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What is a Charley Horse?

How to ease the pain of a Charley horse and prevent them from happening a lot.

What is a Charley horse?

A Charley horse is a painful and uncontrollable muscle spasm or cramp in the legs or feet. Charley horses often last for a few seconds or minutes, but sometimes last for much longer and may interfere with sleep or daily activities.

Many people experience Charley horses at night, but they can also happen during the day. There are certain risk factors that increase your chance of getting them, so identifying them can help prevent them in the future.

You can help ease the pain by stretching and massaging the muscle. Pain medications may be needed if that doesn’t help.

Most common symptoms

Pro Tip

A common misconception is that Charley horses always happen in the calf muscles. They can actually happen anywhere in the leg or the foot, and sometimes in the hands or arms. —Dr. Priyanka Gimbel

A Charley horse feels like an intense cramp or spasm in the calf muscles or other parts of the leg or foot. The pain often comes on suddenly and without warning and you often have to stop what you are doing.

If it occurs while you are sleeping, it may wake you up. It usually only lasts for a short period of time. But even after it has gone away, there can be a lingering soreness in the muscle for days.

Main symptoms

  • Cramping pain, usually in the muscles of the leg or foot
  • Knot, tension, or twitching felt in the muscle when you touch it
  • Charley horse may occur more frequently at night.
  • Cramping lasts for a few seconds or minutes, less commonly for hours or a day

Causes

It is not known what triggers a Charley horse, but there are several theories. It may be from dehydration or imbalances in electrolytes like potassium and magnesium—our muscles depend on certain levels of water and minerals to maintain their health.

Injuries, like sprains, can also hurt muscles and cause them to cramp up painfully.  Not stretching enough before exercising, exercising in the heat, and muscle fatigue can also cause muscle cramps.

Risk factors

Dr. Rx

I’ve seen many patients with peripheral artery disease who get frequent Charley horses. This is because peripheral artery disease results in reduced blood flow to the legs. This can result in Charley horses because they don’t have enough oxygen getting to the muscles. In this case, there may be medications or exercise programs to help increase the blood flow over time and reduce the risk of Charley horses. —Dr. Gimbel

  • Being an athlete because they are more prone to muscle injuries.
  • Taking certain prescription medications (such as diuretics) or having medical conditions (like diabetes) that can cause mild dehydration or changes in electrolyte levels.
  • People with circulation issues who are not getting an adequate amount of blood supply to the leg and foot muscles.

Charley horse during pregnancy

The exact cause of Charley horse during pregnancy is not known, but it’s thought to be related to changes, such as in circulation, weight, and iron levels, that happen during pregnancy. Charley horses are more common during the second or third trimester of pregnancy and more frequent at night.

Some steps to prevent Charley horses in pregnancy include drinking plenty of water throughout the day, doing stretching exercises, and staying active. It’s important to eat a well balanced diet and take your prenatal vitamin daily. Sometimes, your doctor may recommend a magnesium supplement, which could help prevent Charley horses, though the research is inconclusive, according to a Cochrane research review.

Next steps

The occasional Charley horse or when it is short-lived can often be treated at home. But if they are occurring frequently or starting to interfere with your sleep, daily activities, or quality of life, you should see your primary care physician. The doctor will look for possible underlying conditions, such as illnesses or medications you’re taking.

If you have very severe pain, especially if the pain is lasting for hours to days, or the Charley horse is accompanied by any of these symptoms, go to an ER right away:

  • Fever
  • Swelling of the leg or foot
  • Difficulty breathing, chest pain, or dizziness
  • Nausea or vomiting
  • Changes in the temperature or color of the skin of your leg or foot

Treatment

Pro Tip

Make sure you tell your doctor what part of the body you’re getting Charley horses, how often it occurs, how long it lasts, and what makes it better or worse. Also, provide a complete list of any medications and supplements you take and provide a thorough medical history. —Dr. Gimbel

When you get a Charley horse, stop any activity that you are doing and massage the leg (or foot). You can try to do gentle exercises or walking around the room to stretch the leg or foot muscles if you are able to.

Apply a heating pad to the spasm, which can relax the muscles by bringing more blood flow to the area. Sometimes, an ice pack may be more helpful if the Charley horse is caused by inflammation from a recently overworked muscle.

You can also take over-the-counter pain relievers or muscle rubs if the pain is more intense. If they happen often in the same muscle groups or are not relieved by over-the-counter medications, your doctor may recommend physical therapy or prescribe stronger pain medications.

Medication

  • Non-steroidal anti-inflammatory drugs like ibuprofen (Advil) or naproxen (Aleve)
  • Other pain medications like acetaminophen (Tylenol)
  • Muscle rubs which contain camphor or menthol
  • Prescription medications like muscle relaxants in some cases

If your pain does not improve at all within 1 to 2 hours of stretching and taking medications, call your doctor for advice. Depending on your risk factors, they may recommend that you be evaluated by urgent care or the ER to rule out a more serious condition like a blood clot.

Preventative tips

You can help prevent Charley horses in the following ways:

  • Drink lots of water throughout the day and while exercising to avoid dehydration.
  • Limit alcohol and caffeine because these can act as diuretics and cause dehydration.
  • Avoid overexertion.
  • Wear shoes with good support to avoid injuries.
  • Stretch before and after exercising to reduce the risk of injuries.
  • If you have medical conditions that increase your risk of Charley horses such as diabetes or anemia, make sure to talk to your doctor to discuss ways to control these conditions.
  • If you are taking prescription medications that can increase the risk of Charley horses, discuss alternative options (if available) with your doctor.
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