Nocturnal Leg Cramps: EP’s Wellness Doctor Rx

Lying down on the couch or bed when the lower leg seizes with intense sensations and pain that doesn’t stop, and the muscle could be hard to the touch. When trying to move the leg, it feels paralyzed. Nocturnal leg cramps, called muscle spasms or Charley horses, occur when one or more leg muscles tighten involuntarily. Individuals can be awake or asleep when a leg cramp strikes. Chiropractic treatment, decompression, and massage therapies can help relieve symptoms, stretch and relax the muscles, and restore function and health.

Nocturnal Leg Cramps

Nocturnal leg cramps most often affect the gastrocnemius/calf muscle. However, they can also affect the muscles in the front of the thigh/quadriceps and the back of the thigh/hamstrings.

• Often, the tight muscle relaxes in less than 10 minutes.
• The leg and area can feel sore and tender afterward.
• Frequent calf cramps at night can cause sleep problems.
• Nocturnal leg cramps are more common among women and older adults.

Causes

There are no known exact cause/s, making most cases idiopathic. However, there are known factors that can increase the risk. These can include:

Prolonged Sitting and Position

• Sitting with the legs crossed or the toes pointed for long periods shortens/pulls the calf muscles, which can cause cramping.

Prolonged Standing and Posture

• Individuals standing for long periods are likelier to experience nocturnal cramps from the stressed muscles.

Muscle Overexertion

• Too much exercise can create an overworked muscle and can contribute to cramps.

Nerve Activity Abnormalities

• Leg cramps are associated with increased, abnormal nerve signaling.

Lack of Physical/Exercise Activity

• Muscles need to be stretched regularly to function correctly.
• Lack of physical activity for long periods weakens the muscles, making them more susceptible to injury.

Shortening The Tendons

• The tendons, which connect muscles and bones, shorten naturally over time.
• Without stretching, this could lead to cramping.
• Cramps may be related to foot position when sleeping, with the feet and toes extending away from the body, known as plantar flexion.
• This shortens the calf muscles, making them more susceptible to cramping.

Leg cramps at night are unlikely a sign of a more serious medical condition, but they are associated with the following conditions:

• Musculoskeletal disorders.
• Structural issues – flat feet or spinal stenosis.
• Metabolic disorders like diabetes.
• Pregnancy.
• Medications – statins and diuretics.
• Neurological disorders, like motor neuron disease or peripheral neuropathy.
• Neurodegenerative disorders.
• Liver, kidney, and thyroid conditions.
• Cardiovascular conditions.

Chiropractic and Physical Therapy

Rehabilitation with chiropractic, massage, and physical therapy depends on the severity of the injury and condition. A chiropractic treatment plan can include the following:

• Calf muscle stretching.
• Targeted Stretch Exercises.
• Progressive calf stretching exercises – a regular stretching and flexibility program will increase the range of motion and prevent future calf injuries.
• Foam rolling – gentle self-massage with a foam roller can help reduce spasms and improve blood circulation.
• Percussive massage.
• Muscle strengthening exercises will build muscle strength and coordination to prevent future strain injuries.

At-home therapy can include:

Maintain Hydration

• Fluids allow for normal muscle function.
• Individuals may need to adjust how much fluid is drunk based on weather, age, activity level, and medications.

Change Sleeping Position

• Individuals should avoid sleeping in positions in which the feet are pointing downward.
• Try sleeping on the back with a pillow behind the knees.

Self Massage

• Massaging the affected muscles will help them relax.
• Use one or both hands or a massage gun to knead and loosen the muscles gently.

Stretching

• Various stretches will maintain the treatment, help keep the muscles relaxed and retrain the muscles.

Stationary Cycle

• A few minutes of easy pedaling can help loosen the leg muscles before bed.

Walking on the Heels

• This will activate the muscles on the other side of the calf, allowing the calves to relax.

Supportive Footwear

• Poor footwear can aggravate issues with the nerves and muscles in the feet and legs.
• Orthotics may help.

Heat Application

• Heat can soothe tight muscles and increases blood flow to the area.
• Apply a hot towel, water bottle, heating pad, or muscle topical cream to the affected area.
• A warm bath or shower (if available, shower massage setting) can also help.

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References

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Butler, J V et al. “Nocturnal leg cramps in older people.” Postgraduate medical journal vol. 78,924 (2002): 596-8. doi:10.1136/pmj.78.924.596

Garrison, Scott R et al. “Magnesium for skeletal muscle cramps.” The Cochrane Database of systematic reviews vol. 2012,9 CD009402. Sep 12, 2012, doi:10.1002/14651858.CD009402.pub2

Giuffre BA, Black AC, Jeanmonod R. Anatomy, Sciatic Nerve. [Updated 2023 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK482431/

Handa, Junichi, et al. “Nocturnal Leg Cramps and Lumbar Spinal Stenosis: A Cross-Sectional Study in the Community.” International Journal of general medicine vol. 15 7985-7993. Nov 1 2022, doi:10.2147/IJGM.S383425

Hsu D, Chang KV. Gastrocnemius Strain. [Updated 2022 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK534766/

Mayo Clinic Staff. (2019). Night leg cramps. mayoclinic.org/symptoms/night-leg-cramps/basics/causes/sym-20050813

Monderer, Renee S et al. “Nocturnal leg cramps.” Current Neurology and Neuroscience report vol. 10,1 (2010): 53-9. doi:10.1007/s11910-009-0079-5