Leg cramps

Leg cramps are common. The cause is not known in most cases. However, some drugs and diseases sometimes cause leg cramps. Calf stretching exercises regularly can prevent leg cramps. Quinine tablets may be recommended as a last resort if you have cramps regularly.

On this page

  • What are leg cramps?
  • Who gets leg cramps?
  • What causes leg cramps?
  • What is the treatment for a leg cramp?
  • What are the options to prevent leg cramps?
  • References

A leg cramp is a pain that comes from a leg muscle. It is due to muscle spasm which is when a muscle contracts too hard. It usually occurs in a calf muscle, below and behind the knee. The small muscles of the feet are sometimes affected.

A cramp pain typically lasts a few minutes. In some cases lasting only a few seconds, but in some cases lasting up to 10 minutes. The severity of 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.) Can wake up. You can become a distressing condition if your sleep is disturbed regularly.

Many people have an occasional leg cramp. However, frequently occur in some people. They are more common in older people. Approximately 1 in 3 people over 60 years, and about half of those over 80 years, suffers from regular cramping legs. Nearly 4 in 10 people who have leg cramps at least three a week. We present every day in some people.

Unknown cause (idiopathic leg pain)

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 shortens and, hire more can cause muscle spasms. This commonly happens at night in bed, as the natural position is found in the knees slightly bent (flexed), and with feet pointing slightly downward. In this position the calf muscle is relatively small and can 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 medicines can cause cramps as a side effect, or make cramps occur more frequently. These include: diuretics (water tablets), nifedipine, cimetidine, salbutamol, statins, terbutaline, lithium, clofibrate, penicillamine, phenothiazines, and nicotinic acid.
  • Excess muscle effort.
  • Dehydration.
  • Conditions that cause changes in the balance of salts in the blood (such as a sodium salt or low or high potassium level).
  • Some people with renal (kidney) dialysis get leg cramps.
  • Pregnancy – usually in the later stages.
  • An untreated thyroid gland.
  • Peripheral vascular disease (narrowing of the arteries of the legs that causes poor circulation).
  • Excess alcohol.
  • Some rare disorders nerves.
  • Less common causes include liver cirrhosis, lead poisoning, sarcoidosis.

With the above conditions the cramps would be only one of several other symptoms. Therefore, if you are otherwise good, and they have other unexplained symptoms, then the leg cramps are often idiopathic (unknown cause) and not due to a secondary cause.

Note: leg cramps are different from a condition called restless legs syndrome. In this condition, the legs can be uncomfortable, you feel tingling sensations in the legs, walking and relieved. See separate leaflet called 'Restless Legs Syndrome' for more details.

Compare treatment options for leg cramps A Brief decision support.

Stretching and massaging the affected muscle can relieve an attack of cramps. Most cramps soon loosened. Analgesics are often not useful as they do not act sufficiently quickly. However, an analgesic such as acetaminophen can help relieve muscle aches and pain that sometimes persists for up to 24 hours after a cramp is gone.

If cramps do not occur often, then no particular treatment is needed. However, if you have frequent cramps, you may want to consider how to prevent them.

Consider your medication (if any) or other conditions

Tell your doctor if you are taking any of the drugs listed above. It may be the cause of leg cramps, or cause to be repeated more often. Alternative drugs may be available. Also, if you have other symptoms apart from cramps, see your doctor who can examine or have some checks to rule out a secondary cause for cramps.


Diagram of a stretching exercise

Stretching exercises are commonly advised. However, there is a lack of good research evidence to show that they work. A research study concluded that stretching exercises did reduce the number and severity of cramps, but another study did not confirm this. However, many doctors believe that regular stretching calf useless. Therefore, as it can help, worth a try if you are able to do the exercises. If it works, you will not need any pills to prevent 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 cramps ease off, you can then just do the exercise once or twice a day to keep the cramps away.

To stretch the calf muscles, stand about 60-90 cm from the wall. Then, keeping the soles of your feet flat on the floor, bend forward and lean against the wall. You will feel your calf muscles stretch. Do this several times, each time for as long as you can handle. It may take a week or more years before you notice an improvement. Therefore, it is worthwhile to take a 2 – to 4-week test regular calf stretching exercises to loosen see if cramps. Cramps can not go at all, but their frequency and / or severity can be reduced.

The position of the legs when resting in bed

The positions that prevent the calf muscle to shorten during sleep can help. The following are not proven treatments (research studies), but some experts believe help prevent cramps.

  • Using a pillow to rest your feet on the bed while sleeping on your back.
  • Feet hanging over the edge of the bed while he slept on his forehead.
  • Keep blankets loose at the foot of the bed to prevent toes and feet pointing downwards during sleep.

Quinine is used as a last resort – and you need to be aware of the risks

If you take quinine has a good opportunity to reduce the number and / or severity of leg cramps, but can not stop them completely. One tablet before bedtime is the normal dose. Most people can take quinine, but do not take if you are pregnant or may become pregnant. There are some rare conditions that should not take quinine. These include: a previous reaction to quinine, hemolytic anemia anterior optic neuritis-glucose 6-phosphate dehydrogenase.

Side effects are rare in the low dose used to treat leg cramps. However, serious side effects sometimes occur. For example, a condition that is potentially fatal severe is a rare side effect known. In addition, a small number of people taking long-term quinine develop a condition called cinchonism (a complex of nausea, vomiting, dizziness, impaired vision and hearing). Read the drug package insert for a complete list of possible side effects. Note: quinine is dangerous in overdose, especially in children. Keep the tablets away from children.

Therefore, quinine is used only as a last resort when other treatments have not worked, and leg cramps are common and affect their quality of life.

When first prescribed quinine can be done on a trial basis for 4-6 weeks. You should be aware that the small risk of serious side effects. Moreover, it is best to objectively evaluate how well it works quinine. For example, to keep a sleep diary and cramps. Ideally, this should be a few weeks before and after the start of treatment in order to measure its effect. If quinine found to help then you may be advised to continue with it for a few months. You should consider the suspension of quinine every three months or so to see if it is still needed. This is because, in some people, the cramps disappear so that treatment can no longer be necessary. If cramps return, you can always restart the tablets.

Other treatments

Others have suggested as possible treatments for leg cramps. These include: magnesium, diltiazem, vitamin B complex, vitamin E, naftidrofuryl, orphenadrine, and verapamil. In general, they are not presently recommended as most studies found that they do not work very well for 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.