Wednesday, April 05, 2006

Leg Cramps- Nocturnal

Leg cramps- Nocturnal

This is strictly not a pediatric topic. I will be discussing pediatric leg cramps in a different post. A close relative suddenly started waking up with calf pain and tightness that soon became disabling. She had ‘taut’ calf muscles that used to cause an inability to walk in the morning/ walk with great difficulty, over the day this gradually reduced and she was almost well by the evening. This would return the next morning with a vengeance. There was no set pattern and she had good days and bad. None of the usual stuff like massage, oral pain-killers and hot fomentation were very effective. Consulting a physician lead to a possibility of hypocalcemia, thyroid abnormalities etc. the calcium reprts were borderline whle the thyroid reports were fine. A reputed endocrinologist suggested the possibility of Nocturnal leg cramps.

However on reading a lot of information (& I will provide the links below) on the net, I could not find any specific reference to what she was having. Nocturnal leg cramps are supposed to affect people in the sleep, they are supposed to wake up in the night with severe cramping pains, she had none of these symptoms.

Starting her on calcium, Vit D and vitamin E was suggested. Initially there was little improvement. On further online research we found that it was recommended that the supplements (calcium, magnesium, Vit E, Vitamin C etc.) should be taken in the night, and that a higher dose (1200 mg of calcium) should be consumed. On starting this she had a very rapid recovery and is now feeling much better! Of course she is also doing a few calf stretching exercises that are prescribed along with supplements for this condition.

A couple of interesting things, the patient is a young lady of around 30 years, and she consumes a lot of dairy products, both of these should not predispose her to nocturnal cramps and hypocalcemia.

More tips

  • Eliminate as much sugar and caffeine as possible from the diet.

Supplement doses

  • Calcium: 1,200 mg. at bedtime,
  • Vitamin E: 400 I.U. twice a day after meals for two weeks. If symptoms are relieved, cut down to 400 I.U. once a day, If symptoms recur, up the dosage until symptoms are relieved but never take more than 1,200 I.U. daily,

If neither calcium nor vitamin E gives you relief, you may benefit from magnesium, potassium, or vitamin A.

  • Magnesium: 400 mg. daily. (many a times found with calcium)
  • Vitamin A: 10,000 I.U. daily.
  • Potassium: 100 mg./daily, Make sure you eat plenty of potassium rich foods - (bananas, tomatoes, potatoes, broccoli, cantaloupe, oranges, grapefruit)



To stave off future episodes of nocturnal leg cramps, consider the following tips:

  • 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.


Leg Exercise tips:

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 reach comfortably.

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.


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.


This information is not a substitute for medical diagnosis and treatment and is meant for patient education only.