Dec 20, 2018

Interviewer: Do you have leg cramps at night? What's causing them? Let's find out now on The Scope.

Talking to Dr. Jones doctor. Dr. Jones, leg cramps, what are they? Why do they happen?

Dr. Jones: And are they normal?

Interviewer: And are they normal? Yes.

Dr. Jones: Right. Well, first of all, what are leg cramps? A leg cramp is a very strong and painful contraction of a leg muscle that you didn't ask for. It comes involuntarily, you didn't call it up.

There are generally three kinds of cramps. Ones that come on while you're exercising. A muscle that cramps while you're running, this may happen in sprinting, runners or football players, when muscles are asked to do more than the oxygen can be delivered by the blood vessels to the muscles.

Some people have nerve damage from a spinal cord injury, chemotherapy, or other diseases may have muscle cramps. The most common cramps are those that come at night at rest. Is that the kind of cramp we're talking about?

Interviewer: Yeah. Let's talk about the one at night actually. Yeah.

Dr. Jones: Okay. Nighttime leg cramps. Cramps are episodes of pain usually lasting up to a couple minutes caused by a sudden intense involuntary contraction of the muscles. Nighttime leg cramps usually involve the calf muscles or the foot muscles. Although they're most common in people over 50, they can happen to younger people and children. And people over 60, about one third have had resting muscle cramps in the past 2 months. And about 50% of people over 80 have them.

Though cramps at rest are painful for a little while, they're not dangerous in and of themselves. So they don't mean like you're having a heart attack or stroke, or anything. So we have to talk about the fact that from a statistical perspective, normally something that happens to 10% or more of the population. And leg cramps are very common in women who are pregnant or women over 50. Are you pregnant or over 50?

Interviewer: I am not, but I'm actually asking for my mother who actually happens to be in her 50s. So this is great. So let's figure out what's wrong with her.

Dr. Jones: Okay. Well, most nighttime muscle cramps have no known cause. One odd hypothesis that we in the developed world don't squat to poop anymore and these muscles don't get stretched out on a regular basis. Now, this is . . .

Interviewer: My face when you said that.

Dr. Jones: This is an interesting thought, but it's weird and if I ever got down to do that, I'm not sure I could ever get up. So I'm perfectly happy not to be squatting in that position. It's true that many people as they get older don't stretch their calf and foot muscles on a regular basis. Some studies suggest that a program of regular stretching before bedtime decreases the frequency of leg cramps.

There are though medications and medical conditions that can cause leg cramps. Diuretics or water pills, and some blood pressure pills are associated with leg cramps and so, our statins which it seems like everybody over 60 takes today to treat high cholesterol. Medical conditions such as diabetes, and kidney disease, liver disease, thyroid disease, dehydration, low potassium, magnesium, or calcium, all those things can be associated with leg cramps.

So what are you supposed to do? When you get the cramp, stretching the contracted muscle relieves the pain. Pull the ball of your foot towards your knee or stand on the step and lower your heel if you can actually walk to a step.

If you're getting a lot of cramps, you should talk to your doctor. Perhaps if you're on a medication that can be changed, that might be a choice. A blood test for potassium, magnesium, and calcium might be suggested. And a program of regular strength and stretch for your legs is good for all of us and maybe helpful. And you should try to stay well hydrated. And I really love this one, arrange your sheets and blankets at the end of your bed, so your feet have room to flex. So I kind of like my bed all tucked in.

Interviewer: Yeah. Me too.

Dr. Jones: But if I'm lying my back that means my toes have to point and that . . .

Interviewer: They have nowhere to go.

Dr. Jones: That's right. So you want to be able to have your feet pointed up. So they should be loose down there.

Interviewer: Oh, interesting. Okay.

Dr. Jones: Yeah. Personally, I like to be wrapped up kind of like a burrito in bed. So I kind of be...

Interviewer: That sounds comfy.

Dr. Jones: Yeah, yeah. But I need my toes to be able to move. In the past, nighttime cramps were treated with quinine, something most well known for being present in small doses in quinine water with your gin and tonic. But now, it isn't really recommended as large doses of quinine have some adverse effects and risks.

So if you're pregnant and troubled by leg cramps at night, and usually it's in the third trimester and it's common, try to exercise and stretch regularly. Usually, in the third trimester you've kind of slowed down, your feet are kind of puffy, you don't feel like walking. But try to stay a little bit stretched and move regularly, stay well hydrated, and talk to your clinician about calcium and magnesium supplements which sometimes help. So you have leg cramps or your mom, or your auntie.

Interviewer: My mom has leg cramps.

Dr. Jones: Your mom, your mom or you...

Interviewer: Women in their 50s.

Dr. Jones: Women in their 50s. Are you normal? Probably especially if you're over 50 or pregnant. Is it a sign of disease? Probably not. Are there things you can try to do? You betcha and we just talked about them. But if they are happening frequently, these leg cramps, and disturbing your sleep, talk to your clinician. And thanks for joining us on The Scope for being so normal.

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