Leg cramps and vitamins

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Leg Cramps at Night

Leg Cramps at Night

What are nocturnal leg cramps?

Nocturnal leg cramps are pains that occur in the legs during the night. They usually cause awakenings from sleep, but they may also occur while awake at night during periods of inactivity. These cramps mostly happen in the calf muscles but can also occur in the thighs or feet. Nocturnal leg cramps are quite painful and cause the affected muscles to feel tight or knotted. Symptoms may last from several seconds up to several minutes. There might also be muscle soreness after the cramp goes away.

Who gets nocturnal leg cramps?

Although anyone can get nocturnal leg cramps, the number of people who get them increases with age. Slightly more women than men experience these leg cramps.

Nocturnal leg cramps have been reported by:

  • 50 to 60 percent of adults
  • 7 percent of children and teens
  • 40 percent of pregnant women

Some 20 percent of patients who experience nocturnal leg cramps on a daily basis seek medical attention.

Are nocturnal leg cramps the same as restless legs syndrome?

No. While both types of leg disturbances tend to happen at night, or at rest, restless leg syndrome does not cause severe, cramping pain. While restless legs syndrome can be painful, it is more of a discomfort, or a crawling sensation that results in a desire to move the legs. While moving, the restlessness is relieved, but the discomfort returns when movement stops. This does not happen with nocturnal leg cramps where the tightened muscle needs to be actively stretched out for relief.

What causes nocturnal leg cramps?

The cause of nocturnal leg cramps is often times unknown, but some cases have been linked to:

  • Sitting for long periods of time
  • Over-exertion of the muscles
  • Standing or working on concrete floors
  • Sitting improperly

Nocturnal leg cramps have also been linked to certain medical conditions and medications. These include:

  • Narrowing of the arteries/circulation-related diseases
  • Narrowing of the spinal canal in the lower back (lumbar canal stenosis), which can compress nerves that travel from lower back to legs
  • Cirrhosis of the liver (scarring of the liver) due to alcoholism, hepatitis, or other causes
  • Pregnancy
  • Alcoholism
  • Dehydration/electrolyte imbalances
  • Parkinson’s disease
  • Nerve damage from cancer treatment
  • Kidney failure/hemodialysis
  • Osteoarthritis
  • Peripheral neuropathy
  • Neuromuscular disorders (neuropathy, myopathy, motor neuron disease)
  • Structural disorders (flat feet)
  • Endocrine disorders (diabetes, hypothyroidism)
  • Medications: IV iron sucrose, conjugated estrogens, raloxifene (Evista®), naproxen (Naprosyn®), teriparatide (Forteo®)

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This article was medically reviewed by Connie Jennings, MD, a member of the Prevention Medical Review Board, on March 21, 2019.

If painful leg cramps wake you up in the middle of the night, you’re not alone—far from it. Up to 60 percent of adults say they’ve experienced leg cramps at night, according to a 2012 study in American Family Physician.

These ill-timed charley horses—characterized by a sharp muscle contraction that can last several seconds to minutes—usually affect the calf and foot, although they can also strike your hamstring. While we’ve all experienced a leg cramp at one point or another, they appear to be more common after age 50, shows a 2017 study in BMC Family Practice.

“You will find plenty of disparate opinions, but the simple truth is that nobody really knows why these occur,” says Scott Garrison, MD, PhD, an associate professor of family medicine at the University of Alberta who has published multiple studies on nocturnal leg cramps.

There are theories, however. Here are some possible why your legs won’t stop cramping up—and what you can do to find relief.

What are the possible causes of leg cramps?

One or several of the factors below—combined with your individual physiology—could explain why you’re waking up in the middle of the night in pain.

1. Not stretching certain muscles

Some researchers have theorized that our modern lifestyle is to blame. While our ancient ancestors spent lots of time squatting—a position that stretches leg tendons and muscles—contemporary life has mostly removed the need for it. There’s also evidence that our mostly sedentary lifestyles (spending big chunks of time sitting or not moving) decreases muscle and tendon length and limberness, which may lead to cramping.

2. Sleeping in an awkward position

Other experts have observed that, when lying face down in bed, the foot is often in a “plantar flexion” position—meaning the toe points away from you, shortening the calf muscles. When the foot rests in this position for long periods, even small movements of the feet could trigger a cramp. Sleeping on your side, with your feet off the bed, or in some other position that keeps your toes neutral—not pointing away from you—may be a better position for these muscles.

3. Changing seasons

Dr. Garrison’s own research has shown nighttime leg cramps are more common in summer than in winter. While not true for everyone, the frequency of these cramps tends to peak in mid-July and crater in mid-January. It’s important to understand that these muscle cramps are caused by nerve issues—not muscle disorders, Dr. Garrison says. Electromyogram tests have shown that nerves running from the spine down to the calf trigger these cramps.

So why summer? “Nerve growth and repair might be more active in summer because of the greater vitamin D levels,” Dr. Garrison explains. Your body produces vitamin D from sun exposure. And so in summer, when your D levels are peaking, your body may engage in “sped up” neural repair, which could trigger these cramps, he says.

4. Dehydration

There’s some evidence that dehydration promotes nocturnal cramping. “There is a clear seasonal pattern in the frequency of muscle cramps, with higher numbers in summer and lower numbers in winter,” says Michael Behringer, MD, PhD, a professor of sports science at Goethe University in Germany. “This suggests that heat and possibly also fluid balance have an influence on the development of cramps.” Dehydration may promote electrolyte imbalances in the blood, which could be one cramp trigger.

5. Really tough workouts

Hard exercise has long been linked to muscle cramps. “Skeletal muscle overload and fatigue can prompt muscle cramping locally in the overworked muscle fibers,” write the authors of a study in the journal Current Sport Medicine Reports. This happens even among highly trained professional athletes, the study authors say. While staying hydrated may help, there’s no well-established method for preventing these kinds of overuse cramps.

6. Nutrient deficiency

There’s evidence—although much of it is mixed—that calcium, magnesium, and potassium imbalances play a part in cramping. Each of these electrolytes helps maintain fluid balance in the blood and muscles, and so it makes some sense that, if they’re out of whack, cramping may ensue. But again, studies have been inconsistent, so more research needs to be done to know how these nutrients affect cramping directly.

In Depth: Nutrient Deficiencies

7. Standing all day

There’s also research showing that people who spend a lot of time each day standing are more likely to experience leg cramps than sitters. When you’re on your feet but not in motion, blood and water tend to pool in your lower body. This may lead to fluid imbalances, as well as muscle and tendon shortening—all of which could lead to cramping.

8. Medications

Another of Dr. Garrison’s studies links diuretics (high blood pressure meds like Clorpres and Thalitone, for example, have diuretic effects) and asthma drugs (specifically, long-acting beta-adrenoceptors, or LABAs) to a greater risk for nocturnal cramping. It’s possible these drugs have a “stimulatory” effect on motor neurons and receptors, which could promote cramping, his study concludes.

9. Pregnancy

Pregnancy, too, is associated with more frequent leg cramps, possibly due to weight gain and disrupted circulation. It’s also possible that the pressure a growing fetus places on the mother’s blood vessels and nerves causes cramping, according to the American Pregnancy Association.

10. Certain health conditions

Diabetes, hypertension, arthritis, neurological disease, and depression are all associated with leg cramping, too. In some cases, medications could be to blame, as mentioned above. But some of these conditions—namely diabetes and neurological disease—can cause disrupt or even kill your nerves, which may lead to cramping, research shows.

11. Aging

Aging might also play a role in leg cramping, Dr. Garrison says. “It is around the same time that we start losing our motor neurons”—roughly, our early 50s—“that rest cramps start to get more common,” he explains. Both strength and balance exercises may help maintain muscle and nervous system functioning in ways that prevent these issues, research suggests.

How to prevent and get rid of leg cramps

Ease leg cramps with this DIY calf massage:

Dr. Garrison says that, for many years, quinine pills were the go-to treatment for leg cramps. And while they provided “a modest benefit,” he says, they also caused some dangerous side effects like an irregular heartbeat. That’s why the FDA advises people to steer clear of the drug to treat leg cramps.

It’s really all trial and error. Since there is no definitive cause of nighttime leg cramps, there’s also no sure cure. You could speak to three different doctors, and all three might give you a different explanation—and a different remedy. Here are a few worth considering:

✖️ Stretch it out

While the research on stretching goes back and forth, a small 2012 study did find that people who completed hamstring and calf stretches just before bed enjoyed a significant drop in spasm frequency.

And if you’re in the midst of a spasm? “Stretching the affected muscle while you cramp helps abort a cramp,” Dr. Garrison says. If your cramp is in your lower leg or foot, try a standing calf stretch. If the cramp is in your upper leg, these hamstring stretches may help.

✖️ Eat a balanced diet

Ensuring you have plenty of magnesium in your diet—a mineral many Americans don’t get enough—may be beneficial. Beans, nuts, whole grains, and leafy greens are all great sources. (Some research shows that this may not be helpful for everyone, though, so make sure you talk to your doctor before you make any major diet changes.)

One small study found taking B vitamins supplements could help, too. That’s not enough evidence to warrant popping a new pill, but eating more fish, whole grains, and vegetables certainly doesn’t hurt.

✖️ Stay hydrated

You could also try to drink more water during the day—especially if you’re sweating or exercising. Dry mouth, headaches, fatigue, and dry skin are all signs that you’re not drinking enough water. The color of your urine is probably your best guide. If your pee is pale yellow or clear, you’re drinking enough H2O. If your urine is dark yellow (or closer to amber), you need to drink more.

Markham Heid Markham Heid is an experienced health reporter and writer, has contributed to outlets like TIME, Men’s Health, and Everyday Health, and has received reporting awards from the Society of Professional Journalists and the Maryland, Delaware, and D.C.

What Causes Leg Cramps and How Can You Stop Them?

How to Prevent Leg Cramps

There are a number ways you can alleviate nighttime leg cramps. “Once leg cramps set in, the best method to relieve them is movement, either walking around or simply jiggling or shaking your leg,” advised Hyland. “In addition, things like pumping your ankles up and down or rubbing the muscles can help as well.”

Some people with chronic leg cramps have found relief using cool compresses, which work by numbing pain and reducing soreness. But Hyland said anyone who regularly suffers leg cramps should also work to strengthen their muscles, which will make cramps less frequent.

“Our musculoskeletal system hits its peak at the age of 20, and while it maintains its peak for an additional 20 years, the reality is that it begins to break down at age 40,” he said. “This includes muscles becoming less flexible. Once we pass into the fourth decade of life, it is critical we play an active role in stretching and strengthening our bodies to maintain appropriate, maximal health.” He added that it may be best to consult a physician if leg cramps last for 5 to 10 minutes or occur multiple times a week.

What to Take for Muscle Cramps

Analgesic balm or a patch, both sold over-the-counter at pharmacies, can provide further relief. OTC pain relief medications that are formulated to treat menstrual cramps, such a Pamprin and Midol, can be an effective treatment for bad leg cramps.

You may also be able to prevent or alleviate muscle cramps in your legs by making simple lifestyle changes. Drinking plenty of water is essential, since cramps are often caused by dehydration. A healthy diet with plenty of fresh fruits and vegetables can also help to decrease the frequency of leg cramps.

Vitamins and Minerals: Potassium and Magnesium for Muscle Cramps

Additionally, certain vitamins and minerals impact muscle function, particularly potassium and magnesium. A significant body of research has found that increasing your magnesium intake can help with the frequency of night time leg cramps, especially for pregnant women. Health experts recommend getting at least 300 milligrams of magnesium each day. A supplement can help you reach your daily allowance, but so can eating foods rich in magnesium, such as nuts, lentils, and quinoa.

Plan ahead for self-care if your leg cramps appear to be the result of strenuous exercise. Drink plenty of fluids and eat a well-balanced meal before heading out for a long run. Many athletes suggest eating a potassium-rich banana once you reach the finish line.

How to Get Rid of a Charley Horse – 4 simple fixes

How to get rid of a charley horse: This problem plagues athletes and sedentary folks alike. If you’ve ever been jolted out of sleep by a searing pain in your leg that leaves you gasping for breath, you know all too well how painful a muscle cramp can be. If you’ve never experienced a charley horse (sometimes misspelled Charlie Horse), you can count yourself lucky. In this article, we share the four of the most proven methods to overcome or prevent muscle cramps.

What is a charley horse?

A charley horse, as they are most often referred to, is an involuntary reaction that causes the nerves that control the muscle (usually the calf muscle) to misfire, causing the muscle to freeze and lock into a contracted position. A charley horse can be quite painful and can leave you hobbling around for a few days. Besides calf muscles, the muscles in the soles of the feet can cramp as well, which can also be painful. Cramps can occur in any part of the body when muscles over exert. For example, a drummer might get hand cramps after performing outside at a summer event.

Fun related article: origin of the phrase charley horse

What causes muscle cramps?

There is a bit of debate in the scientific community about what causes a charley horse because they often occur in healthy people, sometimes striking at night for no apparent reason. For example, muscle cramps often occur in middle-aged and older people, but they are also common in athletes (long-distance runners and cyclists) and those who maintain active lifestyles. What is known, is that certain groups are more prone than others and that certain factors are likely to increase the risk.

People at risk to get a charley horse:

Here is a quick list of groups most at risk for muscle cramps:

  • Athletes
  • People who are dehydrated or who exert muscles in hot weather
  • People with certain medical conditions including nerve disorders, cirrhosis, an underactive thyroid gland (hypothyroidism), and people who take certain medications.
  • Women who wear high heels
  • The elderly
  • Pregnant women

Related article: Significant risks of low magnesium during pregnancy

Long-distance runners and cyclists, especially individuals who exercise regularly, often experience cramps. This may be purely because of over-use, but it may also be because these individuals have electrolyte deficiencies or imbalances after losing critical electrolytes in sweat.

Dehydration is another factor associated with getting a charley horse, which of course, affects athletes. Other risks include inactivity, anatomical conditions like flat feet; physical conditions such as pregnancy; or the use of certain medications. Women who wear high heels may experience muscle cramps because high heel-shoes position the feet and legs into a cramp-prone position.

1. How to get rid of a charley horse – maintain electrolyte balance

A mineral deficiency or an imbalance of electrolytes such as magnesium, potassium, calcium, and sodium is also likely to increase one’s odds of getting a charley horse.

Related article: Natural electrolytes are essential for life, health, and peak performance

Electrolytes are certain minerals that play an important role in muscle function. Low levels of any of these minerals can allow the muscle to contract, but prevent it from relaxing, Some researchers believe a mineral imbalance can negatively affect blood flow to the muscles and that a deficiency of some minerals. So, to get rid of a charley horse or prevent one in the future, consider adding essential electrolytes.

  • Potassium: A lack of potassium can interfere with the muscles’ ability to use glycogen, a sugar that is the muscles’ main source of energy.
  • Sodium: This is an essential electrolyte; however, most people get plenty of it in their diet. Sodium should only be a nutritional concern if your intake is low or you sweat a lot while working or exercising. If either of these two instances are the case, then replacing sodium is something you should consider.
  • Magnesium: An essential mineral involved in muscle function that helps muscles to contract and relax.
  • Chloride: an electrolyte that helps your body regulate the level of fluids in your body. Chloride’s role in fluid balance makes it especially important because dehydration can be a contributing factor to muscle cramps.

2. Supplement with magnesium

A few years ago, researchers in the United Kingdom found that 300 mg of supplemental magnesium (as magnesium citrate) reduced nighttime or nocturnal leg cramps in individuals who suffered chronic leg cramps. Like magnesium, potassium is an electrolyte found in your muscles. In fact, when your muscles contract, they release potassium into the surrounding tissue.

Electrolytes are certain minerals that play an important role in muscle function. Low levels of any of these minerals can allow the muscle to contract, but prevent it from relaxing.

As mentioned earlier, pregnant women often experience muscle cramps, and it’s no wonder given that there is a high need for magnesium in expectant mothers, and low magnesium is one of the strong theories related to muscle cramps.

3. Correct dehydration

A third preventative measure, especially if you sweat in hot weather, exercise for long periods of time, or work in hot conditions, is to maintain adequate fluid intake. Dehydration can be life threatening, but did you know that mild dehydration reduces your blood volume, which, in turn, can reduce the supply of oxygen to your muscles? When the oxygen supply is reduced to the muscles, they can go into spasm. Be sure to drink plenty of water during the day interspersed with electrolytes.

But don’t rely on sports drinks to prevent muscle cramps. Many sports drinks can contain as much sugar as fruit punch and usually only provide sodium and potassium.

Shop for elete electrolyte add-in by clicking here.

4. Stretch properly

If a cramp does occur, try stretching the affected muscles. For calf-muscle cramps, for instance, try stretching your calf muscle by pulling your toes towards your knees with the affected leg extended straight. Second, relax in a warm bath or take a hot shower (allowing water to hit the affected area) to help relax the muscle. Third, gently massage the affected area, being careful not to apply too much pressure. You can also apply an ice pack to the sore muscle to reduce pain and swelling. If the affected area still hurts, treat it like you would an injured muscle, which means resting the affected leg and avoiding any further muscle strain.

Finally, if you have chronic or severe leg cramps, contact your doctor. It may be the sign of a more serious condition, so it’s important to check with your physician first.

Sources:

  1. Leg Cramps at Night. Electronic version available online at http://www.digitalnaturopath.com/cond/C466089.htm.
  2. Prevention Magazine. The Complete Book of Vitamins and Minerals, Rodale Press: New York, 1998, pp: 319-325.
  3. Roffe C, Sills S, Crome P, Jones P. Randomised, cross-over, placebo controlled trial of magnesium citrate in the treatment of persistent leg cramps. Med Sci Monit. 2002 8(5): CR326-30

Magnesium is one of the most hyped-up natural salves for all types of muscle-related pain—from headaches to digestive distress to menstrual cramps. (One doctor even went so far as to deem it “the miracle mineral for periods.”) So it’s not surprising that some experts believe the mineral can also be a great antidote for leg cramping, whether it’s a Charley horse that wakes you up suddenly at night or a bout of exercise-induced achiness that lingers for days after your sweat sesh.

Here’s the deal: Magnesium plays VIP roles across several different body systems, including muscle and nerve function. It helps shuttle calcium and potassium ions across cell membranes, which is required for healthy nerve impulse conduction and muscle contraction. Given that cramping is, by definition, a series of painful muscle contractions, it makes sense that health pros would consider the role of magnesium deficiency in causing cramps.

Rachel Gargiulo, a certified nutrition consultant, is one expert who’d likely recommend magnesium supplementation if she had a client suffering from frequent leg cramping. “Having a magnesium deficiency is associated with muscle cramps,” she says—a view that’s backed up by science. And Gargiulo isn’t the only one who believes increasing magnesium may prevent recurrent cramps. Dr. Lara Briden, a naturopathic doctor, and Kat Schneider, the CEO and founder of natural supplement brand Ritual, also sing the praises of magnesium and laud its positive effects, especially on the nervous system.

But researchers have a slightly less optimistic perspective on the mineral’s effectiveness for leg cramps, specifically—and it’s worth knowing about before you shell out for a bottle of supplements

Can magnesium really help soothe leg cramps? Here’s what science has to say.

Photo: Stocksy/Bonninstudio

The truth about magnesium’s effectiveness in treating leg cramps

The thing is, there are many causes of leg cramps, and not all of them are linked to magnesium deficiency—for instance, some are a side-effect of medication, while others could indicate vascular disease. In fact, many studies have shown that magnesium is no more effective than a placebo in treating leg cramps, although most of them were done on older adults.

There is, however, some evidence in favor of magnesium’s potential to treat leg cramps in pregnant women. The results of three separate studies were mixed; while two suggested no observed benefits of magnesium supplementation, a third demonstrated a reduction in both frequency and intensity of pregnancy-associated leg cramps in patients who received magnesium supplements when compared to those who received a placebo. Although it’s impossible to draw a definitive conclusion from this limited data, the initial results are encouraging for women who suffer from prenatal leg cramps, which often don’t have a clear cause.

Bottom line? Talk to your doctor about your cramps and ask them whether they think magnesium may help you—they may choose to test your magnesium levels to see if you’re deficient. (Up to 75 percent of people are.) If that’s the case, and your doctor thinks it may be causing your cramps, it may be worth intentionally bolstering your diet with magnesium-rich foods, particularly if you experience any other symptoms of magnesium deficiency, such as depression, anxiety, osteoporosis, fatigue, muscle weakness, high blood pressure, or irregular heartbeat.

Many studies have shown that magnesium is no more effective than a placebo in treating leg cramps, although most of them were done on older adults.

Though magnesium occurs naturally in a range of foods such as green leafy vegetables, legumes, nuts, seeds, whole grains, and even dark chocolate, the body only absorbs 30-40 percent of the dietary magnesium that is consumed. That’s why supplementation is also often recommended. “For prevention of cramps, I’d recommend taking 400mg per day in the form of magnesium glycinate,” says Gargiulo. Both Dr. Briden and Schneider concur with Gargiulo’s suggestion to supplement with magnesium glycinate while steering clear of harsher forms of magnesium, including magnesium oxide, magnesium hydroxide, and magnesium chloride.

If you try oral magnesium supplementation and find it isn’t floating your boat, many physical therapists, coaches, and personal trainers recommend the use of Epsom salts, which are a mineral compound consisting of magnesium and sulfate. You can either apply Epsom salts to a wet cloth and press it against a cramped muscle, or dissolve the salts in a hot bath as a means of alleviating painful cramps.

Magnesium aside, there are a variety of other natural treatments available to assist in managing stubborn cases of cramps—the Mayo Clinic recommends using heat to soothe leg cramps in the moment, and staying hydrated and stretching as preventative measures. And while you’re at it, a serving of magnesium-rich dark chocolate is unlikely to cause any harm. Take that, Charley horse.

If leg cramps are getting you down, you could also try slathering on arnica or snuggling up with a bar of soap while you sleep. (No joke.)

What Causes Muscle Cramps?

Many things can trigger a muscle cramp. They include:

  • Poor blood circulation in your legs
  • Working calf muscles too hard while exercising
  • Not stretching enough
  • Being active in hot temperatures
  • Muscle fatigue
  • Dehydration
  • Magnesium and/or potassium deficiency
  • A problem such as a spinal cord injury or pinched nerve in your neck or back
  • Kidney disease

Muscle cramps can also occur as a side effect of some drugs. Medications that can cause muscle cramps include:

  • Furosemide (Lasix), hydrochlorothiazide (Microzide), and other diuretics (“water pills”) that remove fluid from the body
  • Donepezil (Aricept), used to treat Alzheimer’s disease
  • Neostigmine (Prostigmine), used for myasthenia gravis
  • Nifedipine (Procardia), a treatment for angina and high blood pressure
  • Raloxifene (Evista), an osteoporosis treatment
  • Terbutaline (Brethine), albuterol (Proventil and Ventolin), asthma medications
  • Tolcapone (Tasmar), which helps treat Parkinson’s disease
  • Statin medications for cholesterol, such as atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), or simvastatin (Zocor)

Causes and treatment for leg cramps

Share on PinterestCramps are generally not a sign of an underlying condition.

In most cases, there is no underlying cause and the reason why cramps happen is unclear.

They are thought to be caused by muscle fatigue and nerve dysfunction, but exactly how they happen is unclear.

It has been suggested that the way we sleep, with the foot stretched out and the calf muscles shortened, may trigger night cramps. Another theory is that cramps are more likely nowadays, as people no longer squat, a position that stretches the calf muscles.

Exercise is one factor. Stressing or using a muscle for a long time may trigger a leg cramp during or after the exertion. Cramps often affect athletes, especially at the start of a season, if the body is out of condition. Nerve damage may play a role.

Dehydration is thought to play a role. Athletes who exercise strenuously in hot weather often experience cramps. However, there is a lack of evidence to confirm this, and the theory has been disputed. Athletes who play in cool climates also get cramps, after all.

Sometimes the leg cramps are caused by an underlying condition, situation or activity.

Other conditions that may cause cramps are:

  • Addison’s disease
  • alcohol abuse
  • cirrhosis
  • diarrhea
  • flatfeet
  • gastric bypass surgery
  • hypothyroidism, or an underactive thyroid
  • chronic kidney failure
  • hypolalemia
  • hemodialysis
  • type 2 diabetes
  • cancer treatment
  • lead poisoning
  • sarcoidosis, a disease in which small growths or lumps produce inflammation or swelling of the tissues in any part of the body
  • muscle fatigue
  • vascular disease and venous insufficiency
  • motor neuron problems
  • oral birth control
  • Parkinson’s disease
  • peripheral artery disease (PAD)
  • pregnancy, especially in the later stages
  • use of some medications, including intravenous iron sucrose, conjugated estrogens, naproxen, raloxifene, and teriparatide

Cramps have been linked to electrolysis imbalances, but reseach has not supported these theories.

Older people are more likely to experience leg cramps. Muscle loss starts from the mid-40s and increases if the person is not active. This increases the risk of cramps.

Between 50 and 60 percent of adults and 7 percent of children are believed to experience cramps, and the likelihood increases with age.

They are more common during pregnancy.

Muscle Cramps

What are muscle cramps?

Muscle cramps are sudden, involuntary contractions or spasms in one or more of your muscles. They are very common and often occur after exercise. Some people get muscle cramps, especially leg cramps, at night. They can be painful, and they may last a few seconds to several minutes.

You can have a cramp in any muscle, but they happen most often in the

  • Thighs
  • Feet
  • Hands
  • Arms
  • Abdomen
  • Area along your ribcage

Causes of muscle cramps include:

  • Straining or overusing a muscle. This is the most common cause.
  • Compression of your nerves, from problems such as a spinal cord injury or a pinched nerve in the neck or back
  • Dehydration
  • Low levels of electrolytes such as magnesium, potassium, or calcium
  • Not enough blood getting to your muscles
  • Pregnancy
  • Certain medicines
  • Getting dialysis

Sometimes the cause of muscle cramps is unknown.

Who is at risk for muscle cramps?

Anyone can get muscle cramps, but they are more common in some people:

  • Older adults
  • People who are overweight
  • Athletes
  • Pregnant women
  • People with certain medical conditions, such as thyroid and nerve disorders

When do I need to see a health care provider about muscle cramps?

Muscle cramps are usually harmless, and they go away after a few minutes. But you should contact your health care provider if the cramps

  • Are severe
  • Happen frequently
  • Don’t get better with stretching and drinking enough fluids
  • Last a long time
  • Are accompanied by swelling, redness, or a feeling of warmth
  • Are accompanied by muscle weakness

What are the treatments for muscle cramps?

You usually don’t need treatment for muscle cramps. You may be able to find some relief from cramps by

  • Stretching or gently massaging the muscle
  • Applying heat when the muscle is tight and ice when the muscle is sore
  • Getting more fluids if you are dehydrated

If another medical problem is causing the cramps, treating that problem will likely help. There are medicines that providers sometimes prescribe to prevent cramps, but they are not always effective and may cause side effects. Talk to your provider about the risks and benefits of medicines.

Can muscle cramps be prevented?

To prevent muscle cramps, you can

  • Stretch your muscles, especially before exercising. If you often get leg cramps at night, stretch your leg muscles before bed.
  • Drink plenty of liquids. If you do intense exercise or exercise in the heat, sports drinks can help you replace electrolytes.

Magnesium, a treatment for leg cramps?

Evidence is lacking except for pregnancy-associated cramps

The effectiveness and safety of magnesium has been established for eclampsia and pre-eclampsia, arrhythmia, severe asthma, and migraine.11 There is some evidence for efficacy of magnesium supplementation in treatment of leg cramps in pregnant women but not for other people.2,12

A recent systematic review evaluated the effect of magnesium versus placebo for the treatment of nocturnal leg cramps and found the overall effect of magnesium to be insignificant.2 Seven trials were included, one assessed magnesium infusion versus placebo and the rest assessed oral magnesium therapy but dose and frequency of therapy varied between all studies.

A sub-analysis of three of the studies involving only pregnant women showed a significant difference between the magnesium and placebo groups in the median number of leg cramps experienced per week.2 However the studies only contained a small number of participants (n=361 in total and n=198 in the subgroup analysis), and therefore was underpowered to detect meaningful differences between groups. In addition selection bias may have impacted results as participants were included in the analysis whose leg complaints may have been confused with disorders not known to be associated with magnesium deficiency (ie, restless leg syndrome).

Another recent systematic review evaluated a further seven studies in patients with leg cramp treated with magnesium.12 The elemental magnesium dose given varied between studies. The populations included 322 mostly older patients and 202 women with pregnancy-associated leg cramps. After four weeks of treatment, differences in percentage change from baseline of cramps per week between magnesium and placebo groups were small and not statistically significant.

The authors concluded that magnesium is unlikely to provide a meaningful benefit in reducing the frequency or severity of idiopathic leg cramps in older people.12 The second review also included three further studies on pregnant women; while a meta-analysis was not possible with these, results from the individual studies were considered and found to be mixed. One study found magnesium reduced cramp frequency and pain while the other two found no benefit.12 Although two of the studies were similar in design and setting,13,14 their outcomes were different; this may have been because one of the studies lacked baseline measurement of cramp frequency. If cramp frequency before intervention was not comparable between participants in these studies, it is not appropriate to compare the number of cramps experienced during the treatment period.

Oral magnesium supplementation is well tolerated

Both meta-analyses found that magnesium is well tolerated with the most frequent adverse effects affecting the gastrointestinal system (diarrhoea, nausea, vomiting, flatulence and constipation).2,12

Moderate-to-severe and symptomatic hypermagnesaemia is usually due to excessive supplemental intake of magnesium (eg, as antacids, enemas or by intravenous infusion), most often in patients with kidney impairment. Be aware of the most common clinical features of moderate-to-severe hypermagnesaemia which are usually neuromuscular (eg, loss of deep tendon reflexes, muscle paralysis, depressed conscious state and respiratory depression). Other signs include anorexia, nausea, skin flushing, hypotension, bradycardia/heart block and cardiac arrest.15

When considering magnesium supplements, ensure patients take a product containing magnesium only. Some magnesium supplements are combined with potassium and may contribute to hyperkalaemia in people taking ACE inhibitors or other medicines which cause potassium retention.3 Consider assessing kidney function in people using medicines that may impair or adversely affect kidney function16 and watch for signs of toxicity.15

Magnesium for muscle cramps

We identified seven trials (five parallel, two cross-over) enrolling a total of 406 individuals amongst whom 118 cross-over participants additionally served as their own controls. Three trials enrolled women with pregnancy-associated leg cramps (N = 202) and four trials enrolled idiopathic cramp sufferers (N = 322 including cross-over controls). Magnesium was compared to placebo in six trials and to no treatment in one trial.

For idiopathic cramps (largely older adults presumed to have nocturnal leg cramps), differences in measures of cramp frequency, magnesium versus placebo, were small, not statistically significant, and without heterogeneity (I2 = 0%). This includes the primary endpoint, percentage change from baseline in the number of cramps per week at four weeks (-3.93%, 95% confidence interval (CI) -21.12% to 13.26%, moderate quality evidence) and the difference in the number of cramps per week at four weeks (0.01 cramps/week, 95% CI -0.52 to 0.55, moderate quality evidence). The percentage of individuals experiencing a 25% or better reduction in cramp rate from baseline was also no different, being 8% lower in the magnesium group (95% CI -28% to 12%, moderate quality evidence). Similarly, no statistically significant difference was found at four weeks in measures of cramp intensity (moderate quality evidence) or cramp duration (low quality evidence).

Meta-analysis was not possible for trials of pregnancy-associated leg cramps. The single study comparing magnesium to no treatment failed to find statistically significant benefit on a three-point ordinal scale of overall treatment efficacy. The two trials comparing magnesium to placebo differed in that one trial found no benefit on frequency or intensity measures while the other found benefit for both.

Withdrawals due to adverse events were not significantly different than placebo. While we could not determine the number of subjects with minor adverse events, studies of oral magnesium generally described potential side effects as similar in frequency to placebo.

Ask The Pharmacist: 9 quick hacks for leg cramps

Suzy Cohen Columnist Published 5:02 AM EDT Jul 9, 2018

Some of you have to jump out of bed really fast to mitigate a leg cramp, usually in the back of the calf, or in your thigh.

Leg cramps are not only painful, but they are a leading cause of fitful sleeping, insomnia and daytime fatigue. They speak to bigger problems too, such as dehydration, nutritional deficiencies and sometimes depression. This is because the root cause might be due to an imbalance in one of several key minerals like calcium, magnesium, potassium, zinc or sodium.

Heaviness, achiness, nighttime leg cramps and nighttime urination could be signs of venous disease. Juriah Mosin, Getty Images/Hemera

Today my article will help you deal more effectively with nocturnal leg cramps so you can sleep through the night and feel better during the day.

Now, here are a few of the best hacks for leg cramps:

  1. Avoid sorbitol: There’s an interesting case study about a 34-year old woman who put herself on a diet that consisted of low sorbitol (and low fructose). She essentially cured herself of long-standing leg cramps within a few weeks.
  2. Reduce aspirin and ibuprofen: Many NSAIDs (non-steroidal anti-inflammatory drugs) are known to be drug muggers of natural folate. A deficiency of this B vitamin will produce chronic leg cramps.
  3. Take CoQ10 with your statin: If you take a statin like lovastatin, atorvastatin or others, you should be taking CoQ10 or Ubiquinol every day.
  4. Avoid large doses of vitamin C: If you take too much vitamin C, it can upset your stomach and cause diarrhea. Then you’re faced with dehydration and that’s a trigger for leg cramps.
  5. Cut back on caffeine: Caffeine is a diuretic, so it causes mild dehydration. You may have noticed that on days you drink a lot of coffee, or have several energy drinks, you have more leg cramps. Not only that, but the chlorogenic acid in coffee is a drug mugger for magnesium, iron and zinc.
  6. Drink coconut water: This is a natural electrolyte, and I think it’s healthier for you than those strangely colored drinks that are loaded with sugar and artificial colors.
  7. Heat up a microwavable hot pack: Heat one of these up and it’s sweet relief on your sore muscles. You can heat it up right after you cramp, and apply it to ease the pain faster.
  8. Drink a little pickle juice: This should not help, but it actually does. It’s probably from the salt in the flavoring or from the vinegar. The salt would help with electrolyte balance, the vinegar might serve as a mild muscle relaxant.
  9. Try a massager: The hand-held devices that provide percussion might bring instant relief. There are many at Brookstone, or on Amazon such as the Pure-Wave CM7 cordless massager. I have a much longer version of this article that I can send to you.

If you’d like to receive this to your email, join my online community (200,000 people and going strong!) Just sign up for my free newsletter at suzycohen.com.

More: Ask The Pharmacist: Handling menopause and andropause as a couple

More: Ask The Pharmacist: 6 quick ways to relieve itchy red eyes

Suzy Cohen is a registered pharmacist. The information presented here is not intended to treat, cure or diagnose any condition. Visit SuzyCohen.com.

Published 5:02 AM EDT Jul 9, 2018

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