Patient information leaflet for the treatment of leg cramps Leg cramps are a common and Excessive strain placed on leg usually harmless condition where muscles, such as when exercising, the muscles suddenly contract may cause the muscles to cramp at (shorten), causing in your leg. certain times. This is known as a , and you A sudden restriction in the blood cannot control the affected muscle. supply to the affected muscles. The cramp can last from a few Also, tendons naturally shorten seconds to 10 minutes. When the over time as a person gets older, spasm passes, you will be able to which may explain why older people control the affected muscle again. are particularly affected by leg It usually occurs in the muscles, cramps. Tendons are tough bands although it can affect any part of of tissue that connect muscles to your leg, including your feet and bone. If your tendons become too . short, they may cause the muscles connected to them to cramp. After the cramping has passed, you may have pain and tenderness in Secondary leg cramps your leg for several hours. Secondary leg cramps are caused Three out of four cases occur at by an underlying condition or night during sleep. another identifiable cause. These Causes of leg cramps may include , exercise, toxins, and some The cause of leg cramps is medicines. sometimes unknown (idiopathic). Treating the underlying cause may In other cases, there may be an help relieve your symptoms. underlying condition or another identifiable cause. Idiopathic leg cramps Although the cause of idiopathic leg cramps is unknown, there are a number of theories about what might cause idiopathic leg cramps. These include: Abnormal nerve activity during sleep which causes the muscle of the leg to cramp.

2 Self Help your arms outstretched, about a meter (39 inches) from the wall. Most cases can be treated with Keep the soles of your feet flat on exercises. There are two types of the floor for five seconds. Repeat exercise that you can do: this exercise several times, for • Exercises you do during an about five minutes episode of cramping to relieve Exercises to prevent cramps the pain and stop the cramping If you often get leg cramps, • Exercises you do during the day regularly the muscles to reduce how often you get leg in your lower legs may help cramps. prevent the cramps or reduce their The two types of frequency. exercises are explained For example, if your calf muscles below. are affected by cramps, the following exercise should be Exercises during cramps beneficial: During an episode of leg cramp, Stand about a meter away from a stretch and the affected wall, lean forward with your arms muscle. outstretched to touch the wall while For example, if the cramp is in your keeping the soles of your feet flat on calf muscle: the floor, hold this position for five seconds before releasing, repeat Straighten your leg and lift your foot the exercise for five minutes three upwards, bending it at the ankle so times a day, including one session that your toes point towards your just before you go to bed. shin (the front of your lower leg). Stretch your calves before you go Walk around on your heels for a few to bed each night - see stretching minutes. advice above or page 6 for some Stand with the front half of your alternative stretches that can be feet on a step, with your heels useful especially after other forms hanging off the edge. Slowly lower of exercise. your heels so that they are below If you find these exercises useful the level of the step. Hold for a few you can carry on doing them for seconds before lifting your heels as long as you are able to. Please back up to the starting position. refer to the photos on page 6 and 7. Repeat a number of times Lean forward against a wall with

3 The following night-time advice may also help: Quinine was originally designed as If you prefer to sleep on your back; a medication to treat malaria. It can lie down, make sure that your toes be moderately effective in reducing point upwards, place a pillow on its the frequency of leg cramps side at the end of your bed, with however, there is uncertainty about the soles of your feet propped up its long-term effectiveness and against it this may help to keep your concerns about its safety. feet in the right position while you sleep. Known side effects If you prefer to sleep on your front; include: lie down, hang your feet over the • Tinnitus (ringing in the ears) and end of the bed as this will keep your impaired hearing feet in a relaxed position and help • Headaches stop the muscles in your calves • Nausea (feeling sick) and upset from contracting and tensing. stomach Keep your sheets and blankets • Disturbed vision loose. • Confusion • Hot flushes Painkillers Never take more than the Most leg cramps come on suddenly recommended dose of quinine. and do not last very long. Therefore, An painkillers are unlikely to help overdose of quinine can result in because the cramp will probably permanent blindness and death. have passed before the drugs take Due to these potential risks your GP effect. However, if a severe leg will only prescribe quinine if there is cramp leaves your muscle feeling evidence that a potential benefit of tender afterwards, you could take treatment outweighs the risks. an over-the-counter painkiller such It is recommended that quinine is as paracetamol or ibuprofen. only prescribed when: You have tried the exercise techniques discussed above and they have not helped. You have painful and/or frequent leg cramps which affect your quality of life.

44 In these circumstances, you may References be prescribed a four week course of quinine. NHS Choices website After this time if you have not www.nhs.uk gained any benefit, the treatment NICE Clinical Knowledge will be withdrawn. If you experience Summary - Leg Cramps: Senario any of the side effects listed above, Management for leg cramps of stop taking quinine and immediately unknown cause contact your GP. http://bit.ly/2qif6Td It is recommended that treatment BNF Online – For adverse effects, with quinine is interrupted contraindications and drug approximately every 3 months to interactions of quinine. reassess the benefit. In patients taking quinine long term, a trial http://bit.ly/2ozfBfg discontinuation may be considered, Drug Safety Update on quinine. on the recommendation of a Government safety advisory. http://bit.ly/2pCnZuv Sleep and cramp diary Please note that we have shortened Your GP may ask you to keep a the URLs for publishing therefore “sleep and cramp diary” to record they may appear differently in your how often you get leg cramps. You browser. can use this to record when the cramps occur e.g. the time and which muscle was affected along with other information. Please see the back cover of this leaflet for a copy of the diary.

Date of April 2017 production

April 2019 or Date of next before, in light of review new evidence.

5 Exercises

These gentle stretches should take about 5 minutes. Spend more time on them if you feel the need. Buttock stretch To do a buttock stretch, bring knees up to chest. Cross right leg over left . Grasp back of left thigh with both hands. Pull left leg toward chest. Repeat with opposite leg. Hold for 10 to 15 seconds.

Hamstring stretch To do a hamstring stretch, lie on your back and raise your right leg. Keeping your left leg bent with your foot on the floor, pull your right leg towards you keeping it straight. Don’t hold at the knee level. Repeat with opposite leg. Hold for 10 to 15 seconds.

66 Thigh stretch To do a thigh stretch, lie on right Inner thigh stretch side. Grab top of left foot and gently pull heel towards left buttock For the inner thigh stretch, sit down to stretch the front of the thigh, with your back straight and bend keeping knees touching. Repeat on your legs, putting the soles of your the other side. feet together. Holding on to your feet, try to lower your knees towards Hold for 10 to 15 seconds. the floor. Hold for 10 to 15 seconds.

Calf stretch For the calf stretch, step your right leg forward, keeping it bent, and lean forwards slightly. Keep your left leg straight and try to lower the left heel to the ground. Repeat with opposite leg. Hold for 10 to 15 seconds. Images from: NHS Choices website

7 Date Time Area cramp occured Duration of cramp Comments

8