When to worry about leg cramps

<p><strong>Leg cramps are often a sign of a fluid or electrolyte imbalance from dehydration. However, sometimes leg cramps are a result of something more serious, such as an underlying nervous system or metabolic disorder, blood clot, or a complication from a chronic condition. When to worry about leg cramps? You should seek medical attention if your cramps persist, are severe, or are accompanied by other symptoms.</strong></p> <p>Occasionally I’ll be sitting on the couch or lying in bed at the end of a long day, and my calf muscles will seize up unexpectedly. When it happens, I usually know what went wrong: I didn’t quite get the right amount of fluids or electrolytes in me throughout the day to support my running habit in a <a href="https://science.drinklmnt.com/did-you-know/heat-cramps/" rel="noopener noreferrer" target="_blank">hot climate</a>.</p> <p>“<a href="https://science.drinklmnt.com/did-you-know/what-causes-muscle-cramps/" rel="noopener noreferrer" target="_blank">Leg cramps</a> are most often the result of disrupted fluid and mineral balance in the body,” says <a href="https://www.drtyna.com/" rel="noopener noreferrer" target="_blank">Tyna Moore, ND, DC</a>, a licensed naturopathic physician and chiropractor. “The sodium-potassium pump gets dysregulated. This pump is found in every single muscle and nerve cell and is what keeps electrical signaling stable. It actively moves sodium out of cells and potassium into cells, creating the electrical gradients that allow muscles to contract and relax properly.”</p> <p>A leg cramp is often a sign that something is up with your hydration status, but you may be wondering when to worry about leg cramps, why they occur, how to relieve them asap, and when you should see a doctor. We’ll answer these questions and more in this article.</p> <h2>Understanding Leg Cramps</h2> <p>One colloquial term for a leg cramp is a “<a href="https://medlineplus.gov/ency/article/002066.htm" rel="noopener noreferrer" target="_blank">charley horse</a>,” which is a sudden muscle cramp in your calf, thigh, or foot. Where did this term, which <a href="https://www.merriam-webster.com/dictionary/charley%20horse#h1" rel="noopener noreferrer" target="_blank">dates back to 1886</a>, come from? Who’s Charley, and what’s with his horse?&nbsp;</p> <p>Although the official origin is unknown, people have a few theories. One is that the term refers to a lame horse named Charley who hauled equipment for the Chicago White Sox. The horse’s limping reminded players of their own awkward gaits when they had a muscle cramp.</p> <p>Another theory suggests that Charley was a National League pitcher: Charley “Old Hoss” Radbourn, who frequently experienced leg cramps.</p> <p>What does a charley horse feel like? “Muscle cramp sensations due to dehydration or electrolyte imbalance can definitely vary depending on the severity of the imbalance,” says <a href="https://jen.health/" rel="noopener noreferrer" target="_blank">Jen Fraboni, PT, DPT</a>, a physical therapist and founder of Jen Health.</p> <p>“In general,” she adds, “these muscle cramps will present as a sudden, intense, and localized pain. You may even feel like there is a ‘balling up’ of the muscle or area in question. In instances of severe electrolyte imbalance, additional symptoms will be present, such as excessive or erratic sweating, generalized muscle weakness and fatigue, or even heart palpitations.”</p> <h2>Common Causes of Leg Cramps</h2> <p>Why do leg cramps occur? “While the obvious culprit is dehydration and <a href="https://science.drinklmnt.com/electrolytes/prevent-electrolyte-imbalance" rel="noopener noreferrer" target="_blank">electrolyte imbalances</a>,” Dr. Moore says, “the next thing I assess is iron deficiency. When iron is low, muscles don’t get the oxygen they need, which can lead to cramping. Magnesium deficiency, low thyroid function, and peripheral arterial disease (PAD) are next on my list to investigate. Medications, overtraining, and nerve issues can also be to blame.”</p> <p>Here’s a more in-depth look at some common instigators of cramps.</p> <h3>Dehydration and electrolyte imbalances</h3> <p>Dehydration means your body has lost too much fluid through&nbsp;processes such as sweat, urination, diarrhea, or (bleh) vomiting. But when fluid goes out, we typically lose <a href="https://medlineplus.gov/fluidandelectrolytebalance.html#:~:text=What%20are%20the%20different%20types,nerves%20and%20muscles%20work%20properly." rel="noopener noreferrer" target="_blank">crucial electrolytes</a> along with it.</p> <p>Electrolytes help maintain fluid balance and support bodily processes, such as nerve signaling and muscle function. Weirdly, we can also become overhydrated from drinking too much plain water. This dilutes your electrolytes. When fluids and electrolytes aren’t balanced properly, nerve and muscle function can go haywire.&nbsp;</p> <p>To provide a better explanation, we need to dig into what the <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6267510/#:~:text=Abstract,not%20all%2C%20invertebrate%20nervous%20systems." rel="noopener noreferrer" target="_blank">sodium-potassium pump</a>, a protein in our cell membranes is and how it works. With the help of adenosine triphosphate (ATP), the body’s universal form of energy, the pump gives up three sodium ions in exchange for two potassium ions. The difference in ion concentration creates an electrochemical gradient that allows for nerve impulse conduction. Nerve impulses from motor neurons stimulate muscle contraction and relaxation.</p> <p>However, if your sodium or <a href="https://science.drinklmnt.com/electrolytes/low-potassium/" rel="noopener noreferrer" target="_blank">potassium</a> levels drop or become imbalanced, the disruption to the pump can cause a muscle to remain contracted, almost like it’s “stuck,” leading to a spasm or cramp.</p> <h3>Nutritional deficiencies</h3> <p>If you don’t get enough of <a href="https://pubmed.ncbi.nlm.nih.gov/31082167/#:~:text=Bicarbonate" rel="noopener noreferrer" target="_blank">certain minerals</a> through your diet, you may also develop muscle cramps. The minerals most crucial for electrolyte balance to support nerve and muscle function include sodium, chloride, potassium, and magnesium. Keep in mind that you may have greater electrolyte needs if you eat a <a href="https://science.drinklmnt.com/low-carb/leg-cramps-on-keto" rel="noopener noreferrer" target="_blank">ketogenic or another low-carb diet</a>.</p> <p>As Dr. Moore notes, <a href="https://pubmed.ncbi.nlm.nih.gov/30071093/#:~:text=Results:%20Among%20154%20subjects%20selected,affecting%20those%20undergoing%20maintenance%20dialysis." rel="noopener noreferrer" target="_blank">iron deficiency</a> can also be to blame for leg cramps. Your body requires adequate iron levels to produce hemoglobin to carry oxygen throughout your blood. A lack of oxygen to muscles can cause muscle dysfunction. Plus, it can lead to the <a href="https://pubmed.ncbi.nlm.nih.gov/447849/#:~:text=Levels%20of%20alpha%2Dglycerophosphate%20oxidase,to%20cessation%20of%20physical%20activity." rel="noopener noreferrer" target="_blank">buildup of lactic acid</a>, which can also contribute to pain and cramps.</p> <h3>Muscle fatigue and overuse</h3> <p>Muscle fatigue and overuse can lead to an electrolyte imbalance that triggers cramping, as noted above. But other factors may also be at play. For example, muscle fatigue can disrupt the way your brain and muscles communicate with each other, leading to <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC3249048/" rel="noopener noreferrer" target="_blank">issues with nerve signaling</a> that may cause cramping. Additionally, prolonged exercise can cause <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8997532/#:~:text=Central%20fatigue%20is%20defined%20as,III%20and%20IV%20%5B19%5D." rel="noopener noreferrer" target="_blank">central nervous system fatigue</a>, further disrupting brain-muscle communication.</p> <p>We also have sensory receptors in our muscles called <a href="https://pubmed.ncbi.nlm.nih.gov/9232553/#:~:text=Furthermore%2C%20during%20acute%20EAMC%20the,cramp%20and%20decreasing%20EMG%20activity." rel="noopener noreferrer" target="_blank">muscle spindles and Golgi tendon organs</a>. Exhausted muscles may cause overactive muscle spindles, which can trigger abnormal reflexes and therefore cramps. Fatigued muscles may also have underactive Golgi tendon organs, causing an imbalance in the excitatory and inhibitory signals that cause muscle contractions.</p> <p>Prolonged or excessive activity can also cause <a href="https://www.ncbi.nlm.nih.gov/books/NBK499882/#:~:text=%5B4%5D%20Repetitive%20or%20prolonged%20activity,factors%20to%20myofascial%20pain%20syndrome." rel="noopener noreferrer" target="_blank">muscle hypoxia (oxygen deficiency) and ischemia (reduced or disrupted blood flow</a>). These factors may lead to a prolonged muscle contraction, causing a cramping sensation. The resulting cramping may even exacerbate hypoxia and ischemia, leading to further cramping. Ouch!</p> <p>Muscle hypoxia can also cause the release of <a href="https://www.ncbi.nlm.nih.gov/books/NBK499882/#:~:text=Pathophysiology,tenderness%20in%20the%20affected%20regions." rel="noopener noreferrer" target="_blank">pro-inflammatory cytokines</a>, immune system proteins that can cause inflammation that can make muscles tender or crampy.</p> <p><img src="https://res.cloudinary.com/drinklmnt/image/upload/v1752273765/LMNT-BLOG-When-To-Worry-About-Leg-Cramps-1_fjoytj.webp" alt="a-list-of-common-causes-of-leg-cramps-with-icons" /></p> <h3>Poor circulation or prolonged sitting</h3> <p>Sitting for extended periods can <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9320137/#:~:text=The%20hypothesis%20of%20this%20report,in%20both%20men%20and%20women." rel="noopener noreferrer" target="_blank">reduce circulation</a> in your legs, leading to stiffness, swelling, and cramps.</p> <h3>Medication side effects</h3> <ul> <li>Leg cramps or discomfort can also be a side effect of certain medications. These can&nbsp;include:</li> <li><a href="https://www.ncbi.nlm.nih.gov/books/NBK482322/" rel="noopener noreferrer" target="_blank">Antiarrhythmics (used for heart arrhythmias)</a></li> <li><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC5450696/" rel="noopener noreferrer" target="_blank">Chemotherapy drugs</a></li> <li><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8109617/#:~:text=Specifically%2C%20it%20is%20likely%20that,(with%20no%20incidence%20specified)." rel="noopener noreferrer" target="_blank">Diuretics</a></li> <li><a href="https://www.ncbi.nlm.nih.gov/books/NBK559069/" rel="noopener noreferrer" target="_blank">Inhalers for asthma or chronic obstructive pulmonary disease (COPD)</a></li> <li><a href="https://onlinelibrary.wiley.com/doi/10.1002/mus.23661" rel="noopener noreferrer" target="_blank">Osteoporosis medications</a></li> <li><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC7613583/#:~:text=During%20year%201%2C%20statin%20therapy,the%20upper%20limit%20of%20normal." rel="noopener noreferrer" target="_blank">Statins (used for cholesterol management)</a></li> <li><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC7069845/" rel="noopener noreferrer" target="_blank">Stimulants (used to treat attention deficit hyperactivity disorder, ADHD)</a></li> </ul> <h3>Underlying conditions</h3> <p>Some <a href="https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/symptoms-of-brain-spinal-cord-and-nerve-disorders/muscle-cramps" rel="noopener noreferrer" target="_blank">underlying conditions</a> that affect the central nervous system have links to leg cramps. These can include:</p> <ul> <li>Clonus (abnormal reflex response)</li> <li>Deep vein thrombosis (DVT, a blood clot)</li> <li>Dystonia (a movement disorder that causes involuntary twitching)</li> <li>Illusory muscle cramps (the feeling of cramping but without an actual contraction)</li> <li>Multiple sclerosis (MS)</li> <li>Parkinson’s disease (PD)</li> <li>Peripheral arterial disease (PAD)</li> <li>Spinal cord injury</li> <li>Stroke</li> </ul> <h2>When Leg Cramps Are Serious</h2> <p>Some leg cramps are associated with serious conditions, so when should you see a doctor?</p> <p>“I would recommend seeing a doctor if you have other symptoms associated with your muscle cramps, such as profuse or erratic sweating, generalized muscle weakness and fatigue, or heart palpitations,” Dr. Fraboni says. “It could also be valuable to see a doctor if your muscle cramps are happening very frequently, are difficult to resolve quickly, and are severely painful.”</p> <p>As noted, PAD is a cardiovascular condition that can cause pain or cramping in the legs. Typically the pain occurs during exercise and then resolves when you stop. If you are experiencing this, be sure to talk to your doctor.</p> <p>If you are experiencing muscle cramps and have a chronic condition, such as diabetes, kidney disease, vascular issues, or diseases affecting the nerves, talk to your doctor about your symptoms.</p> <p>I get how going to the doctor or even an emergency room for a muscle cramp can feel strange. You think it will just go away, but I’m glad that several years ago I trusted my gut and went to an urgent care clinic for a cramp in my arm.</p> <p>What I thought was a cramp turned out to be <a href="https://www.nhlbi.nih.gov/health/deep-vein-thrombosis" rel="noopener noreferrer" target="_blank">DVT</a> (a blood clot), a potentially life-threatening situation. Urgent care sent me promptly to the ER. If swelling, tenderness, or red or discolored skin accompanies your cramp, get checked out right away.</p> <p><img src="https://res.cloudinary.com/drinklmnt/image/upload/v1752273766/LMNT-BLOG-When-To-Worry-About-Leg-Cramps-2_yexyyg.webp" alt='“earlier-pull-quote-from-dr-fraboni"/' /></p> <h2>Immediate Relief for Leg Cramps</h2> <p>What should you do if you get a leg cramp? How do you find relief fast? “Pickle juice is my go-to in a pinch at night,” Dr. Moore says. “Then obviously adequate hydration during daytime hours with the use of an electrolyte supplement like LMNT. I encourage folks to sip it slowly throughout the day.”</p> <p>Gentle movements can also help. “My two initial recommendations to relieve a leg cramp would be to gently and slowly lengthen or stretch the muscle while focusing on long, slow exhales,” says Dr. Fraboni.</p> <p>Here’s her technique: “If you are having a cramp in your calf (a super common area), I would recommend gently trying to press your heel down to flatten the foot into the ground with your knee straight, which will stretch the calf. As you slowly ease into a stretch, focus on taking a long slow inhale through the nose and a longer exhale through pursed lips.&nbsp;</p> <p>Why the breathing exercise? “This breath pattern can help to downregulate the nervous system, switching the body into a more parasympathetic state of rest and relaxation to systematically reduce tension in the muscle,” she explains. “You can also gently massage the area with the focused breathing to improve circulation and ease muscle tension.”</p> <p> <img src="https://res.cloudinary.com/drinklmnt/image/upload/v1752541348/LMNT-BLOG-When-To-Worry-About-Leg-Cramps-3_cbiaqw.webp" class="w-full sm:w-2/3 lg:w-1/2" loading="lazy" alt="image-showing-how-to-handle-a-leg-cramp"/> </p> <h2>Long-Term Management and Prevention</h2> <p>My goal is always to try to prevent leg cramps in the first place. So how do you do that? The first trick is to stay hydrated with both water and electrolytes as necessary.</p> <p>“This can be a tough one,” says Dr. Moore, “especially if training in a new climate where it’s particularly dry and hot. Dehydration can sneak up on you. If your skin or lips start feeling dry or the skin on the back of your hand starts tenting, you are dehydrated. Don’t wait for the muscle cramps to kick in—that's a later-stage symptom.”</p> <p>Taking a proactive approach can help. “I recommend that you start drinking water immediately upon waking, prior to coffee or breakfast, aiming to get in about 8 to 16 ounces,” Dr. Fraboni says. She recommends sipping additional water throughout the day, aiming to drink about half your body weight in ounces of water. But remember not to overhydrate with plain water, which can <a href="https://www.ncbi.nlm.nih.gov/books/NBK537231/" rel="noopener noreferrer" target="_blank">dilute electrolytes</a>.</p> <p>“Prior to exercise,” Dr. Framboni adds, “it’s great to make sure you’re pre-loading with at least 12 ounces of water and electrolytes about 60 to 90 minutes prior to a workout.”</p> <p>Then after exercise, consider more water and electrolytes. And if you engage in prolonged activity or exercise in the heat, you will need water and electrolytes throughout your sweat session.</p> <h2>Key Takeaways</h2> <ul> <li>A fluid or electrolyte imbalance from dehydration can cause calf, thigh, foot, or other muscle cramps.</li> <li>This is because a proper electrolyte balance is needed for nerve and muscle function; an imbalance can cause muscles to get temporarily “stuck” in a contracted position.</li> <li>Sometimes leg cramps can signal something more serious, such as an underlying nervous system disorder, blood clot, or a complication from an underlying condition.&nbsp;</li> <li>You should seek medical attention if your cramps persist, are severe, are accompanied by other symptoms, or if you have underlying conditions.</li> </ul> <h2>FAQ</h2> <h3>How do you know if leg cramps are serious?</h3> <p>The occasional leg cramp is likely a sign of a fluid or electrolyte imbalance. However, sometimes leg cramps can signal something more serious, such as an underlying nervous system disorder or a complication from an underlying condition. If your cramp is prolonged or associated with other symptoms, please seek prompt medical care.&nbsp;</p> <h3>What disease starts with leg cramps?</h3> <p>Although leg cramps are often a result of an electrolyte imbalance, they can also be a sign of nutrient deficiencies, metabolic disorders such as diabetes, cardiovascular issues such as peripheral arterial disease (PAD) or atherosclerosis, hypothyroidism, movement disorders such as multiple sclerosis (MS) or Parkinson’s disease (PD), kidney failure, liver disease, alcohol use disorder, and blood clots.</p> <h3>When should you go to the ER for leg cramps?</h3> <p>You should seek medical attention if your cramps persist, are severe, are accompanied by other symptoms, or if you have underlying conditions.</p> <h3>What is the body lacking when you have leg cramps?</h3> <p>When you are experiencing leg cramps, you may be deficient in one or more electrolytes, including sodium, chloride, potassium, and magnesium. Or you may have an iron deficiency.</p>