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.
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.
Several people have mentioned Theraworx, which is a magnesium cream. It works for some and doesn't for others. I guess what works depends on what is causing YOUR muscle cramps. I use magnesium oil after my grandma let me use hers. I was dubious, but it worked quickly and has worked for me since. If I'm woken up by cramps, I'll go spray my legs and feet down with the mag oil, then some lotion and socks and I sleep like a baby for the rest of the night.
In general my experience both professionally and with family members who have noctural leg cramping is that finding something that effectively, and most importantly, continuously relieves leg cramping rarely happens. Hence as listed by individuals in these post, there are abundance of suggestions, but how many are truly effective and valid is questionable. But those who experience the excruciating pain are willing to try most anything to obtain relief. Even pickle juice. Unfortunately there does not seem to be that "one fix, that fits all." But, we can't stop investigating potential calming agents because these people's pain and sleep interrupted nights affects their overall well-being.
One area I think healthcare providers should check themselves on is how often they immediately assume the person's cramping is from low potassium and/or insufficient Mg. And the next step is to suggest the person either begin to take supplements or increase foods and drinks that will boost their levels of these electrolytes. It seems the appropriate first step would be to have these serum electrolyte levels tested before suggesting the person increase intake of these items. As we know, boosting levels of these electrolytes in individuals can have negative results (even worsening cramps) if the increased intake causes to high serum levels and/or kidney function is an issue.
I jog on a regular basis and incidentally found out that the stretches recommended for plantar fasciitis also helped to relieve foot cramps. These include foot flexes before arising in the morning, gentle calf stretches, standing on a towel and bunching it up with your toes, picking up marbles with your toes, and rolling a racket ball under your foot.
One area I think healthcare providers should check themselves on is how often they immediately assume the person's cramping is from low potassium and/or insufficient Mg. And the next step is to suggest the person either begin to take supplements or increase foods and drinks that will boost their levels of these electrolytes. It seems the appropriate first step would be to have these serum electrolyte levels tested before suggesting the person increase intake of these items. As we know, boosting levels of these electrolytes in individuals can have negative results (even worsening cramps) if the increased intake causes to high serum levels and/or kidney function is an issue.
Yeah, the first thing my IM doc did was to send me to the lab. Of course, my mag and K and everything else were stone cold normal! Which is fine, at least my "yoga toes" work for me at night.
ClaraRedheart, BSN, RN
363 Posts
Several people have mentioned Theraworx, which is a magnesium cream. It works for some and doesn't for others. I guess what works depends on what is causing YOUR muscle cramps. I use magnesium oil after my grandma let me use hers. I was dubious, but it worked quickly and has worked for me since. If I'm woken up by cramps, I'll go spray my legs and feet down with the mag oil, then some lotion and socks and I sleep like a baby for the rest of the night.