Nocturnal calf cramps: The best tips, tricks & home remedies

Nächtliche Wadenkrämpfe: Die besten Tipps, Tricks & Hausmittel

Leg cramps are common. 60% of adults report that they have been affected by leg cramps and even one in three is regularly plagued by them. (6) Especially at night, calf cramps are particularly uncomfortable and literally deprive those affected of their sleep and thus endanger their quality of life in the long term.

This article is intended to provide you with the essential information on calf cramps and their causes. Then we would like to give you a few tips and tricks on what you can do not only in the short term, but also in the long term against nocturnal calf cramps.

the essentials in brief

  • Nocturnal leg cramps are the most common form of muscle cramps. Individual muscles or muscle groups contract involuntarily and painfully and cannot be consciously relaxed again.
  • Calf cramps can have many causes. In most cases, they are caused by excessive strain on the leg muscles, a lack of minerals or fluids. Only very rarely are they a symptom of a more serious condition.
  • In addition to gentle stretching exercises to relax the muscles, taking magnesium is the first choice to prevent muscle cramps in the long term. In particularly serious cases, taking quinine sulfate can also be a possible solution to alleviate the symptoms. However, due to severe side effects, it should be the last resort.

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Definition: What are calf cramps?

A calf cramp describes the involuntary and painful tension (contraction) of the calf muscles. This can affect individual muscles as well as entire muscle groups. Cramps per se can affect any muscle group in the body. However, cramps in the calf muscles are the most common.

Anatomically, the lower leg is divided into the shinbone on the front and the calf on the back. Its muscles can be divided into four groups. The front lower leg muscles consist of the so-called stretchers (extensors) on the inside of the leg and the fibula muscles on the outside. The rear lower leg muscles are divided into a superficial and a deep muscle layer.

Suffer

Anyone who is often plagued by calf cramps at night often also suffers from a lack of sleep and is therefore less resilient in everyday life. (Image source: Bruno Aguirre / Unsplash)

One speaks of calf cramps when the superficial and deep muscle layers on the back of the lower leg are affected by uncontrolled muscle contractions. This causes them pain and causes the muscle area to harden during the seizure.

Background: What you should know about calf cramps at night

Before we pass on tips for relieving and preventing your nocturnal calf cramps, you should acquire some background information on calf cramps.

We want to answer these frequently asked questions for you in the following paragraphs.

Why do I have calf cramps at night anyway?

The causes of calf cramps can be very different. In medicine, a general distinction is initially made between so-called paraphysiological and symptomatic muscle cramps.

In most cases, calf cramps at night can be traced back to harmless causes.

Paraphysiological muscle spasms are caused by external causes. In addition to physical characteristics, they also include certain aspects of lifestyle that can promote calf cramps.

Symptomatic muscle cramps, on the other hand, are a symptom of an overriding underlying disease or a possible side effect of certain medications. Muscle spasms without an identifiable cause are called idiopathic. (1)

We have given you an overview of the various possible causes of your calf cramps in the following table.

kind possible causes
Paraphysiological muscle spasms muscle overload
  • through sports, e.g. B. jogging
  • due to foot malpositions as a result of incorrect footwear, e.g. B. high-heeled shoes or shoes that are too small
Hormonal imbalance
  • during pregnancy, e.g. B. by changes in fluid and mineral requirements
  • during puberty
Disorders of the electrolyte balance
  • as a mineral deficiency, e.g. B. magnesium or potassium
  • dehydration, e.g. B. by drinking too little or excessive sweating
Symptomatic muscle cramps diseases
  • Hormonal and metabolic diseases, e.g. B. diabetes mellitus, hypothyroidism, parathyroidism, adrenal cortex disorders, kidney disease and renal insufficiency
  • muscle diseases, e.g. B. myotonia, Brody syndrome, muscle spasm muscle pain and fasciculation syndrome or crampus fasciculation syndrome
  • Diseases of the nervous system, e.g. B. Parkinson's disease, multiple sclerosis or Huntington's disease, polyneuropathies, tetanus (lockjaw), radiculopathies, amyotrophic lateral sclerosis (ALS), stiff man / stiff person syndrome
  • Vascular disorders (eg, deep pelvic or leg vein thrombosis, varicose veins)
  • bacterial infections, e.g. B. Leptospirosis
drug side effects
  • Cholesterol-lowering medicines containing the active substance fenofibrate Medicines for high blood pressure, e.g. B. beta-blockers, ACE inhibitors, diuretics or calcium kanablockers
  • Hormonal contraceptives, e.g. B. pill or hormone spiral
  • Asthma sprays that contain the active ingredient salbutamol
  • insulin
  • chemotherapy drugs used to treat cancer

In most cases, calf cramps are due to harmless, external causes. In the context of disease-related causes, they are usually just one of many possible symptoms, such as B. Restricted movement, sensory disturbances, circulatory problems or fever. If you still suspect something serious behind your cramps, you should consult a doctor to have your symptoms clarified.

What favors calf cramps at night?

The likelihood of leg cramps at night can increase due to various factors. What they all have in common is that they unbalance the body's fluid and electrolyte balance, causing short-term deficiencies or over-stressing the muscles.

These include e.g. B. Sport or heavy physical work, especially in the heat. In addition to possible muscle overload, the heat causes excessive sweating, resulting in dehydration and electrolyte imbalance.

Alcoholic beverage

Alcohol has a dehydrating effect. It causes valuable liquid and minerals to be flushed out of the body via the kidneys and can thus promote calf cramps at night. If you drink alcohol, make sure you also consume enough non-alcoholic beverages to prevent this effect. (Image source: Gerrie van der Walt / Unsplash)

Alcohol consumption can also increase the likelihood, as it has a dehydrating effect on the body. It prevents the reabsorption of fluid via the kidneys and instead ensures that it is excreted more. This also flushes out many of the necessary electrolytes.

Wearing the wrong footwear can also lead to poor posture or shortening of the lower leg muscles. This, in turn, causes the muscles to be stressed incorrectly and excessively. Finally, medication that is permanently required can increase the likelihood of calf cramps at night due to their side effects.

What can calf cramps indicate at night?

In the simplest case, your body tells you in this way that it is dehydrated or that it needs important minerals such as e.g. B. Magnesium is absent. Maybe the last sports unit was a little too intense for your muscles.

Calf cramps at night are usually an indication of an imbalance in your fluid and electrolyte balance.

You can easily correct these signals by making sure that you drink enough during the day, take additional magnesium and, if necessary, do not overexert yourself during sport and include additional stretching exercises in your training.

It is only when other symptoms appear that something serious could be behind your nocturnal leg cramps. Keep an eye on your entire body. if e.g. If you experience additional symptoms such as tingling, numbness, fever, exhaustion or tiredness, you should consult a doctor.


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What can I do about my calf cramps at night?

A muscle spasm can last several minutes and be very painful. Luckily, you can take immediate action to gently but specifically affect the muscles from the outside in the event of a calf cramp and thus quickly bring about their relaxation.

To counteract an acute calf cramp at night, you should try to stretch the muscles gently. To do this, gently pull your toes towards your knee. With this movement you tense the opponents (antagonists) of your calf muscles, the extensor and fibula muscles, and cause a relaxing stretching effect.

Another option would be for you to get up and walk around a bit. The interaction of the muscles while walking causes a contraction and relaxation of the entire lower leg muscles, similar to targeted stretching.

Heat, for example from a warm calf wrap or a hot water bottle, can also relax the muscles in your calf and thus relieve the pain.

What can I do in the long term against calf cramps at night?

There are a number of things you can do to prevent possible calf cramps at night. The central points that you can influence here are drinking enough and consuming enough minerals. Medications should only be an option after you have exhausted all other options.

In this case, drinking enough means between 2 and 3 liters a day. On particularly hot summer days or when doing sports, it can be a little more, since your body loses a lot of water through sweating in the heat. It is important that your drinks are non-alcoholic and contain as little sugar as possible.

An adequate supply of minerals for a balanced balance of electrolytes in your blood can also reduce the risk of cramps in your muscles. The most important minerals include sodium, potassium, magnesium and calcium.

What can I do about calf cramps during pregnancy?

In addition to measures that help immediately, such as stretching and warmth, doctors also recommend taking magnesium. (2) Drug treatment is avoided during pregnancy and lactation, since the usual preparations have a teratogenic effect or even promote labor and are also passed on to the child via breast milk. (7.8)

During pregnancy, the magnesium requirement of the expectant mother increases from the 2nd trimester of pregnancy.

The exact reasons for nocturnal calf cramps during pregnancy are still largely unclear. Doctors suspect a connection between the hormonal changes and the increasing need for minerals and fluids during pregnancy.

The unusual physical strain caused by weight gain can also lead to overstraining of the leg muscles, which then becomes noticeable in muscle cramps at night.

When does it make sense to see a doctor about calf cramps?

You should consider a visit to the doctor if the cramps in your calves are seriously limiting you in your everyday life. If you z. B. You can no longer get enough sleep due to the frequency, measures such as stretching no longer help or the seizures become stronger, you can contact your family doctor or a specialist in internal medicine.

Other warning signs that you should definitely see a doctor for are general pain, numbness or tingling in your legs, restricted movement or other muscle spasms in other areas of your body.

You should also consult a doctor if you have additional symptoms such as headaches or back pain, night sweats, fever, tiredness and exhaustion.

Calf cramps at night: The best tips & tricks for a quiet night

While immediate relief measures such as stretching or heat bring about rapid relief from the pain, the study situation on the long-term prevention of nocturnal calf cramps is surprisingly not that clear. (2,5,7)

Although many studies have shown the long-term effectiveness of the drug quinine (as quinine sulfate or hydroquinine) against leg cramps at night, its use is rarely accompanied by serious side effects. Therefore, medicine is still looking for effective non-drug treatment methods. (2)

Immediate help against calf cramps at night

Muscle cramps in the calves usually only last a few seconds or a few minutes, but the pain that goes with them is almost unbearable. Immediate measures are aimed at relaxing the muscles again and thus relieving the pain.

Active stretching

In the case of a muscle cramp, many people automatically feel the need to stretch the muscle to relieve the cramp. So-called active stretching of the calf muscles is recommended during an acute seizure.

By actively stretching the muscles, you can quickly relieve the cramp.

To do this, pull your toes up towards your knees. You tense your shin muscles and automatically stretch your calf muscles.

In the case of particularly severe pain, it sometimes takes a little effort. It is best to start gently by first bending your knee, gently grasping your front foot with your hands and carefully pulling it towards you in the direction of your knee. You can then slowly try to straighten your knee and thus increase the stretch.

Heat and gentle massages

Heat has a relaxing effect on muscles. It also stimulates blood circulation and can relieve muscle pain. For example, you can make warm calf wraps, lay your lower legs on a hot-water bottle or a warm cherry pit pillow, or give your calves a quick, warm shower.

A gentle massage of the affected muscles can also relieve the pain. This slowly loosens the hardening of the muscle and also stimulates blood circulation.

Long-term measures to prevent nocturnal leg cramps

The treatment options that we present to you here are recommended in the guidelines of the German Society of Neurology. (2)

Non-drug treatment options

Refraining from taking medication should always be the first option for those affected and, if necessary, for the doctors treating them. Many measures are based on empirical values ​​and considerations based on known causal relationships.

Advantages
  • low cost
  • Agents such as magnesium are over the counter
  • little to no side effects
  • applicable to pregnant women
Disadvantages
  • Sustainable effectiveness has not been scientifically proven
  • Unfortunately, there is no clear confirmation from research, since the results of previous studies contradict each other, especially with regard to the intake of magnesium or B vitamins.

    Passive stretching for prevention

    While active stretching provides immediate relaxation of the calf muscles in the case of an acute calf cramp, so-called passive stretching has been shown in studies to be a possibility for long-term prevention. (3.4)

    stretches

    Passive stretching after exercise or just before going to bed can help prevent calf cramps at night in the long term. (Image Source: Alora Griffiths / Unsplash)

    There are various exercises that you can do several times a day, after training or every evening before going to bed:

    • Exercise 1: Bend your upper body and stretch your hands toward your toes. Your heels should be in full contact with the ground. If you have problems with this version, you can also stand about 1 m away from a wall and support your arms on the wall when bending forward.
    • Exercise 2: Step forward into a lunge. Shift your weight to the front leg and bend your knee slightly. Now try to straighten your back leg and touch the floor with your heel. For better balance, you can also support yourself on a wall during this exercise.

    With both exercises, you should be able to feel a pull on the back of your thighs and lower legs.

    Balancing the electrolyte balance

    Proper functioning of the muscles requires, among other things, a complex interaction of minerals. These are found as ions in the water in your body. Due to this form dissolved in liquid, they are also referred to as electrolytes.

    Two minerals are essential for muscle cells: calcium and magnesium. Calcium ions in the muscle cells ensure that they contract. As soon as the impulse of a nerve cell is transmitted to the muscle, they are released and cause a muscle to respond.

    Magnesium inhibits this release of calcium ions in the muscle and thus has a regulating effect on its tension reaction.

    In blood tests of athletes and pregnant women who suffered from muscle cramps, a magnesium deficiency could often be found, so that the conclusion seems reasonable that the susceptibility to cramps can be eliminated by supplementing with magnesium.

    fruit and vegetables

    If you do not want to take additional magnesium supplements, you can also cover your daily requirement with the help of a diet rich in minerals. Foods that contain a lot of magnesium are e.g. B. broccoli, legumes or whole grain bread. (Image source: Alexandr Podvalny / Unsplash)

    If you decide to take magnesium, you should pay attention to the correct dosage, since an overdose of magnesium can also lead to side effects such as diarrhea and gastrointestinal problems.

    The German Society for Nutrition recommends the following amounts as reference values ​​for magnesium for adults:

    Old recommended daily amount for men / women
    15 to 19 years 400 milligrams / 350 milligrams
    19 to 25 years 400 milligrams / 310 milligrams
    25 to 51 years 350 milligrams / 300 milligrams
    51 to 65 years 350 milligrams / 300 milligrams
    from 65 years 350 milligrams / 300 milligrams
    pregnant women 310 milligrams
    breastfeeding 390 milligrams

    Drug treatment with quinine

    As quinine sulfate or hydroquinine, quinine forms a common preparation for the treatment of nocturnal leg cramps. In dosages of a maximum of 200 to 400 milligrams daily, it has an antispasmodic effect. It influences the frequency, duration and intensity of a seizure.

    Advantages
    • has an antispasmodic effect
    • Seizures are rarer, shorter, and weaker
    • Efficacy is scientifically proven
    Disadvantages
  • prolonged use can cause serious side effects
  • prescription
  • Long-term use can have serious side effects. These include tinnitus, nausea and blurred vision. Furthermore, there can be undesirable effects on the gastrointestinal tract, the nervous system, the cardiovascular system and the skin.

    Due to the immense side effects, treatment with quinine is always the last possible option if other measures have not been successful.

    The most serious side effect is the so-called thrombocytopenia. This indicates a lack of thrombocytes (blood platelets), an important component of blood clotting. It comes more to z. B. Nosebleeds, bruises (hematomas), punctual bleeding (petechiae) in the skin and mucous membranes and in the worst case internal bleeding up to a stroke.

    Since 2015, quinine sulphate has been subject to a prescription, as the side effects mean that the intake must be monitored and monitored by a doctor.

    Alternative treatment methods

    These options fall within the realm of alternative medicine and are not recommended in mainstream medical guidelines. Their effectiveness is based on empirical values ​​and is only gradually being scientifically researched through studies.

    alternative characteristics
    acupuncture Acupuncture is one of the most important therapeutic methods in Traditional Chinese Medicine. With the help of fine needle pricks at specific points on the body, blockages that disturb the circulation of life energy and thus cause discomfort are to be removed. The key points for muscles and muscle spasms are the liver and spleen. Acupuncture is often recommended for people who tend to have leg cramps.
    homeopathy Homeopathy is a treatment method from the field of alternative medicine. The basic principle is to fight like with like. In this case, this specifically means that drugs that lead to cramp-like symptoms in healthy people are used in a highly diluted form. The most common remedies for calf cramps include Cuprum metallicum, Magnesium phosphoricum, Valeriana officinalis and Thuja.

    Conclusion

    Repeated calf cramps at night can not only be extremely painful, but also have a long-term effect on sleep and thus the general quality of life. Which exact factors are involved and to what extent in the development and tendency of calf cramps and why they often occur at night has not yet been fully researched.

    Central points that favor the occurrence of nightly leg cramps seem to be overexertion of the muscles and an imbalance of electrolytes in the body. In rare cases, they are just one of many symptoms of a serious underlying disease.

    Even simple measures such as stretching exercises, sufficient drinking quantities, a diet rich in minerals or the additional intake of magnesium supplements can help both in the short and long term before drug treatment with quinine is considered as the last option.

    itemizations

        Parisi, L et al. "Muscular cramps: proposals for a new classification." Acta neurologica Scandinavica vol. 107.3 (2003): 176-86. doi:10.1034/j.1600-0404.2003.01289.x
    Source
        Lindemuth R et al. S1 guideline for cramps/muscle spasms. 2017. In: German Society for Neurology, ed. Guidelines for diagnostics and therapy in neurology. Online: www.dgn.org/leitlinien (accessed on August 5, 2020)
    Source
        Hallegraeff, Joannes M et al. "Stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults: a randomized trial." Journal of physiotherapy vol. 58.1 (2012): 17-22. doi:10.1016/S1836-9553(12)70068-1
    Source
        Coppin RJ, Wicke DM, Little PS. Managing nocturnal leg cramps--calf-stretching exercises and cessation of quinine treatment: a factorial randomized controlled trial. Br J Gen Pract. 2005;55(512):186-191.
    Source
        Blyton, Fiona et al. "Non-drug therapies for lower limb muscle cramps." The Cochrane database of systematic reviews vol. 1.1CD008496. 18 Jan 2012, doi:10.1002/14651858.CD008496.pub2
    Source
        Allen RE, Kirby KA. Nocturnal leg cramps. Am Fam Physician. 2012;86(4):350-355.
    Source
        Young, Gavin. "Leg cramps." BMJ evidence clinical vol. 2015 1113. 13 May 2015
    Source
        Young, Gavin, and David Jewell. "Interventions for leg cramps in pregnancy." Cochrane database of systematic reviews 1 (2002).
    Source
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