Your Health  -  A to Z of Common Medical Conditions

Leg Cramps

Description -  The commonest form of leg cramps is nocturnal leg cramp. This usually occurs in otherwise well, middle-aged (or older) people, though it is also very common in pregnancy. The cause is unknown though it may follow an unusually high amount of activity - long walks, hill climbing, prolonged dancing etc. Typically the person wakes up, suddenly, in the middle of the night with the calf muscles taut and painfully contracted. Getting out of bed, walking around, vigorously rubbing the leg and trying to stretch the muscle, can all help. The muscles are usually tender for some while after the acute attack, which usually only lasts a few minutes, has ceased. Ischaemic pain due to hardening of the arteries (see Atherosclerosis), can often occur in the legs and is usually described as "a cramp" although there is little, or no, contraction of the muscle to see. The pain, which is due to a shortage of blood to the muscle, (intermittent claudication), is, typically, made worse by walking and relieved by rest. It is usually felt in the calves, but sometime in the thigh and buttocks and may be confused for sciatica (see Backache) or vice-versa. If the blood supply to the leg is seriously compromised, pain on rest can ensue, particularly at night, but this chronic, severe ache is nothing like the acute, short-lived muscular contraction of nocturnal leg cramp. Leg cramp can also occur in situations of extreme overuse -as in sporting events - or from prolonged or unfamiliar use as may be experienced by a machine operator or someone driving an unfamiliar vehicle. In hot climates (or hot environments) generalised cramp can result from salt depletion particularly in those doing heavy work. In such circumstances, salt replacement is as important as fluid replacement. Diseases of the muscles, joints and nervous system can all produce generalised muscle cramps of which leg cramps may be part.

Management - The classic treatment of nocturnal muscle cramp is quinine given as a prophylactic, once nightly dose, usually in the form of quinine sulphate, for a month. It is not known why it works, but it nearly always does. Other medications may be prescribed by the doctor depending on the circumstances. Over-use cramp can only be stopped by not over-using, or over straining - changing work practices, driving positions etc. Ischaemic leg pain is an indication of significant disease (see Atherosclerosis). The first thing the doctor will tell patient with ischaemic leg pain if he, or she, is a smoker is to stop smoking immediately and forever. This can sometimes get rid of most of the pain and might, in the long run, prevent amputation. People should be aware of the need to take salt tablets when salt depletion cramps may be likely. Other cramps should be seen by the doctor and the appropriate investigations carried out and treatment discussed.

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