Cramps in the Leg
Leg cramps are common. The cause is not known
in most cases. However, some drugs and diseases sometimes cause
leg cramps. Regular calf stretching exercises may prevent leg
cramps. Quinine tablets may be advised as a last resort if you
have cramps regularly.
What are leg cramps?
A leg cramp is a pain that comes from a leg muscle. It is due
to a muscle spasm which is when a muscle contracts too hard. It
usually occurs in a calf muscle, below and behind a knee. The
small muscles of the feet are sometimes affected.
A cramp pain typically lasts a few minutes. In some cases it
lasts just seconds, but in some cases it lasts up to 10 minutes.
The severity of the pain varies. The muscle may remain tender
for up to 24 hours after a leg cramp. Leg cramps usually occur
when you are resting - most commonly at night when in bed. (They
are often called night cramps.) They may wake you. It can become
a distressing condition if your sleep is regularly disturbed..
.
Who gets leg cramps?
Many people have an occasional leg cramp. However, they occur
frequently in some people. They are more common in older people.
About 1 in 3 people over the age of 60, and about half of people
over the age of 80, have regular leg cramps. About 4 in 10 people
who have leg cramps have at least three per week. They occur every
day in some people..
.
What causes leg cramps?.
Unknown cause (idiopathic leg cramps)
In most cases the cause is not known. One theory is that cramps
occur when a muscle that is already in a shortened position is
stimulated to contract. As the muscle is already shortened, to
contract further may cause the muscle to go into spasm. This commonly
happens at night in bed, as the natural position we lie in is
with the knees slightly bent (flexed), and with feet pointing
slightly downwards. In this position the calf muscle is relatively
shortened and may be prone to cramps. This theory explains why
stretching exercises may cure the problem..
.
Secondary causes
In some cases, the cramps may be a symptom of another problem.
For example:.
•Some drugs can cause cramps as a side-effect, or make cramps
occur more often. These include: diuretics (water tablets), nifedipine,
cimetidine, salbutamol, statins, terbutaline, lithium, clofibrate,
penicillamine, phenothiazines, and nicotinic acid.
•Over-exertion of muscles.
•Dehydration.
•Conditions that cause alterations in the balance of salts
in the bloodstream (such as a high or low sodium or potassium
level).
•Some people who have renal (kidney) dialysis get leg cramps.
•Pregnancy - usually in the later stages.
•An untreated underactive thyroid gland.
•Peripheral vascular disease (narrowing of the leg arteries
which causes poor circulation).
•Excess alcohol.
•Some uncommon disorders of nerves.
•Rare causes include: cirrhosis of the liver; lead poisoning;
sarcoidosis.
With the above conditions the cramps would just be one of various
other symptoms. Therefore, if you are otherwise well, and have
no other unexplained symptoms, then the leg cramps are likely
to be idiopathic (unknown cause) and not due to a secondary cause.
Note: leg cramps are different to a condition called restless
legs syndrome. In this condition the legs can be uncomfortable,
you feel creeping sensations in the legs, and it is relieved by
walking about. See separate leaflet called 'Restless Legs Syndrome'
for details..
.
What is the treatment for a leg cramp?
Stretching and massaging the affected muscle can usually relieve
an attack of cramp. Most cramps soon ease off. Painkillers are
not usually helpful as they do not act quickly enough. However,
a painkiller such as paracetamol may help to ease muscle discomfort
and tenderness that sometimes persists for up to 24 hours after
a cramp has gone..
.
What are the options for preventing leg cramps?
If cramps do not occur often, then no particular treatment is
usually needed. However, if you have frequent cramps, you may
wish to consider ways of preventing them..
.
Consider your medication (where appropriate) or other conditions
Tell your doctor if you take any of the drugs listed earlier.
It may be causing the leg cramps, or making them recur more often.
Alternative drugs may be available. Also, if you have other symptoms
apart from cramps, see your doctor who may examine you or do some
checks to rule out a secondary cause for the cramps..
.
Stretching exercises
Stretching exercises are commonly advised. However, there is
a lack of good research evidence to prove that they work. One
research study concluded that stretching exercises did reduce
the number and severity of cramps, but another study did not confirm
this. However, many doctors feel that regular calf stretching
does help. So, as it may help, it is worth trying if you are able
to do the exercises. If it works, you will not need any tablets
to prevent the cramps.
At first, do stretching exercises of affected muscles for about
five minutes, three times a day. Do the last exercise shortly
before bedtime. If the cramps ease off, you may then only need
to do the exercise once or twice a day to keep the cramps away.
To stretch calf muscles, stand about 60-90 cm from a wall. Then,
keeping the soles of your feet flat on the floor, bend forward
and lean on the wall. You will feel your calf muscles stretch.
Do this several times, each time for as long as you can manage.
It may take a week or so of exercises before you notice an improvement.
So, it is worth giving yourself a 2- to 4-week trial of regular
calf stretching exercises to see if your cramps ease off. The
cramps may not go completely, but their frequency and/or severity
may reduce..
.
Posture of the legs when resting in bed
Positions which prevent the calf muscle from shortening when
you are asleep may help. The following are not proven treatments
(from research studies), but some experts believe that they help
to prevent cramps..
•Using a pillow to prop the feet up in bed while sleeping
on your back.
•Hanging the feet over the end of the bed while sleeping
on your front.
•Keeping blankets loose at the foot of the bed to prevent
toes and feet from pointing downwards during sleep.
.
Quinine is used as a last resort - and you need to be aware of
the risks
If you take quinine you have a good chance of reducing the number
and/or severity of leg cramps, but it may not stop them altogether.
One tablet at bedtime is the normal dose. Most people can take
quinine, but do not take it if you are pregnant or may become
pregnant. There are also some rare conditions where you should
not take quinine. These include: a previous reaction to quinine;
a previous haemolytic anaemia; optic neuritis; glucose 6-phosphate
dehydrogenase deficiency.
Side-effects are uncommon at the low dose used to treat leg cramps.
However, serious side-effects do sometimes occur. For example,
a serious blood disorder which is potentially fatal is a known
rare side-effect. Also, a small number of people who take quinine
long-term develop a condition called cinchonism (a complex of
nausea, vomiting, dizziness, visual disturbance, and hearing impairment).
Read the drug packet leaflet for a full list of possible side-effects.
Note: quinine is dangerous in overdose, particularly in children.
Keep tablets away from children.
Therefore, quinine is only used as a last resort when other treatments
have not worked, and leg cramps are frequent and are affecting
your quality of life.
When quinine is first prescribed it may be done on a trial basis
for 4-6 weeks. You should be aware of the small risk of serious
side-effects. Also, it is best to objectively assess how well
the quinine works. For example, by keeping a sleep and cramp diary.
Ideally, this should be for a few weeks before and after the start
of treatment so as to gauge its effect. If quinine is found to
help then you may be advised to continue with it for a few months.
You should consider stopping quinine every three months or so
to see if it is still needed. This is because, in some people,
the cramps go away and so the treatment may no longer be needed.
If the cramps return, you can always re-start the tablets..
.
Other treatments
Other drugs have been suggested as possible treatments for leg
cramps. These include: magnesium, diltiazem, vitamin B complex,
vitamin E, naftidrofuryl, orphenadrine, and verapamil. In general,
these are not currently recommended, as most studies involving
them found that they do not work very well in most people. Quinine
remains the main treatment. However, your doctor may suggest a
trial of one of these drugs if quinine has not worked or has caused
troublesome side-effects.
References
•Leg cramps, Clinical Knowledge Summaries (November 2008)
•J V Butler, E C Mulkerrin, S T O’Keeffe; Nocturnal
leg cramps in older people Postgrad Med J 2002;78:596–598
•El-Tawil S, Al Musa T, Valli H, et al; Quinine for muscle
cramps. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD005044.
[abstract]
•Daniell HW; Simple cure for nocturnal leg cramps. N Engl
J Med. 1979 Jul 26;301(4):216.
•Coppin RJ, Wicke DM, Little PS; Managing nocturnal leg
cramps--calf-stretching exercises and cessation of quinine treatment:
a factorial randomised controlled trial. Br J Gen Pract. 2005
Mar;55(512):186-91. [abstract]
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