ASK THE DOCTOR: Nocturnal leg cramps
By Dr. JIM MITTERANDO
The Patriot LedgerQ: I have night time leg cramps that wake me up. What can I do?
A: Nocturnal leg cramps become increasingly common with age. They are also common during pregnancy.
Leg cramps affect the muscles in the calf or along the sole of the foot. The cramp usually goes away within a few minutes. You can help relieve the pain by grasping your toes, pulling toward you, stretching your calf muscles.
Prevention - stretching, exercise
Night-time muscle cramps are often caused by tight muscles and inactivity. The best preventative treatment is regular stretching and exercise. If you suffer from regular nocturnal leg cramps, you should stretch your calves and affected areas as part of your bedtime ritual.
The ‘‘runner's stretch'' involves leaning against the wall and stepping forward, leaving the back foot flat on the floor. The ‘‘stair stretch'' requires standing on the edge of a step and dropping your heels while holding on to the banister. It is important to hold these stretches for at least 30 seconds.
Other treatments
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.
The following treatments do not help all people and should complement your stretching regimen.
A tonic for cramps
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 in 1995.
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 activity.
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.
Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.