Help for nighttime leg cramps

Nighttime leg cramps cause pain and sudden muscle tightness in the legs, feet, or both. The cramps can wake you up from sleep. They can last for many minutes or just a few seconds.

Nighttime leg cramps are common in both adults and children. But as people get older, they are more likely to get them. About half of people older than 50 get nighttime leg cramps.

What causes nighttime leg cramps? — Most nighttime leg cramps do not have a cause that doctors can find. When doctors do find causes, the causes can include:

  • Having a leg or foot structure that is different from normal – For example, having flat feet or a knee that bends in the wrong direction
  • Sitting in an awkward position or sitting too long in one position
  • Standing or walking a lot on concrete floors
  • Changes in your body’s fluid balance – This can happen if you:
  • Take medicines called diuretics (also called “water pills”)
  • Are on dialysis (a kind of treatment for kidney disease)
  • Sweat too much
  • Exercising
  • Having certain conditions – For example, Parkinson disease, diabetes, or low thyroid
  • Being pregnant – Some pregnant women do not have enough of the mineral magnesium in their blood. This can cause leg cramps.
  • Taking certain medicines

Is there anything I can do on my own to feel better? — Yes. Things you can try include:

  • Riding a stationary bike for a few minutes before bed – If you normally get little exercise, this might help.
  • Doing stretching exercises (picture 1)
  • Wearing shoes with firm support, especially at the back of your foot around your heel
  • Keeping bed covers loose at the foot of your bed and NOT tucked in
  • Drinking plenty of water, especially if you take diuretics. (Do this only if your doctor or nurse has not told you to limit the amount of water you drink.)
  • Limiting the amount of alcohol and caffeine you drink
  • Staying cool when you exercise, and NOT exercising in very hot weather or hot rooms

If you get a cramp, slowly stretch the cramped muscle. To prevent more cramps, you can try:

  • Walking around or jiggling your leg or foot
  • Lying down with your legs and feet up
  • Taking a hot shower with water spraying on the cramp for 5 minutes, or taking a warm bath
  • Rubbing the cramp with ice wrapped in a towel

Should I see a doctor or nurse? — See a doctor or nurse if:

  • You wake up several times a night with leg cramps
  • Your cramps keep you from getting enough sleep
  • Your cramps are very painful
  • You have cramps in other parts of your body, such as your upper back or belly

Are there tests I should have? — Probably not. Your doctor or nurse will talk with you about your symptoms and do an exam to find out what could be causing your nighttime leg cramps. Depending on your symptoms and exam, you might also need some blood tests.

How are nighttime leg cramps treated? — Treatment is different for everyone. Most people have to try a few different things before they find a treatment that helps them.

Treatment options include:

  • Mineral and vitamin supplementation, including vitamin B complex (three times daily, containing 30 mg of vitamin B6) or vitamin E (800 international units before bed), before using prescription medications. Vitamin B complex (containing fursultiamine 50 mg, hydroxocobalamin 250 micrograms, pyridoxal phosphate 30 mg, and riboflavin 5 mg) showed benefit in one randomized trial [40]; and vitamin E was beneficial in some small studies but not others [35,41].

Iron may be helpful in patients who have iron-deficient anemia; and magnesium supplementation may be of benefit in patients with pregnancy-related cramps [19,42]. However, a systematic review of randomized trials comparing magnesium supplementation with placebo identified four trials involving 322 patients with idiopathic (primarily nocturnal) leg cramps; meta-analysis of the trials found no evidence of significant benefit in the frequency or severity of cramping with magnesium therapy [42]. Three trials involving a total of 202 women with pregnancy-associated leg cramps were identified in the systematic review; only one found benefit.

  • If vitamin and mineral supplements are ineffective, you can try diphenhydramine (Benadryl), 12.5 to 50 mg nightly, at bedtime.

How to stretch the backs of your legs

Stand facing the wall, feet together, about 2 feet from the wall. With your heels firmly on the floor and your shoulders, hips, and knees lined up straight, lean forward into the wall. This should stretch the backs of your legs. Hold this position for 10 to 30 seconds. Repeat 5 times each session, at least twice a day.

Leg stretch

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