Leg cramps: Causes, treatment, and prevention

Why leg cramps, or Charley horses, occur is often not clear. But, they may result from nerve dysfunction, shortened leg muscles, and various health conditions, such as diabetes and kidney failure. Stretching the muscle may bring relief, but an underlying condition will need medical attention.

Leg cramps involve sudden, painful, and involuntary contractions of a leg muscle, causing pain and discomfort in the feet, calves, and thigh muscles

They often occur while a person is sleeping or resting. They can be gone in a few seconds, but the average duration is 9 minutes. They can leave tenderness in the muscle for up to 24 hours after.

In most cases, there is no identifiable reason why they happen, and they are harmless. Sometimes, however, they can indicate an underlying disorder, such as diabetes or peripheral artery disease.

In most cases, people do not know why leg cramps happen, although there are a number of theories.

Some research suggests that muscle fatigue and nerve dysfunction may play a role.

Sleeping with the foot stretched out and the calf muscles shortened may trigger night cramps.

Another theory is that cramps are more likely nowadays, as most people no longer squat, a position that stretches the calf muscles.

Exercise is a 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 their body is out of condition. Nerve damage may play a role.

Some experts believe dehydration and electrolyte imbalances may contribute. Athletes who exercise strenuously in hot weather often experience cramps. However, scientific evidence has not confirmed this connection. Athletes who play in cool climates also get cramps, after all.

Sometimes leg cramps are caused by an underlying condition relating to the nervous system, circulation, metabolism, or hormones. Some medications can also increase the risk.

Conditions that may cause cramps include:

• alcohol misuse
• cirrhosis
• chronic kidney failure
• hemodialysis
• cancer treatment
• muscle fatigue
• vascular disease
• Parkinson’s disease
• peripheral artery disease (PAD)
• restless legs syndrome
• pregnancy, especially in the later stages
• motor neuron disease
• Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS)
• spinal nerve irritation or compression
• hardening of the arteries
• spinal stenosis
• thyroid disease and hormonal problems
• chronic infections
• chronic obstructive pulmonary disease (COPD)
• chronic kidney disease and kidney failure
• diabetes, especially type 2 diabetes
• fibromyalagia

Medications that can trigger cramping include:

• iron sucrose (Venofer)
• conjugated estrogens
• raloxifene (Evista)
• naproxen (Aleve)
• teriparatide (Forteo)

Older people are more likely to experience leg cramps. Muscle loss starts from the mid-40s and increases if a person is not active. This may raise the risk of cramps.

Research suggests that 50–60% of adults and 7% of children experience cramps, and the likelihood increases with age.

The American Academy of Orthopaedic Surgeons (AAOS) suggest the following to ease cramping:

• Stop the activity that caused the cramp.
• Stretch and massage the muscle.
• Hold the leg in the stretched position until the cramp stops.
• Apply heat to muscles that are tight or tense.
• Use cold packs on tender muscles.

Some people use supplements, such as magnesium, to reduce muscle cramps. However, a 2020 review that looked at older adults concluded that they were unlikely to benefit from this treatment. For other contexts, such as pregnancy, there is not enough evidence to show whether supplements help.

Stretching before bedtime may help, but evidence is limited.

No medication is likely to prevent leg cramps.

If a severe cramp leaves a muscle feeling tender, an over-the-counter (OTC) painkiller may help.

In the past, people used quinine. However, the Food and Drug Administration (FDA) urge people not to use this, as it may have 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.

Here, learn more about treating leg muscle cramps.

If there is no underlying cause, leg cramps will probably get better without treatment.

Walking on tiptoes may help stretch the muscles and relieve a cramp.

Stretching exercises may help. If the cramp is in the calf muscle try the following stretches:

Hamstring muscle stretch

Image credit: Zinkevych/Getty Images

1. Sit on the floor with legs straight out in front.
2. Pull the toes up toward the knee, to stretch the calf muscle.
3. Hold for 30 seconds.

Calf muscle stretch

1. Stand about one meter from a wall with both feet flat on the ground.
2. Lean forward against the wall with the arms outstretched and the hands flat on the wall. Keep the heels on the ground.
3. Hold for 10 seconds, then gently return to an upright position.
4. Repeat 5-10 times.

Quadriceps muscle stretch

1. Stand up straight, holding a wall or chair for support if necessary.
2. Pull one foot up toward the buttocks, grasp and ankle, and hold the foot as close to the body as far as possible.
3. Hold for 30 seconds, then repeat with the other foot.

Doing these exercises may help relieve or prevent cramps. They can also serve as a warm up before exercise.

The following measures may also help prevent leg cramps.

• Support the toes when lying down or asleep by propping up the feet with a pillow.
• Keep bedding loose to help prevent the feet and toes from pointing downward during sleep.
• Wear suitable footwear during the day, especially if a person has flat feet or other foot problems.

Keeping fit by getting enough exercise can help. If a person does exercise, they should make sure their program is suitable and that their progress is gradual. Avoid overexertion and training for prolonged periods, and always remember to warm up before starting.

Leg cramps are not usually a cause for concern, but sometimes they can indicate an underlying problem. If cramps are severe or happen frequently, it may be a good idea to seek medical advice.

The doctor may carry out tests to try to identify an underlying cause. If the person is taking medications that can trigger cramps, the doctor may adjust the dose or change the drug.

Leg cramps are a common problem that usually happen for no identifiable reason. Stretching and massaging the muscle can often bring relief.

In some cases, however, there may be an underlying cause that needs medical attention. If cramps are severe or frequent, consider consulting a doctor.

Types, causes, and home treatment

Injury to the muscles, bones, and nerves can all cause a person’s leg to hurt. Leg pain may occur due to trauma, or an underlying condition. Treatment will vary depending on the cause of the leg pain.

There are many causes of leg pain. Causes can relate to the following:

• blood vessels
• nerves
• muscles
• joints
• soft tissues
• bones

The course of treatment depends on the cause of the leg pain. People can often treat leg pain at home, but if the pain is sudden, severe, or persistent, or if there are other symptoms, medical attention may be necessary.

This article examines some common causes of leg pain and treatments.

Fast facts about leg pain

• The causes of leg pain can be musculoskeletal, neurological, or vascular.
• Shin splints and stress fractures can result from repetitive sports, such as running.
• Leg pain can sometimes indicate a serious vascular issue. These can occasionally be fatal, and they require medical intervention.
• People can treat many types of pain at home, but severe or persistent pain can indicate a more serious condition.

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Doctors mostly classify leg pain as neurological, musculoskeletal, or vascular, which can overlap.

Neurological pain

Conditions include restless legs syndrome, in which the legs twitch uncontrollably, neuropathy or nerve damage, and sciatic nerve pain. Neurological pain can be present even when resting, such as in the arms or legs.

Musculoskeletal pain

Musculoskeletal pain examples are crepitus, a popping or cracking sound in the knee, or arthritis, a condition that affects the joints in the body.

For example, injuries to the muscle tendon or ligament during a fall would cause musculoskeletal pain.

Cramps, compartment syndrome, and stress fractures are also musculoskeletal issues.

Vascular pain

Causes of vascular pain include:

• peripheral arterial disease (PAD)
• deep vein thrombosis (DVT)
• vasculitis
• varicose veins
• varicose eczema, discoloration of the skin accompanies the pain

Different causes of leg pain can have similar symptoms. If necessary, getting a correct diagnosis increases the chances of receiving appropriate treatment. Identifying the symptoms and their onset can help find an appropriate diagnosis.

Leg cramps, or Charley horses

Charley horses are transient episodes of pain that can last for several minutes. The muscle — usually the calf at the back of the lower leg — tightens and spasms.

Nocturnal leg cramps are common, with a high prevalence in older people.

PAD

Many people with PAD are asymptomatic. However, a painful ache or cramp in the leg consistently occurs after the same walking distances, but they often ease on resting.

The key symptom is intermittent claudication. Intermittent claudication causes the blood supply to the leg muscles to become restricted. The resulting lack of oxygen and nutrients causes pain.

Claudication involves:

• cramp-like muscle pain during exercise or exertion
• pain in the buttocks, thighs, calves, and feet
• pain when walking or climbing stairs

DVT

DVT refers to a blood clot in the deep veins of the leg. For example, it can emerge after spending a long time sitting on a long-distance flight.

Vascular problems can be serious. Both PAD and DVT can present without symptoms. People whose lifestyle or medical history leaves them prone to vascular problems in the leg should be aware of possible symptoms.

Symptoms include swelling and a hot, painful sensation on one side of the leg. This sensation may only occur when walking or standing up.

The clot may dissolve on its own, but if the person experiences dizziness and sudden shortness of breath, or if they cough up blood, emergency attention is needed. These could be signs that DVT has developed into a pulmonary embolism or a blood clot in the lung.

Shin splints

Engaging in intense exertion during sports can lead to different types of injury.

Jogging and running can create repetitive impact forces that overload muscles and tendons. Shin splints produce severe, localized tenderness in the muscles and sometimes bone pain commonly felt around the shin bone.

Fractures and stress fractures

Heavy pressure, such as a fall, can lead to fractures. Some fractures are easily visible, with severe bruising, swelling, and deformation. These normally receive urgent medical attention.

Stress fractures are small fractures that can result from repetitive stresses sustained during sports, often when activity intensity increases too quickly, such as in running-intensive sports.

The pain may start earlier during each exercise session and eventually become present all the time.

Achilles tendonitis

Achilles tendonitis is a common condition where the large tendon that runs down the back of the lower leg becomes irritated and inflamed.

Hamstring strain

Acute trauma can lead to sprains and strains. A sprain refers to the stretching or tearing of a ligament.

A hamstring strain or injury is very common in athletes and can lead to an acute pain in the rear of the thigh muscle, usually due to a partial tear.

Sprains and strains usually develop due to inadequate flexibility training, overstretching, or not warming up before an activity. Continuing to exercise while injured increases the risk.

Compartment syndrome

When an injury to the leg results in swelling, dangerous muscle pressure levels can lead to acute or chronic compartment syndrome. This possibly may be due to a fracture or severe bruising.

The swelling causes pressure to build up until the blood supply cuts off from muscle tissue, depleting the muscles of oxygen and nourishment. The pain may be unexpectedly severe, considering the injury.

In severe cases, numbness and paralysis may follow the pain. Permanent muscle damage can result.

Sciatic nerve pain

Sciatica happens when something puts pressure on a nerve, often in the spine, leading to pains that run down the leg from the hip to the foot.

It can happen when a nerve is “pinched” in a muscle spasm or herniated disk.

Long-term effects include strain on other body parts as the gait — the way a person walks — changes to compensate for the pain.

People can resolve many cases of leg pain at home without medical intervention.

Self-help for muscle cramps

If doctors have ruled out the serious causes of cramps, self-help measures may be appropriate.

Pain relief medication will not improve leg cramps as they start suddenly, but stretching and massaging the muscle may help.

To relieve the pain when cramps occur, a person can hold the toe and pull it up toward the body while straightening the leg. They can also walk around on heels until the cramp eases off.

To prevent cramps, a person should:

• Always stretch and warm up before and after exercising.
• Avoid dehydration by drinking 8–12 glasses of water a day.
• Regularly stretch and massage the legs.

Learn more about stretching routines.

Sports injury treatment

Over the years, acronyms to guide the management and treatment of injuries have evolved, including Rest, Ice, Compress, and Elevate (RICE). The most recent rehabilitation treatment is PEACE and LOVE.

• Protect: A person should try to protect the affected area by restricting movement for 1–3 days.
• Elevate: People need to elevate the leg higher than the heart.
• Avoid nonsteroidal anti-inflammatory drugs (NSAIDs): Remedying inflammation with NSAIDs may negatively affect long-term tissue healing and recovery.
• Compress: Apply pressure to the affected area using taping or bandage.
• Educate: Physical therapists should educate people on the benefits of an active approach to recovery.

After the first few days, soft tissues need LOVE.

• Load: A person should exercise and move areas affected by musculoskeletal disorders.
• Optimism: Optimistic expectations link to better outlooks and recovery.
• Vascularisation: Aerobic exercise should start a few days after injury to boost motivation and increase blood flow to the injured structures.
• Exercise: Exercises help to restore mobility and strength early after injury.

Many experts are considering using PEACE and LOVE for treatment. People should consult their doctor if they have questions about which method is right for them.

Drugs such as acetaminophen can help with some pain, but if pain persists for more than 72 hours, a person should seek specialist medical advice.

Circulatory issues

A person requires medical attention for claudication and other symptoms of vascular disease due to the risk of developing coronary artery disease and cerebrovascular disease, which could lead to a heart attack or stroke.

To reduce cardiovascular risk factors, doctors advise:

• avoiding or quitting smoking
• reducing excess weight
• managing levels of blood sugar, cholesterol, and lipids
• controlling blood pressure
• exercising and following a balanced diet
• reducing stress where possible

A differential diagnosis strategy can help rule out inappropriate causes, narrow the possibilities, and provide timely intervention.

Leg pain has many different causes, and the symptoms often overlap. If they persist, worsen, or make life difficult, the individual should contact a doctor.

A person can receive treatment based on the cause of the leg pain. They can also treat it at home by stretching, massaging, and staying hydrated. At present, doctors treat sports injuries with the PEACE and LOVE protocol.

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Hold the plastic ring firmly when removing.

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DESCRIPTION

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SUGGESTIONS FOR USE

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BEAUTY TIP

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MAIN ACTIVE INGREDIENT – MATE

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INGREDIENTS

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