I realize you state that you know all about leg cramps, but *I*
don?t know what you know. So, please bear with me a bit while I post
some information on leg cramps. You may find at least one tidbit that
you didn?t know! Most of the sites I found list causes and remedies,
so the answer will be a mix of both. You?ll also see that medical
opinion varies on this topic.
You don?t state that you currently take any medications or
supplements. You don?t say whether the doctor has advised you on how
to treat the cramps or the cause. You really should be evaluated by
your doctor, as some conditions such as diabetes, thyroid disorders,
and Parkinsons?s can elicit nocturnal leg cramps. Some medications,
particularly blood pressure medications and diuretics can cause leg
cramps. I found no reliable information that chocolate causes leg
cramps. Chocolate does contain caffeine and some magnesium, and it may
affect different people in different ways! If you notice that it
bothers you, avoid it for several weeks and see what happens to the
cramps! The fact that they are periodical is probably related to
stress, or the fact that you were more (or less) active physically
during that period. Try keeping a journal of your daily stress levels,
activities, diet, and fluid intake and see if you can track the cause.
Leg cramps affect about 70% of all people over the age of 50!
?What are the causes?
No one knows for sure what causes nocturnal leg cramps. In many cases,
there doesn't seem to be any specific trigger. However, sometimes the
cramps are caused by overexertion of the muscles, structural disorders
(eg, flat feet), standing on concrete, prolonged sitting,
inappropriate leg positions while sedentary, or dehydration. Less
common causes include diabetes, Parkinson's disease, hypoglycemia,
anemia, thyroid and endocrine disorders, and use of some medications.?
Postgraduate Medicine lists these tips on how to avoid leg cramps.
Consider the first one the most important.:
· Drink six to eight glasses of water daily. Doing so will help
prevent dehydration, which may play a role in the cramping.
· Stretch calves regularly throughout the day and at night. (See box
below for more information.)
· Ride a stationary bicycle for a few minutes before bedtime. This
activity can help prevent cramps from developing during the night,
especially if you do not get a lot of exercise during the day.
· Keep blankets loose at the foot of the bed to prevent your toes and
feet from pointing downward while you sleep.
· Do aquatic exercises regularly during the week to help stretch and
condition your muscles.
· Wear proper foot gear.
To stop the cramping:
When cramping occurs, try these steps:
· Walk on or jiggle the affected leg and then elevate it.
· Straighten the leg and flex your foot toward your knee. Grab your
toes and pull them upward toward your knee. You should feel your calf
· Take a hot shower or warm bath, or apply an ice massage to the cramped muscle.
A variation on the second step is most valuable. Simply flexing your
foot, pointing your toes as far towards your knees as possible will
often stop cramping in it?s tracks ? no need to grab the toes, unless
this does not work. During the day, flexing your toes towards your
knees, then as far away as you can will help prevent cramps. This
causes the blood to circulate past the valves in your leg veins. Do
this stretch several times in a row, several times during the day.
Some medications that may help are diphenhydramine hydrochloride
(Benadryl), vitamin E, and prescription muscle relaxants. I recommend
pumpkin seeds, and a diet with a lot of fish, tofu and spinach for
Postgraduate Medicine also recommends these exercises:
Stretch your way to better sleep
Nocturnal muscle cramps can often be prevented by doing leg-stretching
exercises, such as the one outlined below.
1. Stand 30 inches from the wall.
2. While keeping your heels on the floor, lean forward, put your hands
on the wall, and slowly move your hands up the wall as far as you can
3. Hold the stretched position for 30 seconds. Release.
4. Repeat steps 1 through 3 two more times.
5. For best results, practice this exercise in the morning, before
your evening meal, and before going to bed each night.
?Leg cramps occur when the muscle suddenly and forcefully contracts.
The most common muscles to contract in this manner are muscles that
cross two joints. These muscles include the calf (crossing the ankle
and knee), the hamstring (crossing the knee and hip), and the
quadriceps (also crossing the knee and hip).
Leg cramps usually last less than one minute, but may last several
minutes before the contraction subsides. In some patients, the leg
cramps occur primarily at night, and can awaken the patient from
?The most common cause that is typically seen in patients who develop
leg cramps is exercising in an unusual way, meaning either more
activity or a different exercise. Leg cramps are more common in young
(adolescent age) and older (over 65) patients. Patients who weigh more
are more prone to developing leg cramps. Also, some medications can
cause side effects of leg cramping.?
Gradually build up an exercise program, and try to avoid sudden
increases in activity. The "10% Rule" is a good rule of thumb: never
increase your exercise over one week by more than 10% compared to the
week before. Sudden changes in activities can cause leg cramps.?
IMPORTANT: ?When do I need to have leg cramps evaluated by a doctor?
If leg cramps become a persistent and recurring problem, you should be
evaluated by your doctor. Because electrolyte imbalances can cause
cramping, some blood may be analyzed to ensure the levels of potassium
and other electrolytes are normal. There are also muscle relaxing
medications that can be prescribed if the muscle cramping is a
problem, particularly at night. Finally, your medications and medical
history should be reviewed to investigate for possible factors
contributing to your leg cramps.?
Nocturnal Leg Cramps are related to a group of disorders called Sleep
Related Leg Disorders. Alternative Names include Ekbom's Syndrome;
Nocturnal Leg Cramps; Periodic Limb Movement Disorder; Restless Legs
?Researchers are investigating neurologic problems that may arise
either in the spinal cord or the brain. One current theory on the
cause of restless legs syndrome involves a deficiency in a brain
chemical called dopamine. RLS probably has a genetic basis in many
cases, particularly those that develop before age 40. When the onset
of the condition occur in older adults, it most likely due to some
One study found quinine did little to nothing to help with nighttime
leg cramps, and which may even be dangerous.
?There was a significant relationship between serum quinine
concentration and attenuation of cramps. However, the simple expedient
of increasing the nightly dose of quinine may carry the concomitant
risk of cinchonism.?
?Benign nocturnal leg cramps are a relatively common and bothersome
complaint, particularly among the elderly. Careful history taking and
physical examination can exclude the majority of disorders in the
differential diagnosis. Mechanical treatment of an acute muscle cramp
involves stretching of the affected muscle. Prophylaxis includes both
mechanical and pharmacologic measures. The efficacy of quinine sulfate
has been supported in the majority of well-designed studies, but its
use is controversial, and the FDA has banned over-the-counter
quinine-based products used for leg cramps. Potentially fatal
hypersensitivity reactions and thrombocytopenia can occur with use of
?It is probable that leg cramps occur when a muscle that is already in
a shortened position is involuntarily stimulated. This commonly
happens at night where the plantar flexed foot places the calf and
ventral foot muscles in the most shortened and vulnerable position.?
o ?Metabolic disturbance (e.g. hyponatraemia, hypokalaemia,
hyperkalaemia, hypocalcaemia, hypomagnesaemia, hypoglycaemia)
o Chronic diarrhoea
o Severe acute diarrhoea
o Excessive heat causing volume depletion and hyponatraemia
o Pregnancy, especially in the late months
o Cirrhosis of the liver
o Renal dialysis, possibly owing to plasma volume contraction
o Thyroid disease:
§ Hyperthyroid myopathy may be associated with cramps
§ Hypothyroidism is associated with weakness, enlarged muscles and
painful muscle spasms
o Heavy alcohol ingestion, which may induce severe muscle cramps
o Lead toxicity
o Disorders of the lower motor neurone, including amyotrophic lateral
sclerosis, polyneuropathies involving the motor neurone, recovered
poliomyelitis, peripheral nerve injury and nerve root compression.
You had mentioned a ?dysfunctioning liver? as a potential cause of
your cramps. The only liver disorder that might contribute to leg
cramps would be cirrhosis. You would likely only have cirrhosis if you
were a heavy drinker, and you would know if you had cirrhosis!
· Drugs that may cause cramps include:
o Morphine (withdrawal)
o Diuretics (owing to electrolyte loss)
o Nicotinic acid
· Idiopathic nocturnal leg cramps have a relatively benign natural
history, with no serious complications.
· Sleep disturbance may affect quality of life.
· Cramps may occur intermittently during one day or they may persist
over several weeks. Most cases will resolve spontaneously [Salih,
How should recurrent leg cramps be managed?
· Reassurance that idiopathic leg cramps are benign may be all that is required.
· Consider recommending simple measures, although here is a lack of
evidence of benefit for these.
o Stretching exercises are commonly advised. It is recommended that
stretching exercises should be carried out three times daily
initially, and then continued at a frequency that maintains a
cramp-free state. Stretching the calf muscles before going to bed may
help some people [Daniell, 1979; Postgraduate Medicine, 2002].
o Other measures e.g. raising the foot or the head of the bed to
maintain dorsiflexion; using a pillow to prop the feet up in bed while
sleeping in the supine position; hanging the feet over the end of the
bed while sleeping in the prone position; and keeping blankets loose
at the foot of the bed to prevent toes and feet from pointing
downwards during sleep have not been investigated in trials but are
thought by experts to be helpful in preventing leg cramps [Weiner and
Weiner, 1980; Warburton et al, 1987; Kanaan and Sawaya, 2001].
?How should quinine be prescribed?
· Quinine 200-300 mg at bedtime is effective in reducing the frequency
of nocturnal leg cramps. It may take up to 4 weeks for improvement to
become apparent, and the treatment is then given regularly if there is
benefit [BNF 49, 2005].
· Treatment should be interrupted at intervals of about 3 months to
assess the need for further quinine treatment [BNF 49, 2005]. Some
people who found quinine beneficial were able to stop it without any
major problems [Coppin et al, 2005].
· People should be monitored closely during the early stages for
adverse effects as well as for benefit [BNF 49, 2005].
There are several potentially serious drug interactions with quinine
and these should be identified before prescribing.
· Cardiac glycosides: The concomitant use of quinine may increase the
plasma level of digoxin. Halving the maintenance dose of digoxin may
· Anti-arrhythmics: There is an increased risk of ventricular
arrhythmias if quinine is taken with amiodarone.
· Antipsychotics: There is an increased risk of ventricular
arrhythmias, and concomitant use should be avoided with pimozide or
· Antihistamines: Concomitant use of terfenadine should be avoided,
owing to the increased risk of ventricular arrhythmias.
· Antibacterials: There is an increased risk of ventricular
arrhythmias, and concomitant use should be avoided with moxifloxacin.
· Other antimalarials: Quinine should not be prescribed for people
taking mefloquine, as there is an increased risk of convulsions.
?Despite the frequency of this problem, there is limited understanding
and treatment for leg cramps. Supplemental potassium or calcium is not
effective because electrolyte abnormalities do not cause nocturnal leg
cramps. Magnesium is only helpful in pregnancy. Bananas do not help.
Hydration does not help this kind of muscle cramp.?
?Quinine is one of the few treatments shown to help reduce nocturnal
cramps. Quinine is found in low concentrations in tonic water
(one-tenth of prescription dose). Drinking eight to 16 ounces at night
can be a simple remedy.
Quinine is available in a stronger dose by prescription. Quinine is
considered safe when used at low doses. Quinine can interact with
medications including digoxin and warfarin (coumadin). It should be
avoided if you are pregnant or have kidney, liver or heart disease.
Quinine can cause rare side effects including tinnitus (ringing of the
ears), visual changes, vertigo, nausea, decreased platelets (needed
for clotting), and heart arrhythmias. Potential interactions and side
effects prompted the FDA to remove it as an over-the-counter treatment
Other treatments that may be helpful but have not been studied
extensively include: the muscle relaxant, orphenadrine (Norflex), the
anti-seizure medicine, gabapentin (Neurontin), and the blood pressure
medicine, verapamil. Vitamin B complex may be helpful. Vitamin E is
often recommended but studies show that it may not be helpful.
It is important to differentiate leg pain from cramps. Neuropathy
(nerve damage), sciatica, as well as clogged arteries in the leg
(vascular disease) can cause leg pain. These types of pain, tend to
occur throughout the day and not just at night. Vascular disease also
causes cramping with walking. In vascular disease, nighttime pain is
relieved with hanging the foot over the bed so that gravity draws more
blood into the feet. Poor circulation also causes poor healing that
results in persistent sores (ulcers). Leg cramps that occur at rest
may have a different cause and treatment than cramps associated with
Nocturnal leg cramps must be distinguished from restless leg syndrome,
which is a crawling, uncomfortable sensation that forces you to get up
and move the legs.?
?Stopping a cramp
If you do get a cramp, you can usually stop it quickly by flexing your
foot toward your knees. Hold the position until you feel the cramp
subside, then massage the muscles for a moment. You may also find it
helpful to take 25?50 milligrams of over-the-counter Benadryl.
Finally, don?t let leg cramps deprive you of much needed sleep. If the
problem persists, talk to your healthcare provider. He or she may
prescribe a sleep aid.?
I like this web site?s approach. Track down what you think is causing
your cramps, and try to find the best cure of all the posted
recommendations. You really don?t need supplements, so save your
?As we get older, circulation to the legs diminishes, making it likely
that something bad will happen to muscles not getting enough blood.
After that, things get pretty fuzzy. Some say it's not enough exercise
during the day, while others say muscles that have been fatigued by
activity are more likely to involuntarily contract during the night.
Other possible causes include lack of sodium, dehydration, alcohol,
caffeine, or tobacco use, too much sugar in the diet, pinched nerves,
prolonged sitting, flat feet, certain medications, and less commonly,
diseases like diabetes, anemia, and hypoglycemia. It can't be all of
those things, so you might try making a list and checking off the
least likely suspects. Then take action on the others one at a time.
That may be the only way to isolate or identify the problem.?
?Again, there are no guarantees, but there are ways to at least reduce
the probability of getting leg cramps at night. The one stretch
recommended by almost every doctor and physical therapist is the "Calf
Stretch" or "Wall Stretch." Stand 2-3 feet from a wall, feet parallel
to each other, and hands on the wall at head height or above. Keep
your feet flat on the floor and lean forward until you feel a stretch
- not to the point of pain - in your calves. Hold for 30 seconds and
repeat at least once, maybe twice. Make this stretch part of your
daily routine -- once in the morning, once late in the afternoon, and
one more time before you go to bed. Vary the exercise by doing a "wall
pushup" from the same position.
Other measures that may or may not prevent cramps include doing a
better job of staying well-hydrated (six to eight glasses of water or
sports drinks per day), wearing shoes that provide better support and
cushioning, taking magnesium, potassium, calcium, or sodium
supplements, or using prescription muscle relaxants at night. Before
you experiment with supplements, talk to a physician who knows
something about nutrition and sports medicine - and don't assume that
they all do -- or a registered dietician who has experience working
with athletes and exercisers.
Sorry we can't give you an exact answer to the nighttime leg cramp
dilemma, but it just doesn't exist. What causes the problem in one
person may not cause it in another. The same goes for effective ways
to treat and prevent cramps. But at least you now have a working list
of causes, treatment options, and prevention measures to consider.
Good luck in finding the combination that works for you.?
Exercises for leg cramps
Limptar is a German combination drug, consisting of quinine sulphate
and aminophylline. (Very strange name, wouldn?t you say?). You can ask
your doctor if this medication may work for you.
?Organic causes for nocturnal or recumbency leg cramps as venous,
arterial, statical, nervous, rheumatical and metabolic diseases such
as tetany, diabetes and gout must be excluded. This means also
electrolyte disturbances during a medical treatment, for example with
diuretics. In addition there is a very high portion of idiopathic
cramps. In 22 patients with nocturnal leg cramps a four week double
blind study with a combination of quinine sulphate and aminophylline
(Limptar) was started. Unequivocally, Limptar significantly reduced
the number and the intensity of nocturnal or recumbency leg cramps.
There was no influence on angiological and biochemical parameters.
Side effects appeared very seldom.?
?Muscle spasms are diagnosed by the presence of tight or hard muscles
that are very tender to the touch. There are no imaging studies or
blood tests that can diagnose this condition. If the spasm is caused
by nerve irritation, such as in the back, an MRI may be helpful to
determine the cause of the irritation.
At the first sign of a muscle spasm, stop your activity and try
stretching and massaging the affected muscle. Heat will relax the
muscle at first, although ice may be helpful after the initial spasm
and pain has improved. If the muscle continues to be sore,
non-steroidal anti-inflammatory medications may help with pain. In
more severe cases, your health care provider may prescribe anti-spasm
After initial treatment, the cause of the spasm should be determined
to prevent it from recurring. If an irritated nerve is involved,
physical therapy or even surgery may be necessary.
The most common cause of muscle cramps associated with sports activity
is dehydration. Often, rehydration with water or sports drinks will
resolve the cramping.?
?Rub for relief. A little kneading may be all you need to pull in the
reins on a charley horse. Always rub with the muscle, not across it.
So for a charley horse in your calf, start behind the knee and rub
toward the heel.?
Leg Cramps or Charley Horse: What's the Difference?
When your calf tightens up and the ache begins, you probably don't
waste time wondering whether it's a leg cramp or a charley horse. But
there is a difference. Leg cramps, especially in the elderly, often
result when not enough blood gets to the muscles. A charley horse is
likely to be caused by too much blood getting to the muscle (though
there may be other causes as well).
Also, cramps and charley horses attack in different ways. "Leg cramps
usually occur while you're walking and will come more gradually,
building as you use the muscle more," says Steven Subotnick, D.P.M., a
sports podiatrist in Hayward, California, and author of Sports and
Exercise Injuries. "After a rest, the cramps will usually go away."
A charley horse, on the other hand, "comes more suddenly and isn't
necessarily related to physical activity or using the muscle," says
So if you're just lying in bed and you suddenly feel that telltale
tightening in your calf, it's probably a charley horse rather than a
?Let gravity help. As with any type of leg cramp, encouraging blood
flow away from the limbs and toward the heart can bring quicker relief
and less throbbing. "Elevate the area you're rubbing, so gravity works
with you," suggests Ed Moore, the massage therapist for the 1984 U.S.
Olympic Cycling Team.?
You may ask your doctor about a TENS machine. This falls under the
category of alternative medicine, but I have read some good things
about it?s efficacy. Note: Not to be used with a heart pacemaker.
?Electrical nerve stimulation, also called transcutaneous electrical
nerve stimulation (TENS), is a noninvasive, drug-free pain management
technique. By sending electrical signals to underlying nerves, the
battery-powered TENS device can relieve a wide range of chronic and
?The TENS device is a small battery-powered stimulator that produces
low-intensity electrical signals through electrodes on or near a
painful area, producing a tingling sensation that reduces pain. There
is no dosage limitation, and the patient controls the amount of pain
Some experts believe TENS works by blocking pain signals in the spinal
cord, or by delivering electrical impulses to underlying nerve fibers
that lessen the experience of pain. Others suspect that the electrical
stimulation triggers the release of natural painkillers in the body.
Patients can rent a TENS unit before buying one, to see if it is
effective against their pain.?
More information on TENS units:
?TENS machines seem to be a popular option for people who have pain,
especially for people with persistent (chronic) pain. However,
research trials that have studied the use of TENS machines have
provided conflicting results as to how well they work, and how much
pain relief they give. Some conclude that they are not effective.
Others conclude that they seem to help some people. Further research
is needed to clarify their role and effect.
However, TENS machines seem to be popular for various painful
conditions. Their popularity would imply that they may well have some
effect to reduce pain. However, the amount that the pain is eased is
likely to vary from person to person with the same condition.?
I?d try to eat a more balanced diet than spend money on supplements.
Here is a site with foods high in magnesium, calcium and potassium.
Please see your doctor for a diagnosis and what you should take based
on your medical history.
When searching for accurate medical advice online, please consider reliable
medical sites. While some sites that sell supplements may offer some
good advice, remember they are biased towards making a profit.
I hope this answer has contained new information for you. If not,
please request an Answer Clarification, before rating. I will be glad
to respond, so you get the answers you were seeking.
Good luck in your search for a good night?s sleep!
benign nocturnal leg cramps
Nocturnal leg cramps
Periodical leg cramps