Cramps (Nocturnal Cramps in Legs)

Precautions: treat cause (if known), e.g. tetanus, drugs, sodium depletion, hypothyroidism, dehydration.

Physical

• Muscle stretching and relaxation exercises (see Fig. C14): stretch calf for 3 mins before retiring then rest in chair with the feet out horizontally to the floor with cushion under tendoachilles (10 mins)

• Massage and heat to affected muscles

• Try to keep bedclothes off feet and lower part of legs—use a doubled-up pillow at the foot of the bed

• Tonic water before retiring may help

Drugs

Usually unsatisfactory but consider:

• Magnesium Co tab (e.g. ‘Crampeze’): poor scientific evidence but solid anecedotal support or

• Biperiden 2–4 mg nocte