Top 5 Causes of Leg Cramps
What are leg cramps?
Leg cramps are painful and involuntary contractions in the calf muscles, but can also occur in the foot or the thigh.
The pain often lasts for a few seconds or minutes before the muscles relax but they can sometimes last much longer. These may interfere with sleep or daily activities.
Leg cramps (also called a Charley horse) can happen any time of the day, although some people mostly experience these muscle spasms at night.
Leg cramps can be caused by medications, dehydration, a muscle strain from over-exertion, or pregnancy. But they can also be caused by a medical condition like restless leg syndrome or the more serious deep vein thrombosis. Identifying the cause is important to finding the right treatment or avoiding certain triggers.
Most cramps will go away with at-home treatments like massaging the leg, gentle stretching exercises, light walking, or applying ice.
1. Muscle injury
Medications can sometimes be the culprit for leg cramps. Make sure to review your medication list with your doctor or pharmacist if you recently started a new medication (or if you’re on several medications) and are experiencing leg cramping. —Dr. Priyanka Gimbel
- Cramping in the legs that starts after exercise
- Pain that worsens with activity and improves with rest
Muscle injuries are a very common cause of leg cramps. Pushing yourself too hard may lead to muscle strains, which can cause pain and cramping that lasts for a few minutes or sometimes hours.
To prevent this:
- Stretch before and after working out.
- Drink enough water throughout the workout to avoid dehydration (which can contribute to muscle cramps)
- Increase the intensity of your workout slowly.
Treatment involves RICE (rest, ice, compression, and elevation) and sometimes anti-inflammatory medications like ibuprofen (Advil).
2. Deep vein thrombosis
A deep vein thrombosis (DVT) is a serious condition that occurs when there is a clot in one or multiple veins of the leg. It occurs in the deeper veins of the leg and is different from varicose veins, which are swollen veins just under the surface of the skin.
Risk factors for DVT include extended periods of travel (e.g., a long car ride), recent surgery or injuries, obesity, pregnancy, certain medications like birth control pills, smoking, older age, hospitalization or bed rest, and a personal or family history of blood clotting disorders. It is typically diagnosed with an ultrasound.
Treatment usually involves blood thinner medications. If untreated, the clots can travel from the legs to the lungs and cause more serious health issues, so it is important to get this diagnosed and treated as soon as possible.
3. Restless legs syndrome
- Cramping or discomfort typically in both legs
- An urge to move the legs
- Symptoms worsen at rest and at night
- Symptoms improve with activity such as walking or stretching
Restless legs syndrome (RLS) causes a very uncomfortable feeling in your legs and the urge to move your legs. It tends to happen at night or during periods of rest. Moving your legs often helps relieve the discomfort.
Treatment for RLS includes behavioral approaches, avoiding triggers like caffeine, treating other sleep conditions or iron deficiency anemia, and sometimes prescription medications.
4. Peripheral artery disease
If the pain is due to peripheral artery disease, the pain is often in one leg, but sometimes can be both. The leg often gets pale when elevated and a dark red-purple color when lowered down. The leg may feel cooler to the touch compared to the other leg, and pulses may be more difficult to find in this leg. —Dr. Gimbel
- Cramping or pain in one or both legs
- Leg pain caused by the same activities or movements, which may improve with rest
- Leg wounds that do not heal or take a very long time to heal
- Discoloration of the skin
Peripheral artery disease (PAD) is caused by plaque build-up in the blood vessels of the legs, which can lead to decreased blood flow in the legs. People at increased risk of PAD include those older than 40, smokers, those with diabetes, and those with other risk factors for heart disease, like high blood pressure, high cholesterol, and having had a heart attack.
To make this diagnosis, doctors do a non-invasive test called an ankle-brachial pressure index (ABI). This measures the blood pressure in your arm and legs. A very low ABI confirms the diagnosis.
Treatments are aimed at reducing the risk of more plaque build-up and reducing pain with activity. It may take weeks to months to notice an improvement in your symptoms. In very severe cases of PAD, a surgery to open up the blood vessels with a stent may be performed. Treatments include:
- A supervised exercise program
- Quitting smoking
- Losing weight
- Controlling high blood pressure and high cholesterol
- Cramping in lower legs at night
- Pain gets better with massage or stretching
Pregnancy causes many bodily changes, and one is an increased risk of leg cramps at night. They typically start in the second or third trimester of pregnancy, but usually stop after delivery.
Although the exact cause is unknown, you can take some steps to prevent them.
- Make sure you drink plenty of fluids during the day.
- Do stretching exercises and stay active throughout the pregnancy.
- Eat a balanced diet.
- Take prenatal vitamins daily.
- Sometimes, your doctor may recommend a magnesium supplement, which may help prevent leg cramps.
Treatment involves massage of the legs, stretching the calf muscles, and using a heating or cooling pad.
Other possible causes
A number of conditions may also cause leg cramps:
- Medication side effects
- Certain neurological conditions
- Thyroid disease
- Compartment syndrome
When to call the doctor
If you have leg cramps and they’re not going away with at-home treatments, it is a good idea to talk to your doctor to see if any other tests need to be done to determine the cause of the leg cramps and what can be done to treat them. —Dr. Gimbel
- You wake up several times a night or are not getting enough sleep because of cramps.
- The cramps are very painful.
- You have cramping in other parts of your body.
Should I go to the ER for leg cramps?
Typically, leg cramps do not warrant an ER visit. However, if you’re having any of the following symptoms in addition to leg cramps, you should go to the ER immediately:
- Chest pain
- Difficulty breathing
- One leg is more swollen than the other.
- Redness or a rash on the leg
- Fever of 100.4℉ or greater
- Discoloration of the skin, coolness to the touch, or no pulse in the leg
How to stop leg cramps
- Massage the leg.
- Do gentle stretching exercises or try to walk around the room.
- Apply ice or cooling pad.
- Limit alcohol and caffeine intake.
- Drink lots of water throughout the day and during exercise.
- Wear shoes with good support during the day.
- Wear compression stockings if prone to swelling in the legs.
Dr. Gimbel is a board-certified Family Medicine physician and writer/reviewer for Buoy Health. She received her undergraduate degree in Neuroscience with a minor in Sociology from the University of Illinois at Chicago (2008) and graduated from the University of Illinois at Chicago College of Medicine and School of Public Health (2013). She completed a family medicine residency at the University of Michigan in Ann Arbor (2016) and a women's health fellowship at MacNeal Hospital in Illinois (2017). She worked as an assistant professor in the Department of Family Medicine at the University of Wisconsin Madison for a few years prior to transitioning to a telemedicine practice. She joined Buoy Health in 2021 and is excited to help people better understand their symptoms and illnesses through this position.