by Baxter

A Woman’s Legs by Vincent van Gogh

Recently while reading through one of my Family Medicine journals, I came across an article that caught my interest due to the frequent complaints of some of my students.  It was on nocturnal leg cramps.  Yes, quite often my students will ask me what they can do to address these ill-timed leg cramps (as if there is any good time for a leg cramp!).  I’ll get into what we know about the nocturnal leg cramps (NLCs) in a minute, but what caught my eye in reading was the recommendation for treatment:

“Limited evidence supports treating NLCs with exercise and stretching…”

Now, they don’t specify yoga, but as we all know by now, modern yoga would fit the bill. This treatment was recommended before any mention of medications, which is quite unusual for these journal articles.  It is usually the other way around—meds first, non-drug options mentioned last. This gave me a great sense of hope that modern medicine is beginning to grasp the benefit of starting with non-drug treatments for some conditions!

So what are these NLCs and how common are they? Well, according to the American Academy of Family Practice, they are super common, with up to 60% of adults reporting they get these kind of leg cramps.  They are described as recurrent, painful tightening of muscles in the legs, usually the calf muscles. And the NLCs can contribute significantly to insomnia. The exact cause in not known, but they hypothesize that the cramps are probably caused by muscle fatigue or nerve dysfunction, as opposed to low levels of blood electrolytes like sodium, potassium and such, or from other abnormalities.

Just to flesh out the symptoms of NLCs, they are painful and incapacitating, like no walking while they are occurring! They last an average of nine minutes per episode, and the first bout can be followed by hours of recurrent episodes and residual pain. Even though the calf is the most common muscle affected, cramps in the feet and thighs are also fairly common. Sufferers describe them as a spasm, tightening, twinge, strain, or a muscle seizure. And they are usually in one leg, and can cause the limb to move.

Folks with other conditions are sometimes more likely to have NLCs, such as those with vascular diseases, lumbar canal stenosis (narrowing of the spinal cord channel in the lower back), cirrhosis of the liver, patients on hemodialysis, and those who are pregnant, to name a few. Certain medications are also associated with NLCs, such as estrogen, Naprosyn and others. So, definitely check that out with your family MD if you start having them. NLCs are different from other conditions that might seem similar, like restless leg syndrome, claudication (cramps due to vascular narrowing of blood vessels in legs that occur with walking), myositis (muscle inflammation), and peripheral neuropathy (which has many causes).  So you do need to get checked out with your doc to rule out these other conditions, which may not respond to yoga so favorably.

Once you have been diagnosed, you will obviously want to do something to diminish the number of attacks or completely prevent them. A yoga asana approach would include practices and poses that bring movement and stretching to the lower legs, as well as practices that quiet the nervous system, as nerve dysfunction is one of the purported causes of NLCs. I’d start by reclining on the back and doing Thread the Needle pose (Sucirandhrasana), also known as Eye of the Needle or Figure 4 pose. Focus on circling your ankles as well as flexing and extending your foot at the ankle joint.

From there, I’d take one leg up into Reclined Leg Stretch pose. Start with the strap on your heel pad for a few breaths, move it to the arch of your foot for a few breaths, and finally place it on the ball of your foot and more actively pull down with the strap as you push up with the heel of the foot. This last variation will likely give you the most feeling of stretch in the calf muscles, which include the superficial gastrocnemius, the deep soleus, the posterior-lateral peroneus longus, and the posterior-medial tibialis posterior.

Many of the standing poses will bring some stretch to your calves and feet, especially the back foot in poses like Warrior 1 and Pyramid pose (Parsvottanasana). But even Warrior 2, Triangle pose and Extended Side Angle pose (Parsvokanasana) will provide a little stretch to the area, and might be better starting poses for newer students with lots of tightness in that calves. Wall Calf Stretch (a modified version of Warrior 1 with the toes of your front foot touching the wall and either hands or forearms on the wall) really isolates the calf muscles nicely, too. There are other poses that will have some nice benefits for the calves as well, like versions of Childs pose that will bring some stretching pressure and compression from the thigh bones and body down onto the calves and lend to some widening of the muscles. So throw a few Childs poses in the mix. And you can fulfill the “exercise” part of the recommendation by doing more active flowing practices, which will encourage warming and improved circulation to the lower extremities. And finishing off with some supported inversions like Legs Up the Wall or Chair Shoulderstand will release increased blood pressure from the legs for a bit, which could have a lovely calming effect on your legs, as well as your nervous system.

Pranayama practices that quiet the nervous system, like extending the exhalation (perhaps a 1:2 ratio of inhale to exhale) and others would be of great benefit, as would a body scan meditation, where you encourage all of the muscles of your body to release deeply.  Such a meditation could be done just prior to bed to prepare you for a good night’s sleep. There are, of course, other options you could include, but this will get you or your students started if nocturnal leg cramps are disturbing your rest. Let us know if you have a favorite calf release that I did not mention. We love your feedback!

 

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