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Leg cramps

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Leg cramps



Introduction 

Leg cramps are a common and usually harmless condition where the muscles in your leg suddenly become tight and painful.

It usually occurs in the calf muscles, although it can affect any part of your leg, including your feet and thighs.

After the cramping has passed, you may have pain and tenderness in your leg for several hours.

Three out of four cases occur at night during sleep.

Read more about the symptoms of leg cramps.

What causes leg cramps?

Leg cramps can occur for no apparent reason, known as idiopathic leg cramps, or as a symptom or complication of a health condition, known as secondary leg cramps.

Causes of secondary leg cramps can include:



pregnancy



exercise 



certain types of medication, such as statins (medicines that help lower cholesterol levels)



liver disease



During a cramp, your muscles suddenly contract (shorten), causing pain in your leg. This is known as a spasm, and you cannot control the affected muscle.

The cramp can last from a few seconds to 10 minutes. When the spasm passes, you will be able to control the affected muscle again.

When to see your GP

Speak to your GP if your leg cramps are affecting your quality of life; for example, if you have frequent leg cramps or they are interfering with your sleep.

Your GP will ask about your symptoms and examine your legs and feet. They may also ask if you have other symptoms, such as numbness or swelling, which may be a sign that you have secondary leg cramps caused by an underlying condition.

In this case, you may need further tests, such as blood tests and urine tests, to rule out other conditions.  

Treating leg cramps

Most cases of leg cramps can be relieved by exercising the affected muscles. Exercising your legs during the day will often help reduce how often you get cramping episodes.

Stretches

To stretch your calf muscles, stand with the front half of your feet on a step, with your heels hanging off the edge. Slowly lower your heels so that they are below the level of the step. Hold for a few seconds before lifting your heels back up to the starting position. Repeat a number of times.

Medication is usually only needed in the most persistent cases where cramping does not respond to exercise.

If you have secondary leg cramps, treating the underlying cause may help relieve your symptoms.

Leg cramps that occur during pregnancy should pass after the baby is born.

Treating cramps that occur as a result of serious liver disease can be more difficult. Your treatment plan may include using medications such as muscle relaxants.

Preventing leg cramps

If you often get leg cramps, regularly stretching the muscles in your lower legs may help prevent the cramps or reduce their frequency.

You might find it useful to stretch your calves before you go to bed each night (see stretching advice above or try this post-exercise calf stretch).

The following night-time advice may also help:



If you lie on your back, make sure that your toes point upwards –placing a pillow on its side at the end of your bed, with the soles of your feet propped up against it may help keep your feet in the right position. 



If you lie on your front, hang your feet over the end of the bed– this will keep your feet in a relaxed position and help stop the muscles in your calves from contracting and tensing.



Keep your sheets and blankets loose.





 

 

 

 


 


If you have leg cramps, the muscles in your leg will suddenly become tight and painful 

 


Who is affected by leg cramps?

It is difficult to estimate exactly how common leg cramps are because most people do not report their symptoms to their GP.

Two groups of people particularly affected by leg cramps are:



adults over 60 – it is thought that a third of people over 60 experience leg cramps; about 40% of these have three or more cramps a week



pregnant women – about a third of pregnant women have leg cramps, usually during the last trimester of pregnancy (week 27 to the birth)



However, people of all ages, including children, have reported having leg cramps. Both men and women are equally affected.


Pregnancy and baby

All you need to know about pregnancy, birth and looking after a baby, including feeding and trying to get pregnant

 

 

Symptoms of leg cramps 

A leg cramp is an episode of sudden pain in the muscles of the leg caused by an involuntary contracting (shortening) of the leg muscle.

Most leg cramps occur in the calf muscles and, less commonly, in the feet and thighs.

Cramps can last from a few seconds up to 10 minutes. Thigh muscle cramps tend to last the longest.

During a cramping episode, the affected muscles will become tight and painful and the feet and toes will be stiff.

After the cramps have passed, you may have pain and tenderness in your legs for several hours.

When to seek medical advice

If you only get leg cramps occasionally, it is not a cause for concern and a medical diagnosis is not required.

A visit to your GP will only be necessary if you get leg cramps frequently, or if they are so painful they disrupt your sleep and you are unable to function normally the next day.

You should also visit your GP if the muscles in your legs are shrinking or becoming weaker.

When to seek immediate medical advice

There are two situations where leg cramps may be a sign of a more serious underlying health condition.

You should seek immediate medical help if:



The cramps last longer than 10 minutes and fail to improve, despite exercise.



Cramps develop after you come into contact with substances that could be toxic (poisonous) or infectious, for example, if you have a cut that is contaminated with soil, which can sometimes cause a bacterial infection, such as tetanus, or after being exposed to elements such as mercury or lead.



In these circumstances, contact your GP for advice immediately.

Timing of cramps

Research has found that:



three out of four people only have leg cramps at night



one out of five people have leg cramps during the day and night



one out of 14 people only experience leg cramps during the day



 

Causes of leg cramps 

The cause of leg cramps is sometimes unknown (idiopathic). In other cases, there may be an underlying condition or another identifiable cause.

Idiopathic leg cramps

Although the cause of idiopathic leg cramps is unknown, there are a number of theories about what might cause idiopathic leg cramps. These include:



abnormal nerve activity during sleep which causes the muscle of the leg to cramp



excessive strain placed on leg muscles, such as when exercising, may cause the muscles to cramp at certain times



a sudden restriction in the blood supply to the affected muscles



Also, tendons naturally shorten over time as a person gets older, which may explain why older people are particularly affected by leg cramps. Tendons are tough bands of tissue that connect muscles to bone. If your tendons become too short, they may cause the muscles connected to them to cramp.

Secondary leg cramps

Secondary leg cramps are caused by an underlying condition or another identifiable cause. These include:



pregnancy: the extra weight of pregnancy can place strain on the leg muscles, making them more vulnerable to cramping



exercise: leg cramps are often experienced when resting after exercise



neurological conditions (conditions that affect the nerves in your leg muscles): for example, motor neurone disease or peripheral neuropathy



liver disease: if your liver stops working properly, toxins will build up in your blood, which can make your muscles go into spasm



infection: some types of bacterial infection, such as tetanus, can cause muscle cramps and spasm



toxins: in some people, high levels of toxic (poisonous) substances in the blood, such as lead or mercury, can cause leg cramps



dehydration: in some people, low levels of water in the body can lead to a drop in your salt levels, which can trigger muscle cramps



Medication

Certain medications have been known to cause leg cramps in a small number of people. These include:



diuretics: these remove fluid from the body and are used to treat conditions such as high blood pressure, heart failure and some types of kidney disease



statins: these are used to treat people with high cholesterollevels in their blood 



raloxifene: this is used to prevent osteoporosis (thinning of the bones) in women who have experienced the menopause



nifedipine: this is used to treat angina and Raynaud’s phenomenon



nicotinic acid: this is used to treat high cholesterol



Contact your GP if you think your medication may be causing your leg cramps as your dosage may need to be adjusted. Never stop taking a prescribed medication unless your GP or another qualified healthcare professional who is responsible for your care advises you to do so. 

 

Treating leg cramps 

If the cause of your leg cramps is known, it may be possible to treat the underlying cause.

For example, secondary leg cramps that are related to liver disease are caused by high levels of toxins in the blood which trigger muscles spasms. Therefore, muscle relaxants can be used to help prevent your muscles from going into spasm.

If the cause of your legs cramps is unknown (primary idiopathic leg cramps), a combination of exercise and painkilling medication is usually recommended.

Exercises

Most cases of leg cramps can be treated with exercises. There are two types of exercise that you can do:



exercises you do during an episode of cramping to relieve the pain and stop the cramping



exercises you do during the day to reduce how often you get leg cramps



The two types of exercises are explained below. 

Exercises during cramps

During an episode of leg cramp, stretch and massage the affected muscle.

For example, if the cramp is in your calf muscle:



Straighten your leg and lift your foot upwards, bending it at the ankle so that your toes point towards your shin.



Walk around on your heels for a few minutes.



Exercises to prevent cramps

To reduce your risk of getting leg cramps in the future, you should do exercises to stretch the affected muscles three times a day.

For example, if your calf muscles are affected by cramps, the following exercise should be beneficial:



stand about a metre away from a wall



lean forward with your arms outstretched to touch the wall while keeping the soles of your feet flat on the floor



hold this position for five seconds before releasing



repeat the exercise for five minutes



For the best results, you should repeat this exercise three times a day, including one session just before you go to bed. Here's an alternativecalf stretch.

If you find these exercises useful you can carry on doing them for as long as you are able to.

Painkillers

If you have leg pain that persists after an episode of cramping, an over-the-counter painkiller, such as paracetamol or ibuprofen may help reduce the pain.

Quinine

Quinine was originally designed as a medication to treat malaria. Subsequent research has found that it can also be moderately effective in reducing the frequency of leg cramps.

However, there is a small chance that quinine may cause unpleasant side effects including:



tinnitus (ringing in your ears)



impaired hearing



headache



nausea (feeling sick)



disturbed vision



confusion



hot flushes



Thrombocytopenia is a rarer but more serious complication of quinine. It occurs when the number of platelets in your blood falls to a dangerously low level. Platelets help the blood to clot which means people with thrombocytopenia are at increased risk of excessive bleeding such as:



nosebleeds



bleeding gums



bleeding inside the eye



bleeding inside the skull or digestive system (both of which can be fatal)



There have been a number of reported cases of people dying from thrombocytopenia after taking quinine to prevent leg cramps.

Never take more than your recommended dose of quinine. An overdose of quinine can result in permanent blindness and death.

Due to these small but potential risks, your GP will only prescribe quinine if there is evidence that the potential benefit of treatment outweighs the risks.

It is recommended that quinine is only prescribed when:



you have tried the exercise techniques discussed above and they haven't helped prevent your leg cramps



you have frequent leg cramps which affect your quality of life



In these circumstances, you may be prescribed a four-week course of quinine. After this time, if you have not gained any benefit, the treatment will be withdrawn.

If you experience any of the side effects listed above, stop taking quinine immediately and contact your GP. 

Treatment plan

Your treatment for leg cramps will be closely monitored and regularly reviewed. For example:



You may be asked to keep a "sleep and cramp" diary to record how often you get leg cramps.



It is likely that your GP will review your initial treatment after three months.



If your condition improves, your GP may reassess your treatment needs every three-to-six months.





Leg cramps