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I've started having painful leg cramps at night. The doctor is testing me to find out what might be causing it. She says it could be pregnancy (I'm too old), diabetes (I don't have that), a thyroid problem (they are checking for that), a side effect of medications (possible for me), and a long list of other things I don't even understand. If all these things can cause leg cramps, what's really happening inside my legs?
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There have been many attempts by scientists to answer this question. So far, the mechanisms of leg cramps remain a mystery. Clearly, leg cramps at night are more common than cramps during the day -- and not just because people are more aware of such things at night (i.e., less likely to notice while busy during the day).
Electrodiagnostic testing of the muscles in people with leg cramps shows that the motor units to the muscles begin to fire over and over without being asked to. This type of involuntary repetitive firing of the motor unit can cause muscle cramps. But what causes the involuntary repetitive firing? This also remains unknown.
There has been some suggestion that the motor units are abnormal. This makes some sense since leg cramps are more common in older adults and we know that we lose motor neurons as we get older. But it doesn't explain all the other cases in younger adults.
The fact that this symptom is more common at night might help scientists find an answer. Possibilities right now include a change in hydrostatic (water) pressure in the calf muscles from lying down for hours. The resulting shift of fluids then causes the motor neurons to fire repetitively, a condition referred to as hyperexcitability.
But again, this doesn't explain daytime leg cramps. So, some experts suggest it is the result of many factors that converge in one person at one time. And those factors might be different for different groups of people. More studies are needed to find out if this is the case -- or if there is some other explanation for leg cramps.
As your physician has suggested, there are some specific causes of leg cramps. But after all the testing, many patients come up empty-handed. There just isn't a clear cause with an effective treatment method. For you, if you do find that it's medication-related, then a change in meds can help. Some people find relief with other treatments such as acupuncture, massage, or physical therapy.
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