BACKGROUND: Up to 33% of the general population over 50 years of age are affected by nocturnal leg cramps. Currently there are no generally accepted clinical characteristics, which identify nocturnal leg cramps. This study aims to identify these clinical characteristics and to differentiate between them and the characteristics of restless leg syndrome and periodic limb disorder.METHOD: A systematic literature study was executed from December 2015 to May 2016. This study comprised of a systematic literature review of randomized clinical trials, observational studies on nocturnal and rest cramps of legs and other muscles, and other systematic and narrative reviews. Two researchers independently extracted literature data and analyzed this using a standardized reviewing protocol. Modified versions of the Cochrane Collaboration tools assessed the risk of bias. A Delphi study was conducted to assess agreement on the characteristics of nocturnal leg cramps.RESULTS: After systematic and manual searches, eight randomized trials and ten observational studies were included. On the basis of these we identified seven diagnostic characteristics of nocturnal leg cramps: intense pain, period of duration from seconds to maximum 10 minutes, location in calf or foot, location seldom in thigh or hamstrings, persistent subsequent pain, sleep disruption and distress.CONCLUSION: The seven above characteristics will enhance recognition of the condition, and help clinicians make a clear distinction between NLC and other sleep-related musculoskeletal disorder among older adults.
Last year we published a randomised trial demonstrating that stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults (Hallegraeff et al 2012). The results of that study align perfectly with the uncontrolled study of Daniell (1979). In a recent letter to this journal, Daniell and Pentrack (2013) proposed an alternative stretching procedure for preventing nocturnal leg cramps. Some major differences can be identified between their new stretching procedure and the procedure used in our study.
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In 2012, our randomised trial demonstrated that stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults.1 These episodic cramp attacks are characteristic: painful, sustained, involuntary muscle contractions of the calf muscles, hamstrings or feet. The sharp and intense pain may last from seconds to several minutes, accompanied by firm and tender muscles, and in some cases, with plantar flexion of feet and toes.2–5 In his letter, Garrison argues that prophylactic stretching is unlikely to prevent nocturnal leg cramps.
