“I imagine cramps are like revenge from the muscles of leg which are still wandering on the streets of my once love” – Aazz
Maybe it is the lost love or the cramps that wake you up at night, and both are easily treatable. But, both are only normal if they are not with an underlying cause or ailment. Even expert scientists of this modern world could not find till date the precise reason of both.
But one funny theory for cramps going on the rounds involves the brain and dreams. The brain by mistake may instruct the leg to move while dreaming and this confuses the calf muscle to cramp.
Most of the horses sleep standing. Maybe they are also afraid of the Charley Horse’s effect. The sudden pain of charley horse effect of the leg cramp at night causes a lot of discomfort and sleeplessness.
Even though leg cramps at night is a normal issue, the sudden pain is intolerable to many people. Also the stress it causes of immobility, and the following adage implies the severity of the pain.
“In some ways, cramps are worse than having a broken leg.”- Kevin Keegan
If you have Charley’s horse, the ride is not going to be smooth. The sharp pain awakening hard-worked people at night makes it a nightmare for many. Also, age is the primary factor for night cramps its severity gets complicated. It is because older adults remain awake all night even after the pain recedes.
For many leg night cramps are the mini ninjas that are trying to kill them while they are sound sleeping. Even renowned orthopedic doctors are not sure that the nerves sent the wrong signals to the muscles.
The contractions are more focused on the calf muscles and sometimes in the feet also. And if the cramp is more severe and frequently occur it could be a significant issue. Also, it may make the muscle to be sore for many days after its occurrence. Also, insomnia for the older adults due to nocturnal leg cramps is very dangerous for their health.
Charley’s Horse like normal horses does not differentiate gender, and age for its rough ride. But predominantly people above the age of 50 are the most affected by it. One out of three above 60 years are affected by it, and only 7% of younger people are affected. 40 % of pregnant women suffer from leg cramps at night.
Due to overuse or more of the wear and tear of the leg muscle usage could be the primary cause for leg cramps at night. Also, dehydration, nervous compressions, immobility throughout the day for a prolonged period and underlying ailments may be the other reasons.
Leg cramps start abruptly without any trigger or indication and may remit spontaneously. It is a painful sensation associated with involuntary muscle contraction. It may cause the toes to curl or extend involuntarily causing great pain to the calf muscles and sometimes in thighs also.
Scientific testing of muscles during a cramp revealed spontaneous firing of anterior horn cells. These cells coordinate muscle activity followed by discharge within groups of muscle cells. This activity 300 times per second which is considerably more than with voluntary muscle contractions The pain occurs from local metabolite disturbances or local ischemia.
At the middle of the night, only self-care could be handy for relieving the pain and the shouting because of it. Forceful stretching is the best way to get reduced, but it is easy said than done. Massaging the affected muscle gently or applying hot pads or ice packs could alleviate pain.
Eating bananas are time-tested best relief of cramps due to lack of electrolyte deficiency. Also, some lifestyle changes like proper walking, doing some stretching exercises could help avoid or postpone it. Supplements and vitamin intakes can prevent leg cramps at night.
Nocturnal leg cramps give a tightly knotted sensation lasting from seconds to several minutes. But if it persists for more than 10 minutes or occurs frequently, it is time to see the doctor. Few blood tests and proper diagnoses could help to treat it efficiently to provide the best relief.
Doctors will first differentiate leg night cramps with RLS and PLMS. RLS or Restless leg syndrome is only the urge to move the leg during sleep at night. It can be relived easily by the movement as it has no association with muscle contraction. PLMS or Periodic Limb Movements of Sleep are only flexing moves usually at the ankle or knee and not associated with pain.
SYMPTOMS OF LEG CRAMPS AT NIGHT:
The primary issue and symptom of Charley Horse is the cramp of the leg muscles at night. Some common symptoms include:
• Can feel or see a hard lump of muscle tissue behind the skin
• Abnormal leg swellings
• Redness or skin changes on the legs
• Leg pains specifically on the calf muscles
CAUSES: OF LEG CRAMPS AT NIGHT
The root cause of nocturnal leg cramps in this advanced scientific world is still unknown. It could be possible due to many reasons. Even many healthy individuals have leg cramps. It is mostly related to muscle fatigue and nerve problems in general.
Also, it increases with age, and the pregnant woman has a more likelihood of having it.
Several medical conditions like kidney failure, endocrine disease, neuromuscular disorders and many more could cause it. Also, certain medications like diuretics, contraceptives, and others may be the reason.
Persons suffering from the inadequate blood supply, nerve compress ions, and mineral depressions could be other significant causes. However, some predisposing factors may link to the following among other causes which categorizes as per their source:
Structural disorders:
Also known as neurological disorders are due to the abnormalities in the brain, spinal cord or the nerves which could result in muscle weakness. Compression of nerves in the spine can produce cramp-like pain in your legs. Leg cramps at night caused by structural disorders include
• Lou Gehrig’s disease known as Amyotrophic Lateral Sclerosis (ALS) a chronic nervous system disease that affects muscles and impacts physical function
• Peripheral vascular disease or Peripheral artery disease:
• PVD a circulatory system disorder outside the brain or heart and could include disorders that affect the blood vessels. Due to the narrowed arteries restriction of the blood flow happens mostly in the legs.
Parkinson’s disease:
It affects the brain nerve cells that produce dopamine to cause muscle rigidity.
Nerve damages from cancer treatments
Spinal Stenosis:
Also known as Lumbar Stenosis t is a condition which puts pressure on the nerves traveling through the spine. It is because of the narrowing of the spaces within the spine.
Neuromuscular disorders:
It is a broad term comprising many diseases and ailments. It affects muscle functioning directly or indirectly. Some of it may be the causes of leg cramps at night are neuropathy, myopathy, and motor neuron disease. Neuromuscular disorders that affect the nerves that control the voluntary muscles
Cramp-Fasciculation Syndrome (CFS) a rare condition of the muscles characterized by persistent muscle cramping and fasciculation or twitching
Metabolic disorders:
When the normal metabolic process alters due to abnormal chemical reactions in the body metabolic problems occur. It could be due to genetic or hereditary and most of which are autosomal recessive. There are many diseases caused due to metabolic disorders which could be the reasons for the leg cramps at night.
Acute kidney failure or chronic kidney disease:
It is a major catastrophe of the human body nowadays with the kidneys failing to function. It happens to one or both the kidneys. In some cases, there is a condition of chronic kidney disease which slows down the elimination of waste, salt and other elements from the body to cause pain.
Addison’s disease:
It is caused due to inefficient adrenal glands and is also known as hypocortisolism. It is one of the long-term endocrine disorders due to the lack of steroid hormones production by the adrenal glands.
Anemia:
Lack of hemoglobin or red blood cells in the blood causes anemia. It makes the body not to get enough oxygen because it is only the red blood cells which bind oxygen.
Cirrhosis:
Scarring in the liver to be affected is the condition called liver cirrhosis. It is mainly due to the reason of excessive alcohol consumption.
Hypothyroidism:
It is a disorder of the endocrine system also known as low thyroid or underactive thyroid. Due to the insufficient production of thyroid hormone by the thyroid gland, it can cause pain in the legs and tiredness.
Hyperthyroidism:
It is the condition opposite of hypothyroidism producing the excess thyroxine hormone. It accelerates the body metabolism causing rapid heartbeat and weight loss for creating pain in the legs.
Diabetes:
Both the two types of diabetes is due to the lack of insulin secretion or resists the effects of insulin. These chronic conditions increase the sugar level due to improper metabolization of sugar an essential source of fuel for the body. Hence it causes the body weak to cause pain in the legs.
Hypoglycemia:
Also known as low blood sugar is a dangerous condition. Due to the low sugar level could cause various issues including leg pains.
Flat Feet:
Flat feet disorders due to no arch on both or one of the feet which could cause pain in the legs
Diarrhea:
More of loose stools in a day causes diarrhea. Acute diarrhea lasts a short time and a common problem but could cause pain in the legs.
Muscle fatigue:
Due to vigorous exercises, the muscles lose the ability to generate force. Thus muscle fatigue may cause leg cramps at night.
Osteoarthritis:
It is a type of joint disease due to the breakdown of cartilage and underlying bone. Due to joint pain and stiffness may be the reason for leg cramps at night.
Medications and medical procedures:
Due to various illnesses, there are many medicines taken daily from over the counter to specific disease-treating drugs. Also, certain medical procedures like hemodialysis could links to night leg cramps.:
• Statins or medications for lowering cholesterol
• Diuretics or water pills used to expel water from the body to prevent high blood pressure
• Beta-agonists are medications to relax muscles of the airways for easier breathing activators
• Electrolyte imbalances like hypokalemia or low potassium, hypocalcemia or low calcium or hypomagnesemia or low magnesium cause muscle spasms
• Hemodialysis a process of cleaning the blood of kidney failed patients
The following common medications may contribute to the risk of developing leg cramps at night:
• Contraceptives
• Intravenous iron sucrose
• Teriparatide
• Raloxifene
• Medicines used for blood pressure
Other conventional or lifestyle reasons:
Aging most commonly above 50 years of age and only 7 % are affected less of it
• Excessive exercise or putting too much strain on muscles or previous vigorously done exercises
• Sitting for a longer period
• Over-extension of the muscles
• Mobility and movement restrictions
• Standing of working on concrete floors
• Pregnancy often in the later stage
• Excessive Alcoholism
• Dehydration due to lack of drinking enough water
When to see a doctor:
Leg cramps at night are common and can b treated by self in most of the cases. But in the following situations it needs to consult the doctor:
• Frequent severe and persistent cramping during the nights
• Leg cramps occurring when exposed to toxins like lead
• When the leg cramps at night are persistent and severe to affect the next day’s work
• When atrophy or degeneration of cells or developing muscle weakness due to leg cramps
• If the leg cramps at night occur regularly and persist for more than 10 minutes
• When the leg is affected by tetanus infection, the leg cramps could be aggravated and needs to see the doctor immediately
• When sleep is disturbed regularly due to leg cramps
• When there are numbness or swelling, redness, and skin changes
• Does not improve with self-care
• When the cramps associate with muscle weakness
• Not associated with any strenuous physical activity or suddenly increased strenuous exercises
What are the questions to ask the doctor to clarify the doubts about leg cramps at night?
• It is better to be accompanied by a family member or a friend to the doctor to remind the queries below and for emotional support. The following are the questions that could get the clarity one needs about leg cramps at night;
• What could be the cause of cramps?
• What are the other possible causes to it?
• What are the tests needed?
• Is the condition going to be a temporary one or is it going to continue for a long time like a chronic disorder?
• What could be the best courses of actions to be taken?
• Are there any other possible alternatives to the recommended suggestions?
• Is any underlying ailment could be the cause?
• What ways are needed to find the underlying ailment and its treatments?
• Is there any need to consult a specialist for the leg cramps or the underlying ailment?
• What are the necessary things to be done and not done for a good night sleep without sudden waking up due to leg cramps?
• What kind of lifestyle changes and food habits for reducing and curing the leg cramps?
• What kind of exercises and their ways of doing it for reducing the pain and stress?
How to prepare for the consultation with the doctor for leg cramps at night?
• It becomes necessary for giving the right answers to the questions that the doctor may ask for treating Charley’s horse. Only by a proper understanding of the problem the doctor could find the right tests and treatments for leg cramps at night. The questions that the doctor could ask may include:
• From when did cramps start to occur?
• What is the frequency of its occurrence?
• How severe are the effects of the cramps?
• Was there any specific occurrence in life like starting exercising strenuously, going to the gym and others?
• Is it occurring only at nights or even while resting?
• Do stretching and other self-care ways relieve cramps?
• Any other symptoms during cramps like muscle weakness or numbness?
• Any changes in the urine passed after exercises?
• What are the underlying ailments and the medicines and treatments took for it?
• Any family history of leg cramps at night?
TREATMENT OF LEG CRAMPS:
Depending on the severity of the cramps and the patient’s underlying disease conditions treatments are given for cramps. It is essential to treat the underlying disease first to reduce its effects like leg cramps. First self care treatment is necessary.
Self-care during leg cramps at night:
For many leg cramps at night affected people the nightmare of it can vary in intensity. It could last from just a few seconds to 15 minutes or more. The severity of pain and duration depends on the affected person’s health, age, and underlying disease conditions. The following are the steps to be taken to get self-relief from pain.
• Forceful stretching of the affected muscle is the immediate and familiar relief but takes effort and pain withstanding capabilities
• Can walk around till the pain recedes
• Jiggling the leg could help
• Warm baths or showers or applying towel dipped in hot water or heating pad could reduce the pain
• Alternatively applying ice on the affected area could show some benefit]
• Flexing the foot up towards the head as much as possible could be the pain reliever
• Massaging the cramped muscle gently with hands could give a soothing relief
Following are some of the supplements and treatments that are commonly prescribed by doctors.
• Vitamin E supplements
• Vitamin B complex
• Magnesium supplements mainly for a pregnant woman
• Calcium channel blockers
• Medications:
• Calcium channel blockers
• Diphenhydramine an antihistamine drug
• Quinine was previously given to treat leg cramps at night but now not recommended due to its hypersensitivity reactions
• Paracetamols are of no use due to their long time is taken to work of relieving the pain but can be used to ease muscle tenderness after the leg cramps recede
• Pain relievers acetaminophen like Tylenol can help alleviate pain
PREVENTION OF LEG CRAMPS AT NIGHTt:
Though night cramps take everyone with surprise, it can be prevented in many ways including:
• Regular calf muscle stretching exercises
• It may look crazy for someone to stretch the leg muscles riding a stationary bicycle a few minutes before going to bed, but it helps
• Untuck or free the bed covers at the foot of the bed
• Staying hydrated at all times with a minimum of 8 glasses of water every day
• Also, water along with electrolytic solutions for natural contraction and relaxation of the leg muscles. It also helps in replenishing the fluids during physical activities
• Move around during the day without sitting in the same place for a long duration of time
• Wear comfortable and supportive shoes
• Sleep under loose covers and more importantly when you are sleeping on your back
• Walking in a slightly flexed position like pushing a shopping cart ahead of you could postpone the onset of leg cramps at night
• Simple exercises like putting the weight on the cramped leg and bending the knee slightly could help. In case of inability to stand, sitting on the floor or in a chair and extending the affected limb can relieve pain.
• With the affected leg in the straightened position pulling the top of the foot towards the head could ease the back thigh cramp. It is called hamstring cramp stretching. In the case of front thigh or quadriceps stretching use a chair. This front thigh stretching is done by sitting steadily on the chair and try pulling the foot of the affected leg side up towards the buttocks.
Nocturnal or night leg cramps also known as Charley’s Horse are painful but harmless. By proper treatment and lifestyle changes, they could be treated and prevented. But if it is due to an underlying ailment more care as to be taken to avoid insomnia and to have a happy, pain and panicles sound sleeping at nights for better mornings.