Idiopathic leg cramps are common. Estimates of prevalence and frequency of attacks vary, but most adults report having experienced leg cramps at some time.[3]American Academy of Sleep Medicine. International classification of sleep disorders - third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication].[8]Oboler SK, Prochazka AV, Meyer TJ. Leg symptoms in outpatient veterans. West J Med. 1991;155:256-259.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1002979/pdf/westjmed00097-0046.pdf
http://www.ncbi.nlm.nih.gov/pubmed/1659038?tool=bestpractice.com
[9]Naylor JR, Young JB. A general population survey of rest cramps. Age Ageing. 1994;23:418-420.
http://www.ncbi.nlm.nih.gov/pubmed/7825490?tool=bestpractice.com
[10]Abdulla AJ, Jones PW, Pearce VR. Leg cramps in the elderly: prevalence, drug and disease associations. Int J Clin Pract. 1999;53:494-496.
http://www.ncbi.nlm.nih.gov/pubmed/10692732?tool=bestpractice.com
[11]Grandner MA, Winkelman JW. Nocturnal leg cramps: Prevalence and associations with demographics, sleep disturbance symptoms, medical conditions, and cardiometabolic risk factors. PLoS One. 2017;12(6):e0178465.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460850
http://www.ncbi.nlm.nih.gov/pubmed/28586374?tool=bestpractice.com
Prevalence and frequency of attacks are higher in older people.[9]Naylor JR, Young JB. A general population survey of rest cramps. Age Ageing. 1994;23:418-420.
http://www.ncbi.nlm.nih.gov/pubmed/7825490?tool=bestpractice.com
[11]Grandner MA, Winkelman JW. Nocturnal leg cramps: Prevalence and associations with demographics, sleep disturbance symptoms, medical conditions, and cardiometabolic risk factors. PLoS One. 2017;12(6):e0178465.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460850
http://www.ncbi.nlm.nih.gov/pubmed/28586374?tool=bestpractice.com
[12]Maisonneuve H, Chambe J, Delacour C, et al. Prevalence of cramps in patients over the age of 60 in primary care : a cross sectional study. BMC Fam Pract. 2016 Aug 12;17(1):111.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4983045
http://www.ncbi.nlm.nih.gov/pubmed/27520635?tool=bestpractice.com
[13]Hallegraeff J, de Greef M, Krijnen W, et al. Criteria in diagnosing nocturnal leg cramps: a systematic review. BMC Fam Pract. 2017 Feb 28;18(1):29.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330021
http://www.ncbi.nlm.nih.gov/pubmed/28241802?tool=bestpractice.com
Women are reported to experience cramps more frequently than men.[10]Abdulla AJ, Jones PW, Pearce VR. Leg cramps in the elderly: prevalence, drug and disease associations. Int J Clin Pract. 1999;53:494-496.
http://www.ncbi.nlm.nih.gov/pubmed/10692732?tool=bestpractice.com
[11]Grandner MA, Winkelman JW. Nocturnal leg cramps: Prevalence and associations with demographics, sleep disturbance symptoms, medical conditions, and cardiometabolic risk factors. PLoS One. 2017;12(6):e0178465.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460850
http://www.ncbi.nlm.nih.gov/pubmed/28586374?tool=bestpractice.com
[14]Jansen PH, Joosten EM, van Dijck J, et al. The incidence of muscle cramp. J Neurol Neurosurg Psychiatry. 1991;54:1124-1125.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1014704/pdf/jnnpsyc00510-0088.pdf
http://www.ncbi.nlm.nih.gov/pubmed/1783937?tool=bestpractice.com
Idiopathic cramps are less common in children than in adults. Nocturnal leg cramps were reported in about 7% of a cohort of around 2500 healthy children, beginning only after aged 8 years, and peaking in prevalence at aged 16 to 18 years.[15]Leung AK, Wong BE, Chan PY, et al. Nocturnal leg cramps in children: incidence and clinical characteristics. J Natl Med Assoc. 1999;91:329-32.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2608508/pdf/jnma00351-0033.pdf
http://www.ncbi.nlm.nih.gov/pubmed/10388258?tool=bestpractice.com
Most affected children have infrequent cramps.[15]Leung AK, Wong BE, Chan PY, et al. Nocturnal leg cramps in children: incidence and clinical characteristics. J Natl Med Assoc. 1999;91:329-32.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2608508/pdf/jnma00351-0033.pdf
http://www.ncbi.nlm.nih.gov/pubmed/10388258?tool=bestpractice.com
The mean duration per cramp episode has been reported to be 8 to 9 minutes in adults, and 2 minutes in children.[9]Naylor JR, Young JB. A general population survey of rest cramps. Age Ageing. 1994;23:418-420.
http://www.ncbi.nlm.nih.gov/pubmed/7825490?tool=bestpractice.com
[10]Abdulla AJ, Jones PW, Pearce VR. Leg cramps in the elderly: prevalence, drug and disease associations. Int J Clin Pract. 1999;53:494-496.
http://www.ncbi.nlm.nih.gov/pubmed/10692732?tool=bestpractice.com
[15]Leung AK, Wong BE, Chan PY, et al. Nocturnal leg cramps in children: incidence and clinical characteristics. J Natl Med Assoc. 1999;91:329-32.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2608508/pdf/jnma00351-0033.pdf
http://www.ncbi.nlm.nih.gov/pubmed/10388258?tool=bestpractice.com
About 75% of cramp episodes in adults and children occur at night.[9]Naylor JR, Young JB. A general population survey of rest cramps. Age Ageing. 1994;23:418-420.
http://www.ncbi.nlm.nih.gov/pubmed/7825490?tool=bestpractice.com
[10]Abdulla AJ, Jones PW, Pearce VR. Leg cramps in the elderly: prevalence, drug and disease associations. Int J Clin Pract. 1999;53:494-496.
http://www.ncbi.nlm.nih.gov/pubmed/10692732?tool=bestpractice.com
[15]Leung AK, Wong BE, Chan PY, et al. Nocturnal leg cramps in children: incidence and clinical characteristics. J Natl Med Assoc. 1999;91:329-32.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2608508/pdf/jnma00351-0033.pdf
http://www.ncbi.nlm.nih.gov/pubmed/10388258?tool=bestpractice.com
Idiopathic cramps usually involve single muscles or part of a muscle, particularly the gastrocnemius.[1]Bradley WG, Daroff RB, Fenichel GM, et al. Neurology in clinical practice. 5th ed. Volumes 1 and 2. Philadelphia, PA: Butterworth-Heinemann-Elsevier; 2008.[16]Miller TM, Layzer RB. Muscle cramps. Muscle Nerve. 2005;32:431-42.
http://www.ncbi.nlm.nih.gov/pubmed/15902691?tool=bestpractice.com
Most episodes involve the calf muscles, followed by the foot muscles; foot cramps have been reported to be more common in women than in men.[3]American Academy of Sleep Medicine. International classification of sleep disorders - third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication].[9]Naylor JR, Young JB. A general population survey of rest cramps. Age Ageing. 1994;23:418-420.
http://www.ncbi.nlm.nih.gov/pubmed/7825490?tool=bestpractice.com
[14]Jansen PH, Joosten EM, van Dijck J, et al. The incidence of muscle cramp. J Neurol Neurosurg Psychiatry. 1991;54:1124-1125.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1014704/pdf/jnnpsyc00510-0088.pdf
http://www.ncbi.nlm.nih.gov/pubmed/1783937?tool=bestpractice.com
Local cramps in other muscles are less common. However, they are frequently noted in the context of neuromuscular disease.[1]Bradley WG, Daroff RB, Fenichel GM, et al. Neurology in clinical practice. 5th ed. Volumes 1 and 2. Philadelphia, PA: Butterworth-Heinemann-Elsevier; 2008.
Muscle cramps are commonly experienced by pregnant women, particularly during the last trimester.[17]Hertz G, Fast A, Feinsilver SH, et al. Sleep in normal late pregnancy. Sleep. 1992;15:246-251.
http://www.ncbi.nlm.nih.gov/pubmed/1621025?tool=bestpractice.com
These significantly remit after parturition.[17]Hertz G, Fast A, Feinsilver SH, et al. Sleep in normal late pregnancy. Sleep. 1992;15:246-251.
http://www.ncbi.nlm.nih.gov/pubmed/1621025?tool=bestpractice.com
Estimates of the prevalence of cramps during haemodialysis range from 15% to 87%.[18]Neal CR, Resnikoff E, Unger AM. Treatment of dialysis-related muscle cramps with hypertonic dextrose. Arch Intern Med. 1981;141:171-173.
http://www.ncbi.nlm.nih.gov/pubmed/7006544?tool=bestpractice.com
[19]Donauer J, Kolblin D, Bek M, et al. Ultrafiltration profiling and measurement of relative blood volume as strategies to reduce hemodialysis-related side effects. Am J Kid Dis. 2000;36:115-123.
http://www.ncbi.nlm.nih.gov/pubmed/10873880?tool=bestpractice.com
[20]Noordzij M, Boeschoten EW, Bos WJ, et al. Disturbed mineral metabolism is associated with muscle and skin complaints in a prospective cohort of dialysis patients. Nephrol Dial Transplant. 2007;22:2944-2949.
http://ndt.oxfordjournals.org/content/22/10/2944.full
http://www.ncbi.nlm.nih.gov/pubmed/17597087?tool=bestpractice.com
[21]Brass EP, Adler S, Sietsema KE, et al. Peripheral arterial disease is not associated with an increased prevalence of intradialytic cramps in patients on maintenance hemodialysis. Am J Nephrol. 2002;22:491-496.
http://www.ncbi.nlm.nih.gov/pubmed/12381949?tool=bestpractice.com
[22]Ahmad S, Robertson HT, Golper TA, et al. Multicenter trial of L-carnitine in maintenance hemodialysis patients. II. Clinical and biochemical effects. Kidney Int. 1990;38:912-918.
https://www.kidney-international.org/article/S0085-2538(15)57035-X/pdf
http://www.ncbi.nlm.nih.gov/pubmed/2266675?tool=bestpractice.com
The risk of cramps may be similar during haemodialysis and peritoneal dialysis.[20]Noordzij M, Boeschoten EW, Bos WJ, et al. Disturbed mineral metabolism is associated with muscle and skin complaints in a prospective cohort of dialysis patients. Nephrol Dial Transplant. 2007;22:2944-2949.
http://ndt.oxfordjournals.org/content/22/10/2944.full
http://www.ncbi.nlm.nih.gov/pubmed/17597087?tool=bestpractice.com
Estimates of the prevalence of cramps in patients with cirrhosis range from 22% to 88%.[23]Marotta PJ, Graziadei IW, Ghent CN. Muscle cramps: a 'complication' of cirrhosis. Can J Gastroenterol. 2000;14(suppl D):21D-25D.
http://www.ncbi.nlm.nih.gov/pubmed/11110608?tool=bestpractice.com
[24]Konikoff F, Theodor E. Painful muscle cramps. A symptom of liver cirrhosis? J Clin Gastroenterol. 1986;8:669-672.
http://www.ncbi.nlm.nih.gov/pubmed/3805668?tool=bestpractice.com
[25]Kobayashi Y, Kawasaki T, Yoshimi T, et al. Muscle cramps in chronic liver diseases and treatment with antispastic agent (eperisone hydrochloride). Dig Dis Sci. 1992;37:1145-1146.
http://www.ncbi.nlm.nih.gov/pubmed/1618065?tool=bestpractice.com
[26]Angeli P, Albino G, Carraro P, et al. Cirrhosis and muscle cramps: evidence of a causal relationship. Hepatology. 1996;23:264-273.
http://onlinelibrary.wiley.com/doi/10.1002/hep.510230211/pdf
http://www.ncbi.nlm.nih.gov/pubmed/8591851?tool=bestpractice.com
[27]Abrams GA, Concato J, Fallon MB. Muscle cramps in patients with cirrhosis. Am J Gastroenterol. 1996;91:1363-1366.
http://www.ncbi.nlm.nih.gov/pubmed/8677996?tool=bestpractice.com
Clinically relevant cramps (defined as cramps occurring at least once weekly, negatively affecting the patient's quality of life, and requiring analgaesia) were reported in 12% to 42% of these patients.[23]Marotta PJ, Graziadei IW, Ghent CN. Muscle cramps: a 'complication' of cirrhosis. Can J Gastroenterol. 2000;14(suppl D):21D-25D.
http://www.ncbi.nlm.nih.gov/pubmed/11110608?tool=bestpractice.com
Cramp prevalence is significantly higher in patients with cirrhosis than in controls or in patients with chronic non-cirrhotic liver disease. In contrast to other populations, patients with cirrhosis more frequently exhibit cramping during rest rather than during sleep, and higher proportions of episodes involve the fingers and thighs.[24]Konikoff F, Theodor E. Painful muscle cramps. A symptom of liver cirrhosis? J Clin Gastroenterol. 1986;8:669-672.
http://www.ncbi.nlm.nih.gov/pubmed/3805668?tool=bestpractice.com
[25]Kobayashi Y, Kawasaki T, Yoshimi T, et al. Muscle cramps in chronic liver diseases and treatment with antispastic agent (eperisone hydrochloride). Dig Dis Sci. 1992;37:1145-1146.
http://www.ncbi.nlm.nih.gov/pubmed/1618065?tool=bestpractice.com
A number of other chronic medical conditions are associated with nocturnal leg cramps. These include depression, arthritis, cardiovascular disease, and respiratory disease.[11]Grandner MA, Winkelman JW. Nocturnal leg cramps: Prevalence and associations with demographics, sleep disturbance symptoms, medical conditions, and cardiometabolic risk factors. PLoS One. 2017;12(6):e0178465.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460850
http://www.ncbi.nlm.nih.gov/pubmed/28586374?tool=bestpractice.com
People taking strenuous exercise, particularly in endurance events such as triathlons, marathons, and ultramarathons, are predisposed to exercise-associated muscle cramps (EAMC).[28]Schwellnus MP, Drew N, Collins M. Muscle cramping in athletes - risk factors, clinical assessment, and management. Clin Sports Med. 2008;27:183-194.
http://www.ncbi.nlm.nih.gov/pubmed/18206574?tool=bestpractice.com
[29]Fallon KE. Musculoskeletal injuries in the ultramarathon: the 1990 Westfield Sydney to Melbourne run. Br J Sports Med. 1996;30:319-323.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1332416/pdf/brjsmed00008-0048.pdf
http://www.ncbi.nlm.nih.gov/pubmed/9015594?tool=bestpractice.com
[30]Maughan RJ, Shirreffs SM. Muscle cramping during exercise: causes, solutions, and questions remaining. Sports Med. 2019 Dec;49(suppl 2):115-24.
http://www.ncbi.nlm.nih.gov/pubmed/31696455?tool=bestpractice.com
People participating in team sports (e.g., rugby) also report high levels of EAMC.[28]Schwellnus MP, Drew N, Collins M. Muscle cramping in athletes - risk factors, clinical assessment, and management. Clin Sports Med. 2008;27:183-194.
http://www.ncbi.nlm.nih.gov/pubmed/18206574?tool=bestpractice.com
[30]Maughan RJ, Shirreffs SM. Muscle cramping during exercise: causes, solutions, and questions remaining. Sports Med. 2019 Dec;49(suppl 2):115-24.
http://www.ncbi.nlm.nih.gov/pubmed/31696455?tool=bestpractice.com