It has been suggested that the way we sleep, with the foot stretched out and the calf muscles shortened, may trigger night cramps. Another theory is that cramps are more likely nowadays, as people no longer squat, a position that stretches the calf muscles.
Exercise is one factor. Stressing or using a muscle for a long time may trigger a leg cramp during or after the exertion. Cramps often affect athletes, especially at the start of a season, if the body is out of condition. Nerve damage may play a role.
Dehydration is thought to play a role. Athletes who exercise strenuously in hot weather often experience cramps. However, there is a lack of evidence to confirm this, and the theory has been disputed. Athletes who play in cool climates also get cramps, after all.
Sometimes the leg cramps are caused by an underlying condition, situation or activity.
Other conditions that may cause cramps are:
- Addison’s disease
- alcohol abuse
- gastric bypass surgery
- hypothyroidism, or an underactive thyroid
- chronic kidney failure
- type 2 diabetes
- cancer treatment
- lead poisoning
- sarcoidosis, a disease in which small growths or lumps produce inflammation or swelling of the tissues in any part of the body
- muscle fatigue
- vascular disease and venous insufficiency
- motor neuron problems
- oral birth control
- Parkinson’s disease
- peripheral artery disease (PAD)
- pregnancy, especially in the later stages
- use of some medications, including intravenous iron sucrose, conjugated estrogens, naproxen, raloxifene, and teriparatide
Cramps have been linked to electrolysis imbalances, but reseach has not supported these theories.
Older people are more likely to experience leg cramps. Muscle loss starts from the mid-40s and increases if the person is not active. This increases the risk of cramps.
Between 50 and 60 percent of adults and 7 percent of children are believed to experience cramps, and the likelihood increases with age.
They are more common during pregnancy.
The American Academy of Orthopaedic Surgeons (AAOS) suggests:
- stopping the activity that caused the cramp
- stretching and massaging the muscle
- holding the leg in the stretched position until the cramp stops
- applying heat to muscles that are tight or tense (heat packs are available to purchase online)
- using cold packs on tender muscles
Some people use supplements, such as magnesium to reduce muscle cramps, but a review published in 2012 concluded that older adults were unlikely to benefit from this treatment, and that it was unclear whether they would benefit women during pregnancy.
Anecdotal evidence has suggested that mild exercise just before bedtime, such as a few minutes on a stationary bike or treadmill, may help.
No medication is recommended for cramps.
If a severe cramp leaves a muscle feeling tender, an over-the-counter (OTC) painkiller may help.
Quinine has been used in the past, but it is no longer recommended, according to recommendations published by the American Family Physician (AFP). The FDA issued a warning in 2010 about potentially dangerous interactions and side effects.
There is limited evidence that exercise and stretching, calcium channel blockers, carisoprodol, and vitamin B-12 may help. Multivitamins may be of some use during pregnancy.
There is no evidence that nonsteroidal anti-inflammatory drugs (NSAIDs), calcium, or potassium are of any benefit.
Exercises and stretches
If there is no underlying cause, the leg cramps will probably get better without treatment.
Stretching exercises may help.
If the cramp is in the calf muscle you can try these:
- Straighten the leg and pull the toes up toward the knee, to stretch the calf muscle.
- Walk on tiptoes for a few minutes.
- Stand about one meter from a wall with your feet flat on the ground. Lean forward against the wall with your arms outstretched and your hands flat on the wall. Keep the heels on the ground. Hold for 10 seconds, then gently return to an upright position. Repeat five to ten times.
These exercises may help relieve cramp and also prevent future episodes, if they are done two or three times a day.
The following measures may also help prevent leg cramps.
- Supporting your toes when lying down or asleep by propping up the feet with a pillow or letting the feet hang over the edge of the bed.
- Keeping bedding loose to help prevent the feet and toes from pointing downward during sleep.
- Wearing suitable footwear, especially if you have flat feet and other foot problems.
Keeping fit by getting enough exercise can help. If you exercise, make sure your program is suitable and that your progress is gradual. Avoid overexertion and training for prolonged periods, and always remember to warm up before you start.