In 2018, when this blog was started, one of my first posts was titled, “Leg Cramps: A Real Pain.” You can read this article on DrGOpines.com by clicking on either the “Aging” or “Bone and Joint Problems” in the “Categories” column in the lower right of the home page, or clicking the “Search” icon and typing in “Leg Cramps.”
It’s interesting to read that article and compare it to the information shared in a January 27, 2025 essay found on Medscape Internal Medicine. Titled “How to Manage Nocturnal Leg Cramps,” this article proposes a completely different method of treatment barely mentioned six years ago.
This article starts with a multiple choice question asking “What do you recommend to help prevent leg cramps?”
The choices are:
1. Magnesium supplementation
2. Verapamil
3. Calf-stretching exercises
4. Hydroxychloroquine
5. Spironolactone
In 2025, the answer is no. 3– calf-stretching exercises. The patient should first stop any medications (beta-agonists, potassium-sparing diuretics) that trigger cramps, then begin stretching calf and hamstring muscles at bedtime. A big study of leg cramps found conclusively that patients who did calf stretching at bedtime had reduced cramping frequency and severity.
Another recommendation is the use of Vitamin K2. Compared to placebo, vitamin K2 patients experienced “a reduction in the mean weekly frequency of cramps to just fewer than one cramp per week.” Placebo patients still had 3.5 cramps per week.
Magnesium does not provide for significant prevention of leg cramps. Quinine, which used to be the gold standard, has been taken off the market for significant safety issues. Vitamin K2 and calf stretching exercises are the best options for muscle cramp prevention.
Reference: Paauw DS. How to Manage Nocturnal Leg Cramps Medscape Internal Medicine 2025 January 27.
