What are the recommended non-pharmacological interventions for managing nocturnal leg cramps in adults?

Recommended non-pharmacological interventions for managing nocturnal leg cramps in adults include:

• Reassurance that idiopathic leg cramps are common, usually have no serious underlying cause, and can resolve spontaneously.
• Advice to alleviate an acute cramp by stretching and massaging the affected muscle(s), for example, straightening the leg and dorsiflexing the ankle if the calf is affected.
• Daily stretching exercises of the affected muscles, such as combined calf and hamstring stretches, may reduce the severity of nocturnal leg cramps, although evidence is weak and no standard protocol exists.
• Self-care advice to limit dorsiflexion of the foot during sleep, such as propping feet up with a pillow when lying supine, hanging feet over the bed edge when prone, and keeping bed covers loose to avoid toes pointing downwards.
• Offering written self-care information, such as NHS patient leaflets on leg cramps, including instructions on calf stretching exercises.
• Consideration of analgesia for muscle tenderness after cramps, though analgesia during cramps is impractical due to their short duration.

These measures are based largely on expert opinion and anecdotal evidence, as there is limited high-quality evidence supporting their effectiveness, but they represent pragmatic and safe first-line approaches in primary care ¹.