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
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.. .
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.
•Conditions that cause alterations in the balance of salts
in the bloodstream (such as a high or low sodium or potassium
•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).
•Some uncommon disorders of nerves.
•Rare causes include: cirrhosis of the liver; lead poisoning;
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
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 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
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.
•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.
•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
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