Thursday, November 13, 2008

Nocturnal Calf Cramps

There you are, snug in bed, dreaming soundly, recharging after a long day when BOOM!

You are jolted awake by the biggest, most angry pain you have ever felt. You are so out of it that for a split second you are frozen with pain, then you realize it is your calf, and panic a bit, as you know it should be stretched out, but going even slightly into the stretch seems to increase the already excruciating agony.

Have you been there? If so you know I haven’t exaggerated the description just for effect. It can be a frightening and very painful experience. So what on earth could cause such a thing?

Well, believe it or not, nocturnal calf cramps are frequently a symptom of good old trigger points, specifically of the gastrocnemius muscle in your calf. (This is not the only possible cause, however. Nothing is ever that simple!)

It is quite a common occurrence too! All it takes is for you to stay in a position of plantar flexion (foot pointed away from you, thereby tightening the calf muscles) for a prolonged period of time. This is common if you are sitting without your feet flat on the floor, but instead supporting yourself up on your toes, sleeping on your stomach or back with toes pointing down the bed, climbing or running steep hills, or wearing high heels.

Nocturnal calf cramps are also common in pregnant women, which could be due to postural changes to compensate for the change in centre of gravity. As the centre of gravity moves forward and down, there is more stress placed on the calf muscles to help maintain balance. (Although electrolyte imbalances, dehydration, low magnesium or calcium levels, and possibly diabetes are just a few other possibilities, not just for pregnant women, but for anyone suffering from nocturnal calf cramps.)

Therefore, if you are suffering from nocturnal calf cramps, it is a good idea to see your physician and have these possibilities ruled out.

Calf trigger points can also be provoked by a forceful contraction when the muscle is in a shortened position, or if the muscle gets fatigued or chilled.

Your calf muscles have an important job through the day (other than helping you walk and stand upright.) They also work as a pump to squeeze blood back up veins in your legs. At night when you are sleeping, this mechanism is also at rest, possibly causing a lack of oxygen to the area. This might help explain the reason these cramps seem to occur at night.

Treating a nocturnal calf cramp is important; otherwise it could be in spasm for 30 minutes or more! Ouch!

Start by stretching the calf out. You can do this by drawing your toes towards your nose, with knee straight (if you are sitting up in bed), or by standing facing a wall, with hands on the wall at shoulder level, and the leg to be stretched behind you (full foot on the floor, knee straight), with your other leg in front (foot flat on floor, knee slightly bent). Then gently lean your body toward the wall, keeping the back knee straight, foot on the floor, and bending at the knee on the leg in front. Go just until you feel a gentle stretch, and then hold, breathing deeply, for a minute or two. Then stretch the other side too, just to keep things even!

Warmth is great too, and might help you get back to sleep after the episode! A warm buddy, heated up and placed on your calf will help with blood flow, and keep the muscle from getting chilled. You can also heat your calves before bed, if calf cramping is a common occurrence for you.

At night, try to avoid having your feet in the pointed position. This can happen if you are sleeping on your stomach, with your feet pointing down the bed, or lying on your back with heavy covers pulling the toes down. You may need to adjust your covers, or even have your feet out of the covers (with some socks on to keep ‘em warm). If you are a back sleeper you can try putting a pillow or rolled blanket at your feet, to stop them from pointing down. If you are a tummy sleeper, you can place a pillow under your shins (like I do on the massage table), or even have your feet hang off the end of the bed.

Relieving calf trigger points can go a long way to alleviating nocturnal calf cramps. Focus on the medial (inside) of the gastrocnemius muscle, as trigger points here seem to be the most common culprits. You can use a rolling pin to roll up the muscle, and hold on the tender points until they release (please be gentle). You can also use a tennis ball or Kong, or just knead your calves with your hands. Or come in and I’ll do it for you!

Low potassium and calcium levels are possible factors in muscle cramping, as well as vitamin E. Please talk to your doctor before taking supplements.

I hope this gives you some ideas of how to deal with or avoid this painful and frightening situation. Sleep tight!