Leg cramps

Also called Night cramps, Nocturnal leg cramps, Charley horse

Sudden painful calf spasms, usually at night, in most older people at some point. Usually harmless, and quinine is riskier than most people realise.

What it is

Sudden, involuntary, painful contractions of a muscle, most often the calf, most often at night.

They are very common, affecting a majority of people over 60 at some point, and around a third of those over 60 regularly. Most have no identified cause.

Sometimes there is one worth finding: dehydration, exercise, pregnancy, chronic kidney disease and dialysis, cirrhosis, peripheral neuropathy, hypothyroidism, and medicines including diuretics, statins, some blood pressure drugs and long-acting beta agonists.

The important thing not to miss is that leg pain on walking that stops with rest is not cramp; it is claudication from peripheral arterial disease, and it means arteries elsewhere are also narrowed.

Quinine reduces cramps modestly and carries a real risk of serious blood disorders and abnormal heart rhythms. Guidance restricts it to people with frequent, disabling cramps where other measures have failed, for a trial of four weeks with review. Tonic water contains far too little quinine to work and is harmless but useless.

Stretching before bed is the best-evidenced simple measure.

Signs you might notice

A sudden, hard, painful tightening of the calf or foot muscle, lasting seconds to minutes.

A knotted, visibly contracted muscle.

Tenderness in the muscle for hours or a day afterwards.

Usually at night, often waking the person.

Not cramp, and needing assessment: pain in the calf on walking that reliably stops with rest, which is claudication; a swollen, hot, tender calf, which may be a deep vein thrombosis; persistent weakness or wasting; or cramps that are frequent, severe, spreading, or associated with twitching, which occasionally point to a neurological cause such as motor neurone disease.

Also worth checking: new cramps after a medication change.

How it can affect day-to-day life

The main harm is to sleep, and chronic sleep disruption in an older person affects mood, cognition and falls risk far more than the cramps themselves.

They are frequently dismissed as trivial, so people stop mentioning them and simply lose sleep for years.

A medication review is genuinely worthwhile; several common drugs contribute and alternatives usually exist.

Restless legs syndrome is a different thing, an urge to move rather than a painful contraction, and it has a different treatment. See restless legs syndrome.

For people who cannot report pain, night-time distress, calling out or resistance to being repositioned may be cramp, and stretching and positioning are worth trying.

Supporting someone well

During a cramp: stretch the muscle. For a calf cramp, straighten the leg and pull the toes up towards the shin, or stand and lean forward against a wall with the heel down. Massage and warmth afterwards.

Stretch the calves before bed, holding for 30 seconds, several times. This is the best-evidenced preventive measure and costs nothing.

Keep well hydrated, particularly in hot weather and after exercise.

Keep bedding loose over the feet, and try a slightly raised foot of the bed.

Ask for a medication review, especially diuretics and statins.

Do not rely on tonic water, and do not take quinine without a proper discussion of the risks and a planned review.

Get calf pain on walking, or a hot swollen calf, assessed rather than treated as cramp.

Say if sleep is being lost; that is what makes it worth treating.

Where to get help

A pharmacist for advice and a medicines check.

A GP practice for frequent cramps, for a medication review, and for anything that does not fit the pattern.

Urgent assessment for a hot swollen calf or for calf pain on walking.

Age UK on 0800 678 1602 for general older people's health information.