What are leg (muscle) cramps?

Leg cramps, also commonly referred to as night (or nocturnal) leg cramps or charley horse (muscle spasms which can affect any muscle in the body but are most prevalent in the legs), are muscle cramps (sudden, and painful involuntary contractions or spasms). A common ailment, many experience cramping and spasms in the calf muscles and hamstrings, as well as in the feet, most often while at rest or asleep.

A leg cramp can last anywhere between a few seconds and several minutes. It can happen, although rarely, that a painful cramp occurs for up to 10 minutes at a time. Pain is acute, and often severe enough to awaken a person from sleep. Once a contraction ceases, the muscle relaxes but may remain tender and sore for several hours, sometimes for the next 24-hours, as it heals.

For the most part, leg cramps are not considered a serious event, and are more often than not, almost entirely harmless. In these instances, a precise reason for leg cramps may not even be entirely identifiable. That doesn’t mean, however, that they occur for no reason at all. It may merely be that the body is lacking in something, such as an essential nutrient like magnesium, potassium, calcium or sodium. In other instances, legs cramps may be signalling a physical disruption in the body that is associated with an underlying medical condition or disorder.

Seniors (over the age of 60) tend to become more prone to leg cramps, often experiencing more regular occurrences. Night leg cramps are also common among many women during pregnancy. Leg cramps which occur every so often and do not present prolonged symptoms of pain and tenderness can normally be sufficiently treated at home, without cause for concern.

Fun fact – Charley horse: These painful muscle spasms may have originated on the baseball field. One theory as to where the name Charley horse came from dates back to the 1880s where it is believed to have been used as baseball slang when muscular strain or injury caused a painful involuntary cramp in the arm or leg muscles of athletes. Another theory is linked with a lame horse named Charley who used to pull the roller at the White Sox ballpark in Chicago. Others believe that a pitcher, Charley Radbourne (nicknamed Old Hoss) frequently experienced muscle spasms during the 1880s, and the name combined his first name and nickname to come up with what is used in the medical field today.

What causes leg cramps (at night or during the day)?

Causes of leg cramps fall into one of two categories:

• Idiopathic leg cramps (unknown causes): The majority of leg cramp causes are not specifically known. One theory is that a muscle in a shortened position is stimulated to contract and tighten for a prolonged, albeit temporary period, resulting in a spasm (cramp) which further contracts. This may explain why cramps commonly occur at night when the body is positioned with slightly bent knees (promoting muscle shortening) and feet pointed downwards, and possibly also why stretching helps to relieve painful spasm contractions. Added to this, possible abnormal nerve activity during a sleeping or restful state can also cause muscle spasms. Another theory hints that a lack of sufficient blood supply (blood flow) to the muscles also contributes to sudden leg cramps. Aging and the natural shortening of tendons (tough bands of tissue connecting muscles to bone structures) is potentially another contributing factor, especially for seniors.
• Secondary causes: Cramps where a direct causal link can be made are generally categorised as having secondary causes. An underlying medical condition or cramps as a result of a specific activity, can lead to muscle spasms in the legs.

Determinable causes include:

• Exercise and over-exertion of muscles: Muscles which are in use for long periods of time (i.e. are overused) may develop cramps during specific activities (such as running, weight training involving the legs and sports like soccer or football), or shortly afterwards (when a person is at rest). Injuries associated with the over exertion of muscles are also linked with muscle spasms. Exercising in extreme temperatures (hot or cold) can also affect muscles and lead to cramping.
• Dehydration and loss of sodium (salt) / electrolyte imbalance: A lack of water in the body (sometimes due to profuse sweating or lack of liquid intake) can result in reduced salt levels and muscle fatigue, which trigger muscle spasms. A lack of magnesium, calcium and potassium in the blood can also cause leg cramps.
• Pregnancy: Additional weight gained during the gestation period can place strain on the muscles in the legs. This makes them more susceptible to cramps and painful spasms. A lack of minerals (particularly calcium or magnesium) in the system can also occur, especially during the later stages of pregnancy.
• Neurological conditions and disorders: Motor neurone disease (MND) and peripheral neuropathy are some conditions that directly affect the leg muscle nerves, which can result in painful spasms.
• Infections: Bacterial infections, like tetanus, can lead to spasms in the leg muscles.
• Liver disease and toxins: A build-up of toxins (like mercury or lead) in the blood can adversely affect leg muscles, as well as impact the liver which can cease to function effectively.
• Nerve compression on the spine (due to spinal stenosis)
• Peripheral arterial disease
• Sarcoidosis cirrhosis (a multisystem disorder affecting the lungs and the liver)
• Cirrhosis of the liver
• Vascular disease
• Anaemia
• Thyroid disease / disorders (hypothyroidism and hyperthyroidism)
• Kidney disease (chronic kidney failure)
• Alcoholism
• Diarrhoea
• Type 1 and 2 diabetes (as a result of diabetic nerve damage)
• Multiple sclerosis
• Addison’s disease
• Parkinson’s disease
• Medications: The use of certain medications can trigger muscle spasms in some people. Those known to cause such reactions include diuretics (these remove fluid from the body’s system) used in the treatment of hypertension / high blood pressure, heart failure or kidney disease; statins or nicotinic acid for the treatment of high cholesterol; nifedipine used to treat Raynaud’s syndrome and angina; and raloxifene for the treatment of osteoarthritis. Some antipsychotics, steroids and oral contraceptives (birth control pills) can also result in muscle spasms. Leg cramps caused by medication can sometimes be corrected by adjusting the dosage. It is not advisable to simply stop taking a medication for the treatment of a medical condition due to the development of leg cramps. Rather notify a treating medical healthcare professional so that a proper assessment can be made, and spasm symptoms alleviated appropriately. ⁽¹⁾
• Other possible underlying causes relate to: Exposure to cold temperatures (air or water), flat feet and extended periods where a person stands on a hard surface, sitting for long periods of time or awkward sleeping positions. Leg cramps have also been known to affect some individuals following gastric bypass surgery or who undergo dialysis treatment (a process of blood purification in those with kidney dysfunction).

Linked to associated causes, the following individuals are more at risk of developing leg cramps:

• Athletes
• Seniors (older adults)
• Pregnant women
• Infants
• Obese individuals
• Smokers
• Individuals taking medications with a known link to muscle spasms in the legs

Poor blood circulation, muscle fatigue or overuse (that leads to strained muscles), dehydration (lack of electrolytes which assist muscle function and fluids whist help the body’s tissues to process minerals) and nerve malfunctions are some of the main reasons leg spasms are believed to occur, and can happen to just about anyone, of any age, at any time (day or night).

What do leg cramps feel like?

Leg cramps feel a lot like a painful knot in the leg muscle (a hard lump may even be felt at the point of pain and soreness). This painful knot is effectively the contracted muscle.

Cramping contractions effectively render the leg immobile for a few seconds or minutes. Pain is acute (severe and sudden – seemingly coming out of nowhere). A person’s leg, as well as the foot and toes can also become tight or stiffened.

Leg cramps typically affect the calf muscles, but can occur in the thighs and even in the feet. Contractions dissipate as the muscles relax, followed by a gradual reduction in pain. Cramps which occur in the thigh area typically last longer than those occurring in the calf muscles.

Once a muscle has loosened up, pain gradually subsides but the affected area can remain tender and a little sore for several hours, sometimes up to a day.

What should you do when experiencing leg muscle cramps?

During a leg muscle cramp, the following can help to alleviate painful, tender and stiff sensations:

• Stretch the affected muscle: If active at the time of a leg cramp, stop whatever you are doing. Gently stretch the leg (straighten the leg and flex the foot upwards towards the knee) and hold this position. Sometimes, placing a rolled-up towel at the base of the flexed foot, holding the ends on either side of the leg and gently pulling towards the body while stretching can help to release the muscle. Standing facing a wall and leaning forwards (arms stretched) against it can also help. The knee of the affected leg should be kept straight with the heel on the floor, while bending the other knee. This helps to stretch the calf muscles and can be repeated several times to achieve the desired effect. Some find that stepping forwards and into a lunge position on the leg that is not affected by cramp, and straightening the other, pained leg, can help to ease the discomfort experienced. Massaging the affected muscle at the same time or just after stretching it can help too. Both hands can be used to apply pressure to the affected muscle, or alternatively both thumbs (gradually increasing the pressure) to ease the contraction. Alternatively, a heat pad can be applied to the affected muscle after several stretches (this helps to accelerate muscle relaxation). An ice pack or cold compress on the affected muscle can also help to alleviate pain.
• Move about: One of the best things to do is to move, even though muscles stiffen up during a cramp. Moving about signals the body’s muscles to work – i.e. contract and relax. Try and walk slowly (sometimes walking on the heels of the feet or the tip-toes helps) to help the muscles function which stimulates the loosening up of the contracted muscle.
• Hot soaks: A wet cloth soaked in warm water and applied to an affected muscle can help stimulate relaxation, as can a soak in a warm bath with (or without) Epsom salts (magnesium sulphate). A warm shower can also help.
• Hydration: Intake of water or a sports drink containing electrolytes can help to potentially prevent another cramp from developing. It is a good idea to reach for a glass or two soon after a contracting muscle begins to relax, in order to replenish the body.
• Medications: Over-the-counter pain-relievers (NSAIDs / non-steroidal anti-inflammatories) such as acetaminophen, ibuprofen or naproxen can help to alleviate muscle pain and tenderness. Medications may only really be effective for managing any discomfort following a muscle cramp. Care should be taken, however, when using these medications, which should only be consumed according to the recommended dosages. If medication use may be a potential cause of muscle cramps, it is best to consult a medical doctor in order to determine this. A doctor will then assess whether dosages need to be adjusted or an alternative drug prescribed.

When to see the doctor for leg muscle cramps

For most occasional leg cramps, a medical diagnosis is not necessary. Leg cramps which happen fairly frequently (more than once a week) and or / cause so much pain and discomfort that a person’s ability to function or sleep soundly are regularly disrupted should be evaluated by a medical doctor.

If a leg cramp lasts longer than 10 minutes or does not show improvement (loosening up) within this time period, even after moving around or stretching, a medical evaluation may be necessary.

If leg muscles appear to be becoming weaker (or even shrinking / atrophying), a medical consultation is also advisable as soon as possible.

Should a person come into contact with a potentially toxic substance or exposure to an infection and begin experiencing leg cramps, a medical consultation should be booked immediately.

Who to see?

It is best to consult with a primary healthcare provider / family physician or general practitioner (GP) for the evaluation of leg cramps.

How will a doctor assess and treat leg muscle cramps?

At a medical consultation a doctor will discuss the nature of leg cramp symptoms and when they were experienced. He or she may ask if other symptoms have been experienced, such as numbness or pins and needle sensations, and inflammation. This is to either identify or rule out a potential underlying cause.

He or she will also ask a series of questions relating to a person’s medical history in order to assess any potential risk factors for possible underlying medical causes. These questions will include areas of past health concerns, family history, some general lifestyle information (around diet and exercise), as well as recent or current use of medications and supplements (including natural or herbal variations).

A doctor will wish to determine the level of pain and tenderness being experienced with leg cramps, where exactly cramping occurred in the leg and the duration of the spasm (how long it lasted). He or she will also wish to know if more than one muscle spasm has occurred recently.

A doctor will then conduct a physical examination and assess the affected leg, as well as check a person’s overall health (including vitals such as breathing and heart rate). Should there be any indications of a possible underlying medical cause, appropriate testing may be recommended.

For instance, if nerve compression is suspected, an MRI (magnetic resonance imaging) scan which uses radio waves and magnetic field to create cross-sectional detailed visuals of the body’s internal structures may be performed. A doctor may also wish to determine the levels of electrolytes (potassium, calcium and magnesium) in the body and whether they are normal or in short supply. In this instance, a blood sample may be requested for laboratory analysis.

Severe and or / recurrent muscle spasms may be alleviated with prescription medication. In this instance, a doctor may recommend antispasmodic medications should other pain-relieving medications, such as ibuprofen, not be helpful in easing discomfort. A doctor may also recommend physical therapy which makes use of techniques that can help a person to better cope with muscle spasms as they happen, and also prevent further discomforts or complications.

In rare and extreme instances, surgical techniques are an option, whereby the space between the affected nerves can be enlarged as a way to relieve pressure. If all other treatment options have failed or recurrent cramps and spasms are resulting in stenosis (nerve compression), this may be a last resort treatment option which may help.

Can leg muscle cramps be prevented?

If prone to leg cramps, there are various simple things that can be done to help reduce potential triggers. Some things to keep in mind and try, include:

• Doing stretching exercises for the legs, especially the calf muscles, on a regular basis (especially before bedtime). Some find that riding a stationary bicycle for several minutes before bedtime helps circulation and thus reduces the risk of possible leg cramping during the night.
• Placing supports, such as a cushion or pillow (when lying on your back), beneath the toes when at rest (lying down) or asleep. If lying face down, it can help to allow the feet to hang over the end of a bed.
• Using light or loose bed sheets and blankets, or avoiding tucking in bed linen which can force the toes to point downwards during sleep, reducing circulation to the feet.
• Adopting a regular and healthy exercise routine, taking care not to over-exert the body with activities that are too strenuous or require prolonged periods of participation. Stretching before and after exercise is also a good idea. If wanting to increase exercise activity in a regular routine, it is advisable to do so gradually. It can also help to avoid exercising the same muscles on consecutive days, and to take appropriate rest days. Exercising in extreme weather (hot or cold) is not ideal either – indoor temperature controlled environments may be better if one is exposed to such weather conditions.
• Ensuring that one drinks adequate amounts of fluids throughout the day to avoid dehydrating the body. Limiting alcohol intake can also keep dehydration at bay.
• Following a balanced and healthy diet that is rich in potassium, magnesium and calcium. Taking a multivitamin supplement may also ensure that deficiencies in these minerals rarely happen.
• Adapting footwear for better comfort (which may also help to alleviate frequent cramping episodes) if one has flat feet and is more prone to leg cramps.

Reference:

^{1. MedlinePlus. 3 October 2017. Leg pain: https://medlineplus.gov/ency/article/003182.htm [Accessed 19.10.2017]}