No…Not Another Charley Horse!

I had the worst leg cramp last night—woke me up out of sleep!

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If this is a phrase that you have heard yourself say, you are not alone.  According to the American Academy of Family Physicians around 55% of American adults have experienced nocturnal leg cramps and 75% of all reported leg cramps occur at night.  These uncomfortable sensations, typically in the calf, foot, or thigh, can lead to insomnia, frustration and misery. 

So, what causes a “charley horse?”

The truth is most of the time the underlying cause for what causes your charley horse is not known.  When the cause is known, the most common reason for these painful spasms is muscle fatigue.  Many people will be able to identify that their charley horse was triggered by a particularly strenuous day of exercise.   Nerve conduction abnormalities are also postulated to be a cause for nocturnal cramps as patients with underlying neurological disorders experience an increased incidence of muscle cramping.  Cramps have often been attributed to electrolyte disturbances (magnesium, potassium, calcium, etc) and dehydration however, the evidence for these culprits is actually not all that robust.  Many medications have muscle cramps listed as a potential side effect; however, true charley horse muscle cramps are only associated with just a handful and occur very infrequently.  Finally, several underlying medical conditions have an increased association with leg cramps; some of these include Parkinson’s disease, poor circulation, kidney disease (especially those patients on dialysis) , pregnancy, and cirrhosis of the liver.   

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What to do to prevent and treat nocturnal leg cramps? 

When you discuss these annoying nighttime cramps with your doctor, she will first review your medical history and medication list and will inquire about any new exercise or activities.  She will also ask you to describe the cramping as there are other conditions that are not muscle cramps that might be confused for muscle cramping (neuropathy, restless leg syndrome, or peripheral vascular disease are some on the list).  The next steps in treatment will be to address any underlying medical condition that has an association with nocturnal cramps and consider medication side effect.  All patients should do a trial of stretching and massage prior to sleep and ensure adequate hydration when exercising.  When one strikes, stretch the calf muscle pulling your toes toward you, massage the muscle; when you are able, stand with your feet flat on the floor. If needed you can ice or use a heat pack along with Tylenol or ibuprofen for pain and elevate the leg. Should stretching and massage not resolve symptoms your physician may recommend a trial of oral or topical magnesium or vitamin B12 and should this not be successful, a trial of a prescription medication such as a muscle relaxant or calcium channel blocker may be considered.

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The bottom line is, if you are suffering from nocturnal cramps, talk to your doctor to see what can be done to help decrease these painful episodes so you can enjoy a better night’s sleep. 

Oh and in case you were wondering like I did – why do we call this painful muscle cramp a charley horse?   There are several stories and most involve baseball players who were subject to cramps related the quick movements they do while running the bases and fielding balls…no one is sure if Charley was a race horse with a limp, the old horse dragging the field in Chicago; or a pitcher named Charley who was prone to cramps. You can read more here! (

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