On a startlingly clear summer night several weeks ago, I was enjoying an outdoor grilling with friends on an upper-story deck overlooking mountains, with birds flitting in the trees next to us and a breeze providing the perfect temperature after an uncomfortably hot day. Following a lovely dinner, a bottle of wine and a bit of dessert, we broke out the cards. Even though I was concentrating on a new game, the whole environment lent itself to conversations, which drifted leisurely around via ‘whatever pops into the mind’ consciousness. As is rather typical for those 50 and older, after catching up on mutual friends, politics came first, house projects next and then ultimately health issues and aches and pains. Yep! No surprise. Specifically, our conversation turned to the good ol’ fashion ‘charley horse,’ which one of my card-playing companions had experienced recently.
Most readers are more familiar with the term charley horse than they would choose, especially considering that according to studies up to 50% of those over 60 years old suffer the situation on a regular basis. Ouch. I have had a few, even in my 30s and 40s. Luckily this didn’t happen to me often. But as is common, they woke me from deep sleep with expressions of pain already formed on my lips and likely showing on my face. My dad used to get them as well, but more frequently. Unquestionably, he was not serving as a role-model for little ears when it happened. Can’t blame him.
Interestingly enough, charley horse is strictly an American term; and as an older group we are much too familiar with it. Stories accounting the origin of the nickname are not well documented and vary greatly. The only thing they agree upon is that it came out of the sport of baseball (and was first mentioned in print around 1886). But who Charley was and whether his horse was lame remains a mystery. Other countries, less creative in their nomenclature, simply call it a leg cramp.
The Details
A charley horse is not, as some people think, a strain. A strain results from a muscle stretched too far (or even torn if it is severe enough). Likewise, it has nothing in common with Restless Leg Syndrome (RLS) either, aside from the tendency of both to disrupt your sleep. RLS can last for hours and create an overwhelming urge to move or walk, but it lacks the powerful tell-tale pain of the charley horse.
We say ‘cramp,’ but what do we mean by that? It occurs when a muscle suddenly tightens (contracts). It is a forceful – almost violent – contraction. Worse is that it contracts – contracts – contracts with no relax – relax – relax in between the contractions. While such cramps can occur in any muscle, generally it is muscle that crosses 2 joints, and most often happens in the lower extremity. Hence, the charley horse is born.
Despite my own experiences with these spasms being rare, two nights following our deck dinner, I gave a silent little scream around 3:00 am and reached to massage my poor calf muscle. Ah, you think, this was perhaps the power of suggestion? Probably not however. Looking back over my week before this time I could figure out at least two contributing factors.
Charley may Know Why his Horse is Briefly Lame?
The dynamics I know led to my nighttime agony were two of the many common factors:
- Dehydration (due to a lot of walking during a few very hot days, probably accompanied by an electrolyte imbalance, and more wine than usual).
- New shoes on a long walk (with less of an arch than I am accustomed to, and which can also disturb the balance of one’s gait).
Exploring the dehydration issue a bit more, while it is commonly included in advice about the charley horse, its connection has not clearly been proven. Still, it appears an anecdotal straight arrow correlation when evaluated by general physicians and suffers. The role that dehydration plays in electrolyte or mineral imbalances may be key. Depletion of calcium, potassium, magnesium and even salt are prime culprits to developing such spasm (either charley horse or otherwise). Dietary issues (along with extra fluids) are a good starting point for preventative action. Take a look at the chart I prepared to consider these yummy salubrious additions to your meals. They are rich in the necessary relevant minerals. Notice the players that repeat (some under each column).
Foods Rich in 3 Minerals
| Potassium | Magnesium | Calcium |
| Dark Green Leafy Veggies | Dark Green Leafy Veggies | Dark Green Leafy Veggies |
| Soybeans (Edamame) | Soybeans (Edamame) | Soybeans (Edamame) |
| Yogurt | Yogurt | Yogurt |
| Bananas | Bananas | Bananas (moderate) |
| Beans | Beans | Beans |
| Fish | Fish | Fish |
| Nuts & Seeds (moderate) | Nuts and Seeds | Nuts and Seeds. Almonds, sunflower seeds, etc. |
| Dark chocolate | Dark chocolate | * See note |
| Orange or carrot juice | Avocado | Sardines |
| Milk | Milk | |
| Squash & sweet potatoes | Cheese | |
| Beets & Beet greens | Tofu | |
| Clams | Figs | |
| Prunes | Enriched breads & grains | |
| Molasses | “Fortified” products: OJ, cereals, soymilk, etc. |
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* The jury is still out regarding the effect of chocolate on calcium absorption. Oxalate (a product in cocoa) has been shown to inhibit calcium absorption. This is of little concern with diets that are high in calcium-rich foods. Some new calcium supplements (powders and candies) even include cocoa products.
The #1 Culprit as we Age
I have to include a frequent cause not actually personal to me. I don’t take medications (at least not currently), but many muscle spasms occur due to side-effects of medications. As people tend to take more medications as they age, this complication is increased with age as well. [It is difficult to know if it is the medications, poor blood circulation to lower extremities, or a combination that produces the 50% of regular older sufferers.] The number and kinds of pharmaceuticals with this warning are significant. Below is a partial list to watch for. Don’t assume that if you are prescribed one of these medicines that this means you will have a charley horse. But if I was taking one of them and experienced a spasm a couple times a week, I would look into getting help, and perhaps changing medications. One reason that this spasm–medication connection should be explored is that the overt symptoms might represent more systemic conditions.
Some classes & individual drugs* with relationship to leg cramps (or muscle spasm):
- Statins (used to treat high cholesterol). Examples: Lipitor (atorvastatin), Lescol (fluvastatin), Mevacor (lovastatin), Pravachol (pravastatin), Crestor (rosuvastatin), Zocor (simvastatin).
- Corticosteroids (used to reduce inflammation in conditions like arthritis, lupus, and rashes). Example: prednisone.
- Diuretics (‘water pills’ – used to treat high blood pressure and heart failure). Examples: Microzide (hydrochlorothiazide) and Lasix or generics (furosemide).
- Alzheimer’s drug. Example: Aricept (donepezil).
- Mental health drugs. Examples phenothiazines (tranquilizing drugs), lithium (bipolar disorders).
- Asthma medications. Examples: Brethine (terbutaline), Ventolin or Proventil (albuterol sulfate).
- Osteoporosis treatment. Example: Evista (raloxifene).
- Blood pressure and angina treatments. Examples: Adalat, Nifedical, Procardia and generics (nifedipine).
- Myasthenia gravis. Example: Prostigmine (neostigmine).
- Parkinson’s. Example: Tasmar (tolcapone).
- High cholesterol. Example: Niacin (nicotinic acid) an over-the-counter B-vitamin used in high doses in place of statins or similar drugs.
*Note: chart complied from numerous sources including Mayo Clinic, Webmd, Drugs.com, individual pharmaceutical references and Consumer’s Reports, among others.
Skip the Quinine
For those who remember their history book lessons, you may recall that quinine (customarily attributed to a product of the Cinchona tree) was used to treat malaria, quite effectively. Later in the 1940s, doctors started prescribing doses of 200-300 mg to treat leg spasms. But in 2010, the FDA banned its use for that purpose. While quinine is still available for treatment, especially from Canadian on-line sites, it is banned by the FDA for a reason – and not just to make more money for pharma companies selling opposing chemical options. It really does have some potentially serious risks. Some of the side effects are related to moderate to severe hypoglycemia, skin conditions like rashes, hives, vision and hearing loss, blood and organ problems (including cardiac, kidney and lung), severe stomach, colon and intestinal reactions. Additionally, it can interact with many other medications. Why take chances?
‘Tonic water’ (containing quinine) was created into a concoction adding sugar and gin, first adopted by British soldiers to make malaria medicine more tolerable. A spoonful-of-sugar, and all that. But, the amount of quinine in your gin and tonic is about 20 mg/glass – so pretty harmless except for the most extreme of sensitive reactions.
Personally, I love my gin and tonic and realize that at 20 mg/glass, the alcohol probably carries a lot more worrisome baggage than the tonic water. I’ll keep drinking it. Furthermore, I have no love for the FDA, who I suspect sometimes of unfairly picking and choosing the winners and losers. Despite both of those points, I would not take quinine to treat leg cramps.
Nerve Compression?
Compression of nerves in the spine can lead to a myriad of problems, but I wouldn’t schedule the MRI as my first step after a leg cramp. [Of course, any step after a leg cramp would be difficult.] Recurrent charley horses may require aggressive management, but the course of action should first start at home. Some good-habit changes (like appropriate exercise, stretching and added nutrition) can alleviate many irritated nerves (just ask your chiropractor). And even consumption of certain foods (mentioned earlier) along with adequate hydration may assuage nerve inflammation. If I suspected severe nerve compression as a cause of frequent charley horse pain, my own regimen might still come first, followed by myofascial release technique, chiropractic treatments, physical therapy or anti-spasmodic meds (probably in that order) and perhaps before my first MRI, but definitely before more aggressive or invasive treatments.
Bed Time as a Useful Time
When I woke with my recent charley horse (stifling my whimpers) and began massaging, likely I was doing the same as you have done, if you ever had this spasm. It is our instinct, and it turns out to be a good one. Common advice to stand up and do lunges or other maneuvers might seem laughable to those writhing in their short-term agony. It’s not bad advice. I just wonder how many would follow it. I doubt that I would. There are other recommendations you might find less daunting. Certainly the points made previously in this post will not ensure you never get a charley horse, but it’s a good start.
Further, these bedtime suggestions, together with recommendations above, will provide us a significant chance at drastically reducing such occurrences, or avoiding onset if you have never known a charley horse.
- Don’t avoid fluids in the evening due to nocturia concerns.
- If you get up to urinate during the night, take the opportunity to stretch the calves. Point toes up toward the nose and then down to the ground (several repetitions).
- Perform the same motion above when you retire for the evening. Add to it by lying on your side and bringing your heel up to your behind (performed on both sides).
- Try to change position while you sleep. Long-held awkward positions encourage spasms.
- Loosen the bed covers. Loosening the sheets and blankets will keep weight off your feet and is especially useful to those who sleep on their backs (although sleeping on your side with legs bent will also help).
Final Thought
Because so many small aches and pains crop up with age, it can occasionally feel depressing. However, the charley horse (like many of the others) need not be a losing battle. You don’t have to take it lying down. And best of all, with just a little extra thought and a tiny bit more attention to certain habits, you can avoid it altogether.
So…..back to the original question.
How do you Stop a Charley Horse?
You now have the most important of home-tools, but
most people just shout WHOA.
Pic credits: Cover hand puppet: reddit.com; Massage of leg pic: goodeveningworld.com; calf muscle pics:popsugar.com
Appreciated the article on leg cramps. Dr. Oz Says: The #1 Cause of Leg Cramps (and ALL Other Muscle Cramps) is Magnesium Deficiency. That seemed to be true for me. I found that drinking milk caused me to have leg cramps.The calcium/magnesium imbalance in the body is one cause of leg cramps. When I began to take Magnesium Citrate regularly, my leg cramps all but disappeared. I keep a homeopathic remedy ( no quinine in it) for leg cramps at my bedside with a glass of water. If a stretch in bed causes a cramp, I take the remedy ( 4 tablets that dissolve in the mouth) and drink water. After a few minutes of standing on the leg, the pain goes away and I can go back to sleep.
Glad you have a plan for yourself. Thanks for sharing as others might find the same remedies useful. drB