Nocturnal (Evening) Leg Cramps
Nocturnal leg cramps are a complaint that I’ve heard from several of my clients. Nocturnal myoclonus is a sudden, involuntary contraction of the calf muscles that occurs during the night, or while at rest. These cramps can affect persons in any age group, but they tend to occur more often in middle-aged and older populations. Occasionally, muscles in the soles of the feet also become cramped. The sensation can last a few seconds or up to ten minutes, but the soreness may linger. Nocturnal leg cramps should not be confused with restless leg syndrome, a crawling sensation that is relieved by walking or moving around. Although very uncomfortable, restless leg syndrome typically does not involve cramping or pain.
The root cause of nocturnal leg cramps is not always known. Sometimes the cramps are caused by dehydration, overexertion of the muscles, structural disorders (e.g. flat feet), standing on concrete, prolonged sitting, or inappropriate leg positions while sedentary. Less common causes include diabetes, Parkinson’s disease, hypoglycemia, anemia, endocrine disorders (including thyroid), and use of some medications. In some cases, there doesn’t seem to be a specific trigger. On the whole I have found that leg cramps typically occur in a specific area of the muscle in question, and that region is locked in a long-term spasm. This calls for a deep (somewhat uncomfortable) massage. Once the area is relaxed, cramps typically disappear.
Consider some of the following measures to help prevent recurring cramps
- Drink six to eight glasses of water daily to prevent dehydration.
- See a massage therapist for a therapeutic calf, leg, and foot massage
- Keep blankets loose at the foot of the bed to prevent your toes and feet from pointing downward while you sleep.
- Try a massaging your calves before falling asleep.
- Consider light exercise (such as a stationary bicycle) for a few minutes before bedtime, especially if you do not get a lot of exercise during the day.
- Stretch your calves regularly throughout the day and at night. Two different stretches are shown. (See illustration) Stretch in the morning, before your evening meal, and before going to bed each night.
- Towel Stretch – Sit on a hard surface with your leg stretched out in front of you. Loop a towel around the ball of your foot, and pull the towel toward your body. Be sure to keep your knee straight. Hold this position for thirty seconds and then alternate.
- Standing Calf Stretch – Facing a wall, put your hands against the wall at about eye level. Keep the one leg back, and your heels on the floor. Hold for thirty seconds, and then alternate.
- Magnesium can be very helpful for muscle cramps. Some people taking magnesium may get relief from leg cramps right away, but a long-standing deficiency can take weeks to overcome with supplements.
- There are some reports that muscle cramps at night may be associated with oxygen depravation from sleep apnea. Try taking several deep breaths at the first sign of cramping to see if more oxygen helps.
- Nocturnal leg cramping often responds to 400-800iu of vitamin E per day. In one of the largest studies, 103 of 125 people who had been experiencing leg and foot cramps at night reported relief after taking vitamin E. A daily dose of 300iu was effective for half of the participants, while the others required 400iu or more for relief.
- Peppermint has a weak action but can lessen cramps.
- A special form of niacin (vitamin B3) called inositol hexanicotinate is supposed to help treat chronic calf cramping.
- Pyridoxine (vitamin B6) is also purported to help reduce leg cramps.
- Taurine, an amino acid in meat can have a positive effect in the treatment of leg cramps. It is often used in combination with glutamic acid and aspartic acid.
- DL-Phenylalanine (an essential amino acid) is supposed to dampen the pain of cramping.
- Other anecdotal dietary suggestions include calcium (sometimes in the form of dolomite), potassium (bananas) and anti-oxidants (like pycnogenols, grape-fruit seed extract)
- If you are experiencing persistent leg cramps talk to your doctor before increasing the dosages of any of the above vitamins or minerals above the recommended daily allowance (RDA)
- The most popular prescription medication is quinine sulphate (but it can have adverse effects and is very toxic in overdosage.)
- Other prescription medications include diphenhydramine hydrochloride, verapamil hydrochloride (Calan, Isoptin, Verelan), diazepam, carbamazepin, chloroquine phosphate (Aralen Phosphate), hydroxychloroquine sulfate (Plaquenil Sulfate) and simple muscle relaxants.
If you experience a leg cramp, try any combination of the following natural treatments
- Gently stretch your calf muscles by straightening your leg and flexing your foot toward your knee. For more stretch, gently grab your toes and pull them upward toward your knee.
- Massage the affected muscles or have your partner massage them.
- Make a massage appointment for some deep muscle therapy
- Take a hot shower or warm bath, or apply an ice massage to the cramped muscle.
- Walk on the affected leg and then elevate it.