Nina Radcliff

Dr. Nina Radcliff

Have you ever been awakened from blissful sleep with leg muscles spazzing with what seems like mind-bending pain? Or have been surprised while sitting, standing, swimming or after a workout by the excruciating, hard-to-soothe muscle spasms, known as a charley horse?

If you, or someone you love, has ever had one — you know just how painful it can be when the calf or leg muscle involuntary spasms or cramps. It can rocket you into great discomfort for a few seconds or longer. And if the cramp is severe, your muscle may be sore for days afterward.

Women, men and children get charley horses. And many wonder, why? What in the world is setting those tight, knotted sensations in their leg muscles into motion?

While you can get a leg cramp if you overwork your muscle; sit too long without moving; don’t drink enough water; or, stand too long on hard surfaces — there are other factors too that can contribute to the likelihood of “those” spasms of agony. Time to break it down and look at what the aches are about — along with what works, what doesn’t work, what may work and what to avoid.

And it’s good to know that as painful as they feel, leg cramps are essentially harmless (I never consider pain harmless as it impacts you at your core. You can lose sleep and impact other important vitals of your well-being, I understand. And if you have experienced pain, you know what I mean.)

Dr. Nina’s What You Need To Know: About Charley Horses

What is a charley horse? Another name for leg cramps, charley horses are when a muscle spasms — when one or more muscles involuntarily contract. While charley horses can occur in any muscle, they’re most common in the back of your calves, followed by your foot and thigh.

People who have experienced them use these terms to describe them: “spasm,” “tightening,” “twinge,” “strain” and “muscle seizure.”

And again, the severity can range in each episode from being uncomfortable to dreadfully painful and incapacitating. And, in some cases, they can cause limb movement, for example your foot pointing upwards (known as flexion).

On average, they last for 9 minutes, but can be followed by hours of recurrent episodes and residual pain. Additionally, because they occur at night, charley horses can interfere with your sleep, causing several untoward problems such as irritability, headaches, difficulty with focus, and lack of enjoyment the following day, to name a few.

What causes charley horse cramps? Most cases are idiopathic, the medical term for a “disease or condition that arises spontaneously or for which the cause is unknown.” However, each of the following has been associated with leg cramps:

• Exercise-related: Although different from nighttime leg cramps, in that these spasms often occur during, immediately after, or up to 6 hours after strenuous exercise, they are similar in that the muscle contracts “violently, as if it had been prodded with a jolt of electricity. And it remains balled in a tight knot…,” and that there is no convincing biological explanation for them. Consequently, most doctors consider this condition to be different than charley horses. Exercise-induced leg cramps are common amongst endurance athletes and also can occur when you do not stretch properly or workout in extreme heat or cold temperatures.

• Inadequate blood circulation to the leg muscles, known as peripheral vascular disease

• Neurological problems: Nerve compression in the spine, known as stenosis; Parkinson’s disease; and nerve damage from cancer treatment

• Certain medications: statins; diuretics that alter electrolyte levels

• Dehydration

• Pregnancy

• Inadequate mineral intake of calcium, potassium, magnesium, sodium

• Smoking

• Certain medications: diuretics; statins to treat high cholesterol; medications for chronic obstructive pulmonary disease, or COPD

How are leg cramps different from restless leg syndrome, or RLS?: RLS is a condition where you feel “pulling, searing, drawing, tingling, bubbling, or crawling” beneath the skin, usually in the calf area. It can also affect your thighs, feet or even the arms. These sensations cause an irresistible urge to move and “shake it off.” It shares similarities with leg cramps in that it is uncomfortable and generally occurs in the same location and at nighttime, but it differs in that it is not cramping.

How is a charley horse diagnosed?: An occasional charley horse probably doesn’t require medical attention and an official diagnosis. However, if they are frequent or recurring, say more than once a week, speak with your health care provider. They can usually make a diagnosis based on your medical history and a physical examination. They will ask questions such as do your leg cramps occur at night, is there visible muscle tightening, or a sudden, intense pain? Your doctor will also differentiate leg cramps from other common conditions such as RLS, exercise-induced leg cramps, and peripheral neuropathy.

A physical examination rarely demonstrates leg cramps because they are involuntary, unpredictable and usually occur at nighttime. However, the general appearance, how your pulses feel, and your sensation, strength and reflexes are key to determining if there is an underlying medical cause.

How are charley horses treated?: If an underlying medical condition is identified, treating it (surgery for pinched nerves, quitting smoking, discontinuing a medication, losing weight) may improve or cure your leg cramps.

For idiopathic, or unknown causes, there are no treatments that have been proven both safe and effective. Most treatments have not been rigorously tested. Quinine which has shown some effectiveness in treating nocturnal leg cramps is no longer recommended. The U.S. Food and Drug Administration issued a warning about multiple drug interactions with quinine and stated that the potential for serious adverse effects (heart rhythm abnormalities, low platelet counts, and allergic like reactions) outweighs the modest benefit of the drug.

Some “harmless” therapies that have potential benefits include passive stretching, deep tissue massages, physical therapy, ensuring hydration, and increasing consumption of foods and drinks rich in potassium, magnesium, and calcium or, in some cases, starting supplements.

For severe or intractable leg cramps, your doctor may consider prescribing a muscle relaxant or calcium channel blocker to ease symptoms.

What to consider when you get a charley horse: While it is easy to recommend, I understand it is more of a challenge to put these into motion during an episode but breathe deeply (inhale and exhale slowly) and try:

• To use your hands to apply pressure to the site of the cramp to help relieve pain.

• You can also try using both of your thumbs to gradually apply pressure to the site of the cramp until the pain goes away.

Other considerations that may help are:

• Stretching the muscle

• Standing on the cramped leg

• Flexing your foot

• Grabbing your toes, pulling them toward you

• Icing the cramp

• Taking a warm bath

Prevention: Here are some simple things you can consider to help prevent future cramps:

• Stretch during the day, before exercise and too, before bed — all, with a focus on your calf and foot muscles

• Stay hydrated by drinking plenty of water

• Don’t exercise outside in the heat in extremely hot weather

• Move around during the day to exercise your feet and legs

• Wear comfortable, supportive shoes

• Sleep under loose covers, especially if you sleep on your back.

• And that sage old wives’ tale about eating bananas for leg cramps? It’s true. The potassium helps. You might also add multivitamins with magnesium and zinc.

• If you have frequent and severe leg cramps, consult with your health provider. You’ll want to make sure there’s not a health problem causing the cramps.

Where does the name “charley horse” come from?: There are many theories and the facts are unclear. One theory is that sometime in the late 1880s, the grounds crew in Chicago used a lame horse called Charley. Another is that teammates started referring to injured players as Charley the Horse. Another story contends that a pitcher named Charles was nicknamed “Old Hoss.” One day, as he was running the bases, he got a leg cramp.

Charley horses are common and can occur in any muscle at any time. They’re usually treatable and can sometimes be prevented. And any pain caused by a spasm won’t typically last more than a day. However, if you experience charley horses frequently, talk with your doctor about treatments.

Dr. Nina Radcliff, of Galloway Township, is a physician anesthesiologist, television medical contributor and textbook author. Email questions for Dr. Nina to with “Dr. Nina” in the subject line. This article is for general information only and should not be used for the diagnosis or treatment of medical conditions and cannot substitute for the advice from your medical professional.

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