Leg cramps: causes, therapies, self-help

Leg cramps can be uncomfortable but mostly harmless. The causes are often easy to identify. 

This is how calf cramps show up

They can hurt like hell and usually come without warning – during gymnastics, when running in the woods, in the swimming pool or at night while sleeping. The muscle contracts extremely painfully becomes hard and feels like in a vice. Just a slight wrong movement and the next wave of pain is here. This can go on for seconds to minutes.

Those who know this – and that is the majority – often instinctively apply the right remedy: They stretch the calf muscles. Pull the tip of your foot towards your body, step forward with your heel. Or put the attacked leg straight back and press the heel firmly on the floor. Then the spasm resolves and the pain goes away. Only sometimes does an uncomfortable feeling remain, like sore muscles.

The cramps (medical crampi or crampus syndrome, in a broader sense doctors also use the term spasm, plural: spasms) can occur during the day, during certain activities, but also in the evening in bed, when falling asleep or in the middle of the night. Sometimes muscles in the front or sides of the shin, the sole of the foot and the toes also contract.

It is not always possible to find a cause for painful muscle cramps. If these so-called idiopathic calf cramps do not occur too often and resolve immediately, especially after the stretching exercises, there is usually no need to worry.

Important: Calf cramps often have to do with two opposing undesirable developments: Either those suffering from calf pain overwhelm their muscles , or they under-challenge them. The incorrect strain on certain muscles due to joint problems can also play a role, as can venous disorders such as varicose veins.

The typical triggers of calf cramps often include a temporary lack of fluids and minerals (e.g. in the case of severe diarrhea or vomiting), hormonal and metabolic influences (pregnancy, hypothyroidism) and drug side effects (more on this below).

“Ordinary” leg cramps are common in everyday life. The finely regulated interplay of muscles and nerves is always somehow involved. Also common, but different: nerve damage from diabetes or alcohol. Less common and more complex: the different, often hereditary disorders of the nerves and/or muscles, which are summarized under the term ” neuromuscular diseases ” (information in the list below and in the chapters “Causes: Nerve Disorders” and “Causes: Muscle Diseases” in this post).

How calf cramps develop

  • Overworked or untrained muscles, impaired fluid and mineral balance

Athletes often have pain attacks in their legs – if they expect too much, they don’t let their muscles come to rest. If you also sweat heavily and drink too little, you lose fluids and important minerals.

The nerves need these, in order to be able to transmit orderly commands to the muscle fibers, which then contract, expand or relax as required.

The muscle functions themselves are also dependent on a balanced mineral balance. Muscles that are already overtired have double problems with the necessary fine-tuning if minerals such as magnesium and potassium are missing.

The other side: Those who return motivated after a long break in training often soon feel how the muscles that have been shortened by doing nothing become uncontrollably hard, for example when the hard-working gymnast is tensing these parts with certain exercises.

People who sit at their desks a lot and in front of the television in the evening often feel the consequences of under-straining their muscles at night.

Some also notice that their leg or foot muscles cramp after being in uncomfortable shoes for a while and that their muscles were under constant tension as a result. In the case of foot misalignments, flat feet or splay feet, evening or night foot cramps can also occur.

  • Changes in muscle in old age and during pregnancy

With age, the muscles tend to shorten, the body breaks down muscle mass if you do not consciously counteract it through regular exercise.
Many older people also drink too little or have a one-sided diet. This affects the fluid and mineral balance (electrolyte balance).

In addition, there are other influences: hormonal changes, circulatory disorders, problems with the backbone and the nerves running there, and side effects of various drugs.

The interplay of hormones and metabolic changes lead to shifts in the fluid and mineral balance in pregnant women. Especially in the second half of pregnancy, there is an increased need for magnesium, among other things. A deficiency here can then be the reason for nocturnal calf cramps.

Pathological causes of leg cramps

If the muscles keep cramping painfully and persistently, possibly not only in the calf or foot, but also in other parts of the body,and if there are additional complaints such as pain, swelling or numbness, there can sometimes be a serious cause.

Anyone who has a chronic metabolic disease such as diabetes or chronic kidney weakness should carefully monitor physical changes anyway so that they can consult their doctor early to counteract possible complications.

Kidney patients who need dialysis sometimes have more problems with leg cramps.

For people who suffer from alcohol addiction, cramps and paresthesia in the legs are also alarm signs of deficiencies and nerve damage.

Infections with a high fever and/or diarrhea and vomiting quickly lead to threatening imbalances in the water-salt balance (electrolyte balance) with a pronounced mineral deficiency.

In addition, nerve disorders such as polyneuropathies can be responsible for calf cramps. Nocturnal, painful leg cramps are occasionally an indication of amyotrophic lateral sclerosis, a progressive disease of the motor nerves in the brain and spinal cord.

Certain muscle diseases (myopathies, including so-called myotonia) are rarely hidden behind the cramps. Such diseases are mostly hereditary and often make themselves felt in toddlers, children and adolescents with characteristic complaints.
It is typical for a subgroup of muscle diseases such as the so-called myotonia that once tense muscles only relax with great effort. For example, the hand clenched into a fist or the closed eyelids can only be opened slowly. In addition, there is increased muscle stiffness, sometimes paralysis attacks and, in some clinical pictures, calf cramps.

Leg cramps: when to seek help?

In any case, speak to your practitioner, if

  • You frequently have muscle cramps in your leg
  • You find that stretching the calf muscles and using other self-help tips does not resolve the cramps,
  • the cramps are very painful and often last for minutes,
  • You cannot sleep because of the cramps and are tired and unable to concentrate during the day,
  • the cramps start over and over again with certain movements.

You should see a doctor if you have any other symptoms or abnormalities, for example:

  • Paralysis in the leg, tingling and numbness (emergency!),
  • frequent or sudden pain in the leg, foot or groin,
  •  Swelling of the leg or foot,
  • Back pain.

You might need to see a specialist in nerve diseases (neurologist, possibly also with a focus on neuromuscular diseases) or orthopedic surgeon,  or if necessary a specialist in human genetics.

Do not confuse calf cramps with other leg complaints, such as restless legs syndrome, or temporary, often nocturnal muscle twitches that are less painful. In this case the muscles do not cramp up or become hard. But the abnormal sensations can lead to lasting sleep disorders.

Overview of possible causes of calf cramps

Lifestyle, physical characteristics

  • Unfavourable sleeping position (for example, sleeping with an overstretched foot because the duvet is firmly wrapped at the foot end, lying uncomfortably because the mattress does not fit etc)
  • Overworking the muscles during the day (often triggers calf cramps at night)
  • Excessive or one-sided strained muscles when exercising (cramps while exercising)
  • Sports activity at high temperatures with insufficient fluid intake (cramps during sports )
  • Swimming in cool water (dangerous cramps while swimming)
  • One-sided postures in which the muscles are held for a long time (example: prolonged sitting in a certain position – cramps at rest, when moving again, at night)
  • Misalignments of the foot or leg, such as flat feet, which stress the muscles more or one-sided, poorly fitting shoes, which lead to increased tension in the leg muscles (cramps while walking, at rest, at night)
  • Physical activity after a long break, exercise with muscles that have already shortened (cramps during activity, at night)
  • Signs of old age (cramps often at night, but also during the day. Possible reasons: too little water, too little exercise, undesirable drug effects, muscle breakdown, muscle shortening, nerve disorders)
  • Pregnancy: cramps often at night

Electrolyte imbalances, metabolic problems, hormonal imbalances

  • Disturbed water-salt balance (electrolyte balance), lack of magnesium, sodium and other minerals or salts (cramps during the day, during activities, at night. Causes for this can include: too little water, sweating, diarrhea, vomiting, alcohol abuse, increased urine output with kidney weakness)
  • Medicines (laxatives, high blood pressure drugs, contraceptives – cramps at night and during the day)
  • Pathological magnesium deficiency (hypomagnesaemia – cramps during the day and at night)
  • Kidney weakness (kidney failure – especially with chronic kidney weakness, calf cramps and muscle twitching among other complaints)
  • Endocrine and metabolic diseases:
     parathyroid hypofunction (paroxysmal muscle spasms)
     sequelae in adrenal failure (including muscle cramps and muscle weakness in the legs)
     Diabetes mellitus (night cramps)
     hypothyroidism (cramps at night possible, but not predominant)
     Diabetes insipidus (Illness due to a certain hormonal disorder or impaired kidney function; calf cramps are also possible)

Neurological disorders/diseases (nerves, spinal cord, brain)

  • Nerve damage due to diabetes (polyneuropathy: burning and stabbing pain, for example in the feet, numbness, muscle spasms, mainly at night; there are also overlaps with magnesium deficiency, see above)
  • Over-excitable motor nerves: Crampus fasciculation syndrome (symptoms usually without pathological development with leg cramps, pain in the legs), neuromyotonia
  • Stiff-Person Syndrome
  • Dystonia (diverse symptoms, often already in childhood, often with muscle cramps in different skeletal muscles during exercise, stress or cold, also at rest, muscle stiffness, muscle weakness; uncontrollable movements in dystonia)
  • Nerve damage from alcohol abuse (pain in the legs, muscle cramps often at night, muscle weakness, numbness, tremors, sweaty, cold feet)
  • Brain and spinal cord diseases such as amyotrophic lateral sclerosis (often nocturnal leg cramps at the onset of the disease)
  • Constricted nerves in the spinal canal, intervertebral disc problems (pain in the back and legs, numbness, paralysis, leg cramps possible)

Muscle disorders

  • Myotonia, dystrophy, metabolic myopathy

Other diseases of the central nervous system (here: the brain)

  • Diseases that affect the movement centers in the brain, such as Parkinson’s disease and other diseases, including spastic ones, that affect the muscle-nerve pathways can also be accompanied by cramps (or spasms) in the legs. However, other key symptoms are in the foreground in such diseases, and muscle disorders affect other parts of the body besides the legs.

Bacterial infections

  • An infectious disease, which is rather rare in temperate Western European climates, such as leptospirosis, which is mainly transmitted by animals, initially triggers severe, cramp-like calf pain in addition to fever and flu-like symptoms.

Therapy for calf cramps: stretching and moving

The basis of the treatment and prevention of calf cramps are exercises that stretch the lower leg muscles . Moderate but regular exercise is the best remedy for painful cramps. This means drinking enough and eating a balanced diet. Sometimes magnesium supplements are helpful in consultation with the doctor. If the symptoms have a pathological cause, the doctor will treat the respective illness.

Obviously, Colon Hydrotherapy cannot help with your leg cramps per se. But having colonics helps you to hydrate your body and we can also help you with diet recommendations to make sure that you have enough minerals.

Leg cramps
© W&B/Martin Ley

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