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Bedtime leg stretching reduces frequency and severity of nocturnal leg cramps

Clinical Question:
Do leg stretching exercises immediately before bedtime reduce the frequency and severity of nocturnal leg cramps in older adults?

Bottom Line:
Exercises for stretching calf and hamstrings muscles immediately before bedtime significantly reduce both the frequency and severity of nocturnal leg cramps in older adults. (LOE = 1b-)

Reference:
Hallegraeff JM, van der Schans CP, de Ruiter R, de Greef MH. Stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults: A randomized trial. J Physiotherapy 2012;58(1):17-22.  [PMID:22341378]

Study Design:
Randomized controlled trial (single-blinded)

Funding:
Unknown/not stated

Allocation:
Concealed

Setting:
Outpatient (any)

Synopsis:
The value of bedtime exercises in the treatment of nocturnal leg cramps is currently uncertain. These investigators enrolled 80 consenting adults, 55 years or older, experiencing nocturnal leg cramps at least once per week. Exclusion criteria included current use of quinine or sleep-assisting medication. Patients randomly received (concealed allocation assignment) instructions on daily leg stretches before sleep or were advised not to stretch at all. Stretches used in the experimental group included calf stretch while standing, hamstrings stretch while standing, and hamstrings and calf stretch while sitting (see the original article for pictures and more detailed print directions on performing the maneuvers). Individual patients, unmasked to their treatment group assignment, self-assessed outcomes using daily diaries. Outcomes included the change in the average number of nocturnal leg cramps per day and the severity of nocturnal leg cramps as measured on a 10-cm visual analog scale ( VAS; from 0 = no pain to 10 = the worst pain imaginable). Complete follow-up occurred for all patients at 6 weeks. Using intention-to-treat analysis, the frequency of nocturnal leg cramps reduced significantly more in the experimental group than in the control group (1.2 fewer cramps per night 95% CI, 0.6 - 1.8). The severity of cramps did not improve in the control group, but was significantly reduced in the experimental group (1.3 cm less than baseline on the 10-cm VAS). In most studies using a 10-cm VAS pain scale, a change of at least 2 cm is needed to be considered clinically significant.

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