety or efficacy. Quinine, while often effective for reducing the frequency and intensity of cramps, has a significant risk of major allergic reactions. The other prescription medications carry risks as well. So, they are not generally recommended. They are most often used in only severe cases.
    Over-the-Counter
    • Diphenhydramine hydrochloride (Benadryl)
    • Calcium
    Prescription
    • Quinine sulfate
    • Simple muscle relaxants (for example, meprobamate, Equanil, Robaxin)
    • Verapamil hydrochloride (Calan, Isoptin, Verelan)
    • Chloroquine phosphate (Aralen)
    • Hydroxychloroquine sulfate (Plaquenil)
    • Carbamazepine (Tegretol)
    • Phenytoin (Dilantin)

    Prevention

    To reduce your chance of getting nocturnal leg cramps, take the following steps:
      Stretch three times a day and just before going to bed.
      • Face a wall, put your hands on the wall, and keep them there. Step backward. Keep your knees locked. Keep your heels on the floor until you feel a strong pull in your calves. Hold that position for 10 seconds. Repeat two or three times.
    • Exercise feet and legs regularly.
    • Drink plenty of liquids.
    • Eat plenty of potassium-rich foods. These include bananas, tomatoes, potatoes, broccoli, cantaloupe, oranges, and grapefruit.
    • Wear comfortable, supportive shoes.
    • Sleep with toes up, not pointed downward.

    RESOURCES

    American Academy of Family Physicians http://www.familydoctor.org

    American Academy of Orthopaedic Surgeons http://www.orthoinfo.aaos.org

    CANADIAN RESOURCES

    The College of Family Physicians of Canada http://www.cfpc.ca

    Women's Health Matters http://www.womenshealthmatters.ca

    References

    Allen RE, Kirby KA. Nocturnal leg cramps. Am Fam Physician. 2012 Aug 15;86(4):350-5.

    Butler JV, Mulkerrin EC, et al. Nocturnal leg cramps in older people. Postgrad Med J. 2002;78:596-598.

    Garrison SR, et al. The effect of magnesium infusion on rest cramps: randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2011;66(6):661-666.

    Nocturnal leg cramps. EBSCO DynaMed website. Available at: http://dynamed.ebscohost.com. Updated August 23, 2012. Accessed October 24, 2012.

    2/11/2011 DynaMed's Systematic Literature Surveillance. Available at: http://dynamed.ebscohost.com/about/about-us: El-Tawil S, Musa T, et al. Quinine for muscle cramps. Cochrane Database Syst Rev. 2010;(12):CD005044.

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