Leg Cramps: Treatment & Support
If you’ve ever woken up in the middle of the night with an excruciating pain in your leg or foot, there’s a good chance you know what leg cramps feel like. Thankfully, leg cramps are usually harmless, but if you’ve ever had one, you’ll be all too aware of how painful they can be. And while for some people they only last a few seconds, others may be in pain for up to 10 minutes. In some cases, the affected muscle can also feel sore and tender for up to 24 hours following a cramp.
Many people have a cramp in their leg occasionally, with up to 60 per cent of adults thought to have had leg cramps at night at some point or other (i). But if you’re getting older, you’re more likely to have them more often – according to the National Institute of Health and Care Excellence (NICE) a third of the over-60s experience cramps when they’re at rest, with 40 per cent saying they have three or more attacks per week (ii).
What causes leg cramps?
The cramp is caused by a muscle spasm, which happens when a muscle contracts (shortens) suddenly. The muscle most commonly affected is the calf muscle (gastrocnemius), but the muscle at the front of your thigh (quadriceps) and back of your thigh (hamstrings) are also prone to spasms. You can also get cramp in your feet, hands, arms, abdomen and the muscles along the ribcage – though the leg muscles are the most affected.
There are different types of cramps, depending on what’s causing them:
Idiopathic cramps are the most common type – these happen for no apparent reason.
Symptomatic cramps are a symptom or complication of a health condition, including liver disease, a neurological condition such as motor neurone disease or peripheral neuropathy, lead or mercury poisoning or an untreated underactive thyroid gland (hypothyroidism). If you have acute or chronic diarrhoea or you’re a heavy drinker of alcohol, these things can also cause leg cramps.
Several types of medicines also cause leg cramps, including diuretics (often used to treat high blood pressure), statins (cholesterol-lowering drugs), raloxifene (a treatment for osteoporosis), nifedipine (used to treat angina and Raynaud’s phenomenon), nicotinic acid (a drug used to treat high cholesterol), and the asthma drugs salbutamol and terbutaline. Muscle cramps can also be a symptom of opiate drug withdrawal.
Paraphysiological cramps, meanwhile, affect healthy people but are caused by a physiological stimulus, the best example of which is exercise (leg cramps are common while playing sports). Some experts believe low levels of substances called electrolytes – such as magnesium, calcium sodium and potassium – or dehydration may trigger cramps too. They’re also very common in pregnancy, possibly because of the extra weight putting pressure on muscles nerves and blood vessels (some also believe low levels of calcium and magnesium in pregnancy may cause leg muscle spasms).
Another thing that may trigger paraphysiological cramps in the foot is wearing high heels, especially where the toes become stuck in a cramped position for long periods of time, forcing them into spasm.
If you experience irresistible urges to keep moving your legs, you might not be experieicning leg cramps, but rather restless leg syndrome. You can learn more about restless leg syndrome — from causes to prevention — in our guide.
Leg cramps: what are the treatments?
If you have idiopathic cramps – that is, cramps where there’s no underlying health condition or physiological stimulus – the most common treatment is to do stretching exercises that stop a cramp once it’s started and exercises to help prevent having recurrent cramps (see below).
Over-the-counter painkillers such as paracetamol and ibuprofen can also be used to relieve the soreness and tenderness that can follow a cramp.
The drug quinine sulfate used to be prescribed to people whose quality of life was affected by cramps – if it meant they weren’t getting enough sleep, for instance. These days, however, it’s not generally recommended, thanks to the many side effects it can cause, including tinnitus, hearing and/or vision difficulties, headache, nausea and hot flushes.
A more serious side effect of taking quinine sulfate is a condition called thrombocytopenia, which can increase your risk of excessive bleeding (indeed, according to the Medicines and Healthcare Products Regulatory Agency, a small number of people are known to have died from thrombocytopenia after taking quinine for leg cramps, including two cases in the UK (iii) ). Quinine should also never be taken during pregnancy.
Some people will still be prescribed quinine by their GP as a last resort, especially if they’re having severe and frequent leg cramps – usually this treatment is given for just four to six weeks in the first instance.
Meanwhile, there is a very small amount of quinine in tonic water, and many people who have cramps at night find drinking a small bottle of tonic water in the evening helps.
Treating secondary leg cramps
If you have an underlying condition that’s causing leg cramps, treating that condition can often treat the cramps too. In the case of cramps related to liver disease, muscle relaxants are sometimes used to prevent the muscles from going into spasm.
Some people are affected by leg cramps because of a certain medicine or medicines they’re taking. If you think your medication is causing a problem, speak to your GP about it, as in many cases there are alternative treatments available.
Exercises for leg cramps
When you have a leg cramp, the pain can be agonising. To make the pain go away as quickly as possible, you need to stretch the muscle that’s in spasm and massage it gently, which can help it to relax.
Cramp in your calf
If you’re in bed, straighten your leg and pull your toes back towards you. Getting up and walking around on your heels for a few minutes can help too.
Cramp in your quadriceps
A cramp in the muscle in the front of your thigh can be relieved by standing up, holding onto the foot of the affected leg while bending your knee and pulling your heel gently in towards your buttocks.
Cramp in your hamstrings
If the cramp is in the back of your thigh, stand up and place the affected leg one step in front of you, with just the heel of your foot touching the ground. Slowly bend the back knee and lean forwards from the hips (put your hands on the bent knee or thigh to balance yourself). Keep leaning forward until you feel a stretch in your front leg.
With all stretches, hold until the muscle starts to ease up. You may also find it useful to apply a warm towel or pad on the affected muscle to help it relax. Some people also find massaging the muscle with ice can be beneficial.
Meanwhile, keeping your muscles supple can help prevent cramps in the first place. If you have cramps in your calves more than just occasionally, try doing this stretch three times a day:
Stand about 60-90cm from a wall (you should be facing the wall).
Keeping your feet flat on the floor, bend forward to lean on the wall, placing your hands on the wall at approximately shoulder height. You should feel the stretch in your calf muscles – hold for as long as you can, then repeat a few more times.
An alternative way of stretching your calf muscle is to stand on a step with your heels hanging over the edge of the step.
Drop your heels to feel the stretch in your calf muscles.
Hold for up to 30 seconds, then do it again a few more times.
Keep doing preventative exercises for at least two to four weeks, as it may take a while before you see any improvement in your leg cramps.
The position you sleep in can either make leg cramps more or less likely, some experts believe.
If you like to sleep on your back, avoid letting your toes fall forwards. Put a pillow at the end of the bed so that the soles of your feet are propped up against it (that is, your toes are pointing upwards, not forwards).
On the other hand, if you like to sleep on your front, hang your feet over the end of the bed – this keeps your toes in the best position. Either way, keeping the blankets loose at the end of the bed will stop your toes from getting into the wrong position, which may make cramps more likely. Learn more on how to improve the quality of your sleep to support your body, including your legs.
If you have a cramp on any part of your body that lasts longer than 10 minutes and doesn’t respond to stretching or massaging, contact your GP for advice as soon as possible or call your local out-of-hours service (alternatively call NHS 111).
Can diet help?
Experts are divided over the issue of nutritional deficiencies being involved in triggering leg cramps. However, many think cramps are caused by a lack of hydration, especially during hot weather or while you exercise and afterwards, so make sure you drink enough water (check the colour of your urine – the paler it is, the more hydrated you are).
It’s also thought that an imbalance of electrolytes (sodium, magnesium potassium, calcium etc.) may play a part in muscle cramps, as it may affect the nerves controlling the muscles. This may be a particular problem if you exercise heavily, and explains why many sports people use drinks containing electrolytes during and after participating in their activities.
Eating a healthy varied diet will also help make sure you’re getting the right nutrition to keep cramps at bay. Many nutritional therapists recommend getting plenty of the following foods in your diet if you get leg cramps:
Foods rich in potassium are often recommended for leg cramps. As well as bananas, try eating more sweet potatoes, spinach, avocado, dried apricots and mushrooms, and drink coconut water or kefir (fermented milk).
Fish that contain soft bones that you eat are a good source of calcium. If you don’t like fish, try kale, yoghurt, watercress, broccoli or figs.
If you’re sweating a lot through exercise or being in a hot climate, you may need to top up your sodium levels. However, be careful not to eat more than 6g of salt each day. The type of salt you eat may also be important – go for organic sea salt such as Cornish sea salt, as it contains lots of minerals and is more nutritious than ordinary table salt.
Meanwhile, try to limit the amount of caffeine in what you eat and drink, as too much caffeine could have an effect on your blood vessels, making them constrict and reducing the circulation to your muscles. Instead of tea, coffee, caffeine-based soft drinks and chocolate, go for decaffeinated versions, water or herbal tea.
Natural support for leg cramps
Whether you’re affected by the occasional leg cramp or you get them regularly, they’re never a pleasant experience. Thankfully there are a few natural supplements that may help provide relief:
When leg cramps are brought on by exercise, the cause is often thought to be poor blood circulation. If you’re affected by exercise-related leg cramps, taking a fish oil supplement may be useful, since the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), found in oily fish, are believed to help improve blood flow in the arteries. This may be because they help reduce levels of triglycerides – fat-related substances – in your bloodstream, which may in turn help your blood flow more efficiently.
If you’re a vegetarian or vegan you can still benefit from an omega-3 supplement, thanks to the availability of products that contain the natural triglyceride (TG) form of omega-3, which is sourced from plant organisms called microalgae rather than fish.
Many natural health practitioners also believe vitamin E is useful to boost blood circulation, as it’s thought to help widen blood vessels and may help prevent blood clotting inside the blood vessels.
Leg cramps that come on when you walk more than a short distance can be caused by a condition called intermittent claudication. This is found in people who are in the advanced stages of atherosclerosis – or thickening of the arteries – which itself is thought to be accelerated by high levels of a substance called homocysteine in the blood. Vitamin B12 is thought to work with other B vitamins (namely folic acid and vitamin B6) to lower blood levels of homocysteine.
However many strict vegetarians and vegans may be deficient in B12, as it’s mostly found in animal-based foods. Some sources also suggest some elderly people are also deficient in B12 (iv), possibly because they produce lower levels of stomach acid, which is needed to release B12 from proteins in food.
Also known as palmitoylethanolamide, PEA is a type of fatty acid made naturally by the body and found in all cells, tissues and fluids including the brain (it’s also found in foods such as soya beans, peanuts, eggs, flaxseed and milk). Described as an endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides (v), PEA is an alternative to CBD, since both substances are thought to have similar properties including the ability to reduce pain and inflammation. However researchers suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (vi) with no known side effects (v).
Your body naturally increases its production of PEA when your cells are damaged or threatened. But in certain situations – such as when your body is experiencing chronic inflammation – the level of PEA in your cells drops (v). When this happens, PEA supplements may be helpful. In fact experts from the institute for Neuropathic Pain in The Netherlands have published a small number of case reports that suggest PEA may be helpful for people suffering from painful night cramps (vii).
Experiencing leg cramps can impact upon your entire daily routine, but this guide should help to ease some of the symptoms. For even more information on a range of other health conditions, feel free to visit our health library.
Available online: https://patient.info/doctor/muscle-cramps
Available online: https://cks.nice.org.uk/leg-cramps#!backgroundSub:1
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.