Nocturnal Muscle Cramps

This article aims to answer some questions that nurses may have about nocturnal muscle cramps, such as what they are, which patient populations are more likely to get them, and what interventions can nurses expect to incorporate to treat them.

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Nocturnal Muscle Cramps

If you have ever experienced pesky painful cramping in the muscles of your thighs, calves, or feet, then you can lend some empathy to your patients if they report this agonizing sensation. As a nurse using sound clinical judgment to prioritize patient care, irritating muscle cramps may be low on your totem pole of symptoms or issues to address; however, there are still some clinical considerations to make, as well as some interventions that you might be able to use to help your patients. 

What Are Nocturnal Muscle Cramps?

Nocturnal muscle cramps usually occur in leg muscles from the sudden, unintentional tightening or contracting of these muscles. One cramping incident can last up to ten minutes, and the discomfort from this incident can sometimes be felt long after it has ended. According to the Cleveland Clinic, about 75% of people who experience muscle cramps reported getting them at night. These cramps can seriously interrupt a person's sleep pattern and affect daily function. 

Who is at Risk?

Nurses can expect that some patients with the following medical conditions might report experiencing nocturnal muscle cramps:

  • Lumbar Spinal Stenosis and other neuromuscular diseases
  • Pregnancy
  • Renal failure and dialysis
  • Liver failure
  • Diabetics
  • Cardiovascular diseases and peripheral vascular disease (PVD)
  • Dehydration

The following types of medications have nocturnal muscle cramps as a side effect, so be sure to check your patient's medication list:

  • Statins
  • Certain blood pressure medications
  • Diuretics
  • Certain sleep aids

Nurses should also consider these other factors when identifying nocturnal muscle cramps:

  • Aging adults are more likely to experience nocturnal muscle cramps as tendons shorten as a person ages.
  • Patients facing prolonged bed rest may report these cramps as sedentary activity is a factor.
  • Certain sleeping positions and tucked-in bed linens can place a person's feet in a non-neutral position which causes cramping at night.
  • Certain electrolyte imbalances could cause muscle cramping, so be sure to review the patient's lab work and report any out-of-range values 

You should ask the patient these assessment questions and consider the information mentioned above:

  • Can you describe what they feel like, when they happen, and how long they last?
  • Do you have any medical problems that might be related?
  • What medications and OTC medications are you taking?

What are the Possible Interventions?

After reporting to the patient's doctor, you can anticipate applying these interventions and should offer to assist the patient as needed:

  • Ask your patient to flex their foot to stretch the muscle
  • Have your patient massage the area
  • Offer the patient a warm cloth to place over the affected area
  • Offer to untuck the patient's bed linens near their feet and suggest a change in sleep position
  • Offer to assist the patient with walking in their room or hallway to stretch the muscles if the patient is able
  • Obtain an order for pain relieving medication for the patient, such as an NSAID (if applicable) for discomfort that may continue after the initial cramping episode
  • Encourage oral hydration, but first, be sure to check the patient's orders for fluid restrictions or NPO status 

Each patient and situation is unique, so this information will not apply to every patient experiencing nocturnal muscle cramps. You should always use your nursing judgment and report the patient's symptoms to their doctor. Furthermore, you may consider assessing the patient's legs for warmth, redness, and swelling in addition to the painful sensation. These other symptoms may be a sign of a different, more severe health problem that requires further assessment and testing. You can use the information you gained in this article to advocate for your patients, provide comfort, and continue expanding your ever-evolving nursing practice. 

References/Resources

Leg Cramps: Cleveland Clinic

Criteria in diagnosing nocturnal leg cramps: a systematic review: BioMed Central Primary Care

Nocturnal Leg Cramps and Lumbar Spinal Stenosis: A Cross-Sectional Study in the Community: International Journal of General Medicine

Night leg cramps: Mayo Clinic

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Danielle BSN

About Danielle BSN, BSN, RN

Danielle is an aspiring health writer with over a decade of nursing experience. She has spent most of her bedside career in Med/Surg, focusing on managing chronic health conditions and organ transplantation, as well as preparing and recovering patients for a variety of surgical procedures. She currently works in case management and is passionate about patient and nursing education.

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Specializes in oncology.

I had restless legs for years..I mean dozens of years.. Tried everything: Just o few here

  • Quinine
  • Benedryl
  • Stretching before bed
  • Bath before bed
  • Husband massage
  • Heating pad
  • Muscle ache creams
  • Raising my legs on pillows
  • sleeping pills
  • Ibuprofen
  • Tylenol
  • ASA (yes I am that old)

Finally, finally found about a muscle intervention by a PT called deep needling. It has made my life both during the day and night a miracle of no  leg cramps. (It is not acupuncture)

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Specializes in Private Duty Pediatrics.

With a doctor's order, Theraworx (topical magnesium) massaged into the muscle can help a great deal. Massage should be perpendicular to the muscle fibers.

And pay attention to dehydration.

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Specializes in oncology.
Kitiger said:

With a doctor's order, Theraworx (topical magnesium) massaged into the muscle can help a great deal.

I  have had my problems with nocturnal and daily leg cramps  which started in 1978! On a previous post I have outlined what I tried to alleviate the cramps  and I was never hesitate to try any promised relief

Quinine

Benedryl

Stretching before bed

Bath before bed

Husband massage

Heating pad

Muscle ache creams

Raising my legs on pillows

sleeping pills

Ibuprofen

Tylenol

ASA (yes I am that old)

1) Theraworx does not need an RX, MD order etc. The OP is erroneous. It is available at Walmart, Amazon. It is a topical magnesium cream the has to be messaged in to the cramping leg 2 times per day. It does not provide relief at all (following the directions of my husband massaging it in 2 times per day) but I paid the $15.00 . My husband was very agreeable to cooperating in the massage routine because he knew my discomfort, 

2) I have tried every tip there was for fighting leg cramps. My nightly chronic problem started in 1978 so I did OJ, Oral Magnesium, and more and that I have highlighted in my previous post.  It didn't matter if I was premenstrual, post menses, either walked a lot that day, or laid in bed that day. The goofiest solution I received was tie a tourniquet on your leg so the blood would supply alternate paths avoiding your muscle (!) and I tried it! 

3) With regards to Theraworks, does it get beyond the skin level? No. Muscles are not at skin level. Believe me when I so wanted it to work...muscle cramps have been the bane of my existence and effected work life, relaxation time etc. 

I don't know what any solution will help others. Believe it or not I had to leave work because I was exhausted from not sleeping the night before because of  leg cramps that required me  to move my leg after a minute or two to relieve the horrible urge to move the leg. It was like "riding a bicycle  in bed", 

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Specializes in Private Duty Pediatrics.
londonflo said:

 

1) Theraworx does not need an RX, MD order etc. The OP is erroneous. It is available at Walmart, Amazon. It is a topical magnesium cream the has to be messaged in to the cramping leg 2 times per day. It does not provide relief at all (following the directions of my husband massaging it in 2 times per day) but I paid the $15.00 . My husband was very agreeable to cooperating in the massage routine because he knew my discomfort, 

. . . 

I don't know what any solution will help others. Believe it or not I had to leave work because I was exhausted from not sleeping the night before because of  leg cramps that required me  to move my leg after a minute or two to relieve the horrible urge to move the leg. It was like "riding a bicycle  in bed", 

The OP was talking about patients. While I know that Theraworx is an OTC med, we still need a physician's order to use it on our patients. At least, that is true in home care. 

Theraworx has helped me a great deal. I guess different people react differently. For example, I use pseudoephedrine for congestion, and it works well. But I have friends who got no relief with pseudoephedrine but were helped by phenylephrine. And phenylephrine doesn't help me.

Having the "horrible urge to move the leg", like "riding a bicycle in bed" sounds like the primary problem is restless leg syndrome.

I could be wrong; it's happened before.

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Specializes in Private Duty Pediatrics.
londonflo said:

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d87274cf-97b5-4965-9187-caec621e6177

Could it be that massaging any foam into the muscle would help as much as the relief I get from Theraworx? I've tried massaging with Eucerine Cream - that I use regularly for my dry skin on my hands - but it didn't help my muscle spasm in my legs. 

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Specializes in oncology.

I thought nocturnal leg cramps were the same as restless legs?

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Specializes in Psych, Addictions, SOL (Student of Life).
londonflo said:

I thought nocturnal leg cramps were the same as restless legs?

They are two different things though they may be caused by the same or similar etiologies. I've had both and will take restless legs over the cramps any day.  I have had some success with TENS but best of all has been a product called Arnicare it's a homeopathic preparation that states can keep cramps from happening or stop them once started.  It has worked well for  me even if its partially placebo effect.

Hppy

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I get nocturnal foot cramps. They are awful! I find the only thing that helps are those "yoga toes" toes separators that splay your toes apart. My physician could not find a physical cause. 

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Specializes in Psych, Addictions, SOL (Student of Life).

A frind told me tp boil a plantain then drink the water from it.

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Specializes in oncology.
hppygr8ful said:

They are two different things though they may be caused by the same or similar etiologies.

Thank you. I had both but I thought the daytime cramps were a continuation of restless legs. So happy to be cramp free, day and night with dry needling but will keep your suggestions in mind. .

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