You don’t have to be an Olympian to feel the misery of a leg cramp or a shooting pain that comes out of nowhere. You don’t even need to be a weekend warrior. The leg cramp, calf cramp or hamstring cramp, sometimes affectionately called a Charley Horse, can affect all of us — athletes and couch potatoes alike.
The good news is most cramps — which can occur anywhere on the leg — really aren’t anything to worry about, most of the time. Though, in rare instances, leg cramping can be a sign of underlying disease.
Here’s what you need to know.
1. Understanding the charley horse
First, some basic biology.
“A leg cramp is really just a muscle contracting and tightening spontaneously,” said emergency medicine specialist Dr. Scott Dresden of Northwestern Memorial Hospital in Chicago. “The problem is that can be very painful for several seconds or even several minutes.”
Why we get a leg cramp, calf cramp, or even a hamstring cramp, is really poorly understood. “There are a lot of thoughts as to why it happens, but there is not one definitive answer,” he explained.
Some potential reasons for cramping include dehydration (especially among athletes or any of us working out in hot, humid conditions.) Another potential reason could be electrolyte imbalance. Or it might be some type of miscommunication between nerves that make muscles contract and those that stop contractions. Even some medications have a side effect of leg cramping.
Don’t be surprised if your leg, calf or hamstring muscles ache for a while, even after the cramp has eased.
“What happens, especially when it’s a bad, painful cramp, is that some people might develop tiny micro-tears in the muscle from the strong contractions,” said Ron DeAngelo, director of sports performance training at the UPMC Rooney Sports Complex in Pittsburgh. “The micro-tears heal, but it can take about 24 hours or so to feel better.”
2. When a cramp wakes you up
So you’re snoozing, having a pleasant dream, and the next thing you know is that you’re writhing in bed because your calf, thigh or seemingly your entire leg cramped. Maybe even your foot cramped.
You’re not alone.
“These kinds of nighttime or nocturnal cramps are common and most of the time they’re not something that is indicative of disease,” said Dr. Michael Hanak, assistant professor of family medicine at Rush University Medical Center.
The nighttime pain can be on any part of your leg, and can affect everyone, both young and old, men and women.
There is a laundry-list of reasons why you might be experiencing nighttime leg cramping. Maybe you stand all day at work, or maybe you sit all day, or sit with your legs not flat on the floor. Maybe you’re pregnant or dehydrated. “Maybe people are just sleeping awkwardly,” said DeAngelo. “A lot of these nighttime leg cramps have a lot do with positioning while sleeping.”
You might want to make sure you are wearing proper footwear during the day. “If your gait is off say due to wearing shoes that aren’t fitting right or inappropriate for the sport you do, you could cramp at night,” he says.
If you want to avoid that rude awakening, stay hydrated, and think about stretching your legs before you nod off. To relieve the ouch when you’re awakened, stretch it out.
Don’t confuse the aching nighttime leg cramp with the “crawling” sensation that happens with a sleep disorder called restless leg syndrome, which doesn't cause cramping.
3. Weekend warrior leg cramps
So you started running or walking this summer only to experience stinging calves, quads and hamstring muscles. Chances are you were just dehydrated, according to DeAngelo.
“If people are deconditioned and start exercising they may underestimate how much they’re actually sweating,” he says.
All that sweat means you need to take in more water. If you don’t, the communication between the nerves that make your muscles relax or tighten may misfire, resulting in leg cramps, he said.
“The best thing to do is to stop exercising when you get a leg cramp, then stretch and rehydrate,” said DeAngelo, adding that it’s smart to hydrate before you begin your workout, too.
4. When to see a doctor
Many people worry that a leg or calf cramp signals a serious problem, like deep vein thrombosis (DVT), which is basically a blood clot that forms in one of the deep veins of your body, generally the leg.
Aside from cramping, which usually occurs in the calf, other symptoms include one-sided (generally) swelling of the leg, foot and ankle as well as severe pain in the foot and ankle. One area of the leg may seem warmer than other parts of the leg. And the skin may be discolored, either pale or reddish
It’s a serious condition that can lead to a life-threatening pulmonary embolism, according to Dr. Dresden, assistant professor in emergency medicine Northwestern University Feinberg School of Medicine.
"It’s smarter to get in to see someone right away if you have symptoms of a DVT or are just concerned," he elaborated.
Since leg, calf and hamstring cramps generally go away on their own, no treatment is usually needed.
But for some people, leg cramps can be a regular occurrence. Individuals with endocrine problem like diabetes, structural problems like flat feet, poor circulation and those with neurological or neuromuscular disorders often have leg cramps.
"Once an underlying problem is brought under better control, the leg cramps might no longer be an issue,” said Dr. Hanak of Rush University Medical Center.
Certain medications used to treat high blood pressure, such as diuretics and beta-agonists, used to treat respiratory problems, can also cause cramping. “If that’s a problem, my advice is to talk to your doctor to see what can be done and what changes can be made,” said Hanak.