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, which may be the most helpful intervention if cramps do not affect quality of life.
• To alleviate an acute cramp attack, advise stretching and massaging the affected muscle(s), for example, straightening the leg and dorsiflexing the ankle if the calf is affected.
• Self-care advice to reduce frequency includes performing stretching exercises of the affected muscles three times daily; combined daily calf and hamstring stretching may reduce severity of nocturnal cramps, although evidence is weak and no standard protocol exists.
• Sleeping advice to limit dorsiflexion of the foot, such as propping feet up with a pillow when lying supine, hanging feet over the bed edge when prone, and keeping blankets loose to avoid heavy covers, is suggested based on expert opinion.
• Offer written self-care information, such as NHS patient leaflets on leg cramps, which include instructions on calf stretching exercises.
• Consider analgesia for muscle tenderness after cramps, though analgesics are impractical during cramps due to their short duration.

These non-pharmacological measures are based largely on expert opinion and anecdotal evidence, as there is limited high-quality evidence supporting their effectiveness, but they are considered safe and pragmatic first-line approaches before considering pharmacological treatments.

Pharmacological treatments like quinine are generally not recommended routinely due to safety concerns and limited benefit, and other drugs lack strong evidence for use in idiopathic leg cramps.

Patients should be advised to return if the frequency, severity, or nature of cramps changes or if they impact quality of life.

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