Night Time Leg Cramps: Perform These 3 Stretches Before Bed

Have you ever jumped out of bed with an intense cramp in your leg or foot?  Night time leg cramps occur suddenly and are extremely painful.  Pain can be sharp and last for a few seconds or several minutes.  They can lead to substantial sleep disturbances.

Nighttime cramps occur in almost 50% of older adults.  Medications are prescribed to treat people with severe leg cramps.  However, the effectiveness of these medications is mixed and many have serious side effects. Thankfully, there is a series of proven home stretching exercises you can perform to alleviate your nighttime leg cramps.

Causes and Treatment of Leg Cramps

Leg cramps are actually sustained involuntary muscle contractions of your calf, hamstrings, or foot muscles.  We don’t fully understand what causes these painful leg cramps.  Experts believe an abnormal activity of nerves is the most widely accepted cause.  The abnormal firing of nerves is due to medications (diuretics and steroids to name a few), physical inactivity, and age-related changes in your nerves, muscles, and tendons.  People with other health problems like thyroid disorders, high blood pressure, and neurological diseases are more at risk.

Foot cramp

Medications and supplements are commonly used to decrease the activity of the excited nerves in order to reduce leg cramping.  Quinine is moderately effective in reducing the frequency and intensity of cramps.  However, its use comes with the potential for serious and sometimes life-threatening side effects, especially in women.  Other medications have been used to treat leg cramps such as magnesium, Vitamin B, calcium, and Vitamin E; however, none of these appears to be effective.

Proven Stretches for Leg Cramps

The combination of physical inactivity and age-related changes in your nerves, muscles, and tendons predispose you to cramps at night.  Regular daily physical activity, such as a walking program, will increase lower leg blood flow to your nerves, muscles, and tendons.

Stretching exercises at night calm your excitable nerves and lengthen your shortened muscles and tendons.  A 2012 study of 80 adults over the age of 55, showed significant improvements in the severity and frequency of nighttime cramps after performing nightly stretches before bed.  The following 3 videos show stretches that are easily performed in 10 minutes or less prior to settling in for the night.

Standing Calf Stretch

Stand facing a wall with your elbows straight and both hands on the wall at chest level.  One leg is forward with your knee bent, and the other leg is back with your knee straight. Both feet are in full contact with the floor. Your back heel remains in contact with the floor as you lean towards the wall.

Hold the stretch for a minimum of 10 seconds and as long as 30 seconds.  Perform 2 to 3 stretches on each leg immediately prior to bed each night.

Standing Hamstring Stretch

Face a chair that is placed against a wall.  Place one heel on the chair with your knee fully straight.  Hold on to something for balance.  Bend at the waist so that your trunk tilts forward, keeping your back straight. The foot on the floor should maintain full contact and the other heel remains in contact with the chair.

Hold the stretch for a minimum of 10 seconds and as long as 30 seconds.  Perform 2 to 3 stretches on each leg immediately prior to bed each night.

Seated Hamstring Stretch

This stretch is similar to the standing version.  Not everyone will need to perform both.  To perform the sitting version sit on the side of your bed with one leg extended in front. The other foot maintains on the floor.  Bend at the waist so that your trunk tilts forward, keeping your back straight.

Hold the stretch for a minimum of 10 seconds and as long as 30 seconds.  Perform 2 to 3 stretches on each leg immediately prior to bed each night.

Start Stretching Tonight

Nighttime leg cramps can be miserable.  They severely disturb your sleep leaving you with little energy to do things during the day.  Regular nighttime stretching will alleviate much of the distress.  In order to achieve the best results, stretching must be done each night.  Infrequent or random stretching will do little good.

Give these 3 stretches a shot for at least 6 weeks and see how things are going.  If you want more help give us a call.  Our physical therapists can help you find the right stretches for you and supplement these with massage and other manual therapy treatments.   You don’t have to keep suffering from nighttime leg cramps.

Calf Muscle Strains:  Exercises for Your Best Recovery

Calf muscle strains are injuries to the muscles on the back of your leg, below your knee.  Two major muscles make up your calf.  The gastrocnemius muscle is the large outer muscle in the back of your lower leg.  The smaller soleus muscle lies underneath your gastrocnemius.  Both plantarflex the foot.  This occurs when the toes are pointed downward like when stepping on the gas pedal of a car.  These muscles are also highly active when pushing off during walking, running, or jumping.   Calf muscle injuries occur as a result of normal daily activities such as walking or stepping down from a curb.  Calf muscle injuries are also very common in sports such as tennis, football, soccer, and basketball.

leg muscle strain

Common symptoms of calf muscle injuries include sharp pain in the lower leg while walking or attempting to push off with your toes.   Older adults and athletes with a previous history of muscle strains are particularly susceptible to calf muscle injuries.  Larger individuals are also at an increased risk.  Calf muscle injuries are very slow to heel with full recovery sometimes taking 3 to 6 months.  They also tend to reoccur often, especially in athletes.  Thankfully, early rehabilitation can expedite your recovery from these nagging injuries.

Proven Treatment for Calf Muscle Strains

Traditionally, treatment for calf muscle injuries has included rest, ice, compression, and sometimes medications to control pain.  This approach will result in an initial decrease in pain.  However, a more aggressive approach is required to achieve the best long-term outcome.

A 2018 study from Denmark, investigated the effectiveness of early versus delayed physical therapy on recovery after muscle injuries.  Individuals receiving early physical therapy began treatment 2 days after their injury.  Compared to those who delayed treatment, early physical therapy made resulted in a pain-free recovery and return to sports 3 weeks sooner.  These findings suggest too much rest early after a muscle injury can result in a prolonged recovery.  The following exercises are components of this proven approach to recovery from calf muscle injuries.

Calf Stretch

It is important to maintain ankle range of motion and flexibility as your injured muscle heals.  Gentle stretching will help your injured muscle heal at its normal length.  Begin sitting with your knee straight and a towel or belt wrapped around the ball of your foot.  Gently pull your toes towards your shin and hold this stretch for 15 to 30 seconds.  Performing the exercise with your knee straight emphasizes the stretch to your gastrocnemius muscle.  Slightly bend your knee to emphasize stretching your soleus muscle.   Perform this stretch multiple times each day.

Calf Isometrics

It is important to begin muscle activation exercises early after your injury.  This will help diminish pain and facilitate blood flow to your healing muscle.  Slight pain (<5/10) is acceptable during exercise.  Sit with your knee extended and foot up against the wall or another immovable object.  Gently push your toes and foot down into the wall like you are stepping on the gas pedal of a car.  You will feel your calf muscle contract slightly.  Hold the contraction for at least 10 seconds.  Perform the exercise with your knee straight to emphasize activation of your gastrocnemius muscle.  Slightly bend your knee to emphasize your soleus muscle.  Perform this exercise multiple times daily.

Heel Raise Exercises

As  your pain decreases, progress from isometric to heel raise exercises.  This involves rising up on to your toes from a standing position.  Perform the exercise with your toes turned out to emphasize the inside aspect of your calf muscles.  This is where most calf muscle injuries occur. Perform the exercise with your toes turned in to emphasize the outer aspect of your calf muscles. Hold weights in your hands or use a bar over your shoulders to increase the load.  Perform 10 to 20 repetitions for multiple sets several days per week.

Final Thoughts on Calf Muscle Strains

Other treatments, such as manual therapy, can expedite your recovery from calf muscle strains.  More challenging balance and sport-specific exercises are incorporated as soon as your pain decreases and strength improves.  Pain free function takes several months.  However, starting the right exercises early is a proven approach.  These 3 exercises are only a small sample of an effective physical therapy program.  Your physical therapist can perform an individual assessment and design an exercise program based on your unique problems and goals.  Contact us today if you have questions about which exercises are right for you.

Painful Achilles Tendon? Learn the Right Exercises

Painful Achilles tendon disorders are common in people who perform repetitive running and jumping activities.  It is also common in less active people.  Sedentary individuals with chronic disease such as high blood pressure, obesity, and diabetes are at an increased risk.  Even though it is commonly injured, the Achilles tendon is one of the largest and strongest tendons in the human body.  It spans from the calf muscle in the lower leg down to its attachment on the heel.  It is important to transfer forces during routine walking and explosive movements in sport.

Irritation of the tendon is commonly referred to as “Achilles tendinitis” which implies the presence of inflammation.  However, studies show there is an absence of inflammation in most people who are suffering from a painful Achilles tendon.  It is now widely believed the problem is related to degeneration and weakening of the tendon, not inflammation.  This explains why many treatments aimed at reducing inflammation, such as rest and anti-inflammatory medications, are ineffective.

The Role of Exercise in Managing a Painful Achilles Tendon

Research suggests 3 out of 4 athletes with a painful Achilles tendon will fully recover with conservative treatment including exercise.  The prognosis for sedentary individuals is less favorable.   Regardless of age or activity level, 4 to 6 months of conservative treatment is recommended.  Research suggests exercise is the most successful conservative treatment for painful Achilles tendon disorders.   The focus of the exercise program is to progressively load and strengthen the painful tendon.

Some pain, usually 5/10 or less is acceptable during exercise.  However, increased pain experienced during exercise should not persist into the next day.  If this occurs, you would be best served to see your physical therapist.   Traditionally recommended exercise includes eccentrics characterized by slow lowering of the heel from a tip-toe position.  More recently, other forms of strengthening exercise have been shown to be equally effective.  The 4 exercises described here have been supported by research.

2-Leg Heel Raise

This is the first exercise to be performed as part of a progression.  Stand with equal weight distributed between both legs.  Hold on to a wall or other object for support.  Slowly rise up on both tip-toes.  Pause 2 seconds then slowly lower to the starting position.  Typically 3 sets of 15 repetitions are performed daily.  As pain diminishes and strength improves over a few weeks, begin performing this exercise with the heels hanging from a step.  This will increase the range of motion of the exercise and provide a stretch stimulus to the tendon.   The exercise can be further progressed by adding a backpack with 10 pounds of weight.

1-Leg Heel Raise

This exercise should be performed during the first few weeks along with the 2-leg exercise.  If pain greater than 5/10 persists after the exercise and into the next day, the 1-leg version may need to be delayed.  Discuss this with your physical therapist.  Start by standing on the involved leg only.  Slowly rise up on to the tip-toe.  Pause 2 seconds then slowly lower to the starting position.  Typically 3 sets of 15 repetitions are performed daily.  As pain diminishes and strength improves over a few weeks, begin performing this exercise with the heels hanging from a step.  This will increase the range of motion of the exercise and provide a stretch stimulus to the tendon.   The exercise can be further progressed by adding a backpack with weight.

Eccentric Heel Drop

This exercise can also be performed during the first few weeks along with the 2-leg and 1-leg exercises.  If pain greater than 5/10 persists after the exercise and into the next day, it may need to be delayed.  Discuss this with your physical therapist.  Start by standing on the uninvolved leg only.  Slowly rise up on to the tip-toe of the uninvolved leg.  Then shift the weight onto the involved leg.  Slowly lower to the starting position using the involved leg only.  Repeat this sequence of “up with the good” and “down with the bad” leg.  Typically 3 sets of 10 to 15 repetitions are performed.  As pain diminishes and strength improves over a few weeks, begin performing this exercise with the heels hanging from a step.  The exercise can be further progressed by adding a backpack with weight.

Heavy Slow Resistance Heel Raise

For many people with a painful Achilles tendon, performing the previous 3 exercises regularly will achieve outstanding results within 3 months.  However, many athletes involved in running and jumping sports will require higher loads to strengthen the injured tendon.  Heavy slow resistance exercise is performed with progressively higher loads performed very slowly.  The exercises are initially performed with loads which allow 3 sets of 15 repetitions.  Every 2 to 3 weeks, the load is increased and the repetitions are decreased.  The goal is to slowly perform 3 to 4 sets of 6 to 8 repetitions with high loads to fully stimulate tendon remodeling.  These exercises can be performed with a barbell on the back or with exercise machines such as a leg press or calf raise machine.

Speed Recovery by Combing Exercise with Manual Therapy

Achilles tendon

Many people will fully recover within 12 weeks to 1 year of performing the Achilles tendon loading exercises.  This length of recovery may not be acceptable for some people.  Thankfully, research shows greater improvements can be made when exercise is combined with manual therapy performed by a physical therapist.  One recent study showed the addition of soft tissue techniques resulted in 100% of patients achieving a successful outcome at 12 weeks compared to 50% who performed only exercise.   During each session 15 minutes of soft tissue mobilization is applied to the lower leg, ankle, and foot musculature.  The purpose is to improve mobility and further stimulate tendon healing and remodeling.

Closing Thoughts

Painful Achilles tendon disorders can be debilitating.  Thankfully, exercise and other conservative treatments delivered by a physical therapist have been proven to be effective.  Recovery is usually not quick or easy.  Success is dependent on your commitment to perform the exercises regularly.  Expect some pain during the exercise but don’t progress things too quickly if pain persists into the next day.  Often a little guidance from your physical therapist can keep you on the right track.  Contact your physical therapist if you would like some help.

3 Plantar Fasciitis Stretches for Heel Pain

Plantar fasciitis is the most common cause of heel pain in both athletes and older adults.  It is caused by degenerative changes in the plantar fascia of your foot.  Your plantar fascia is a thick band of ligaments that supports your arch.  The most common symptom is heel pain during your first few steps of walking.  Plantar fasciitis affects 10% of the population at some time in their life.  Plantar fasciitis stretches are effective at reducing your pain.  This article will show you 3 simple stretches to “heel” your pain.

plantar fasciitis exercises

Weakness of your lower leg and foot muscles contribute to this condition.  However, research has found inconsistent results when treatment includes strengthening exercises only.  Plantar fascia stretches are proven to be more useful for helping people with plantar fasciitis.   The remainder of this article discusses how you can alleviate pain from plantar fasciitis through regular stretching.

Plantar Fasciitis Stretches

A 2016 study performed in Brazil compared the effects of 3 different treatment approaches.  One group performed stretching exercises alone.  Another group performed stretching plus strengthening exercises for the foot.  The third group performed stretching plus strengthening for the foot and hips.

All 3 groups showed significant improvements in pain and function after 8 weeks of treatment.  However, there were no differences between groups.  This suggests adding strengthening exercises to a program of stretches confers no additional benefit.  Therefore, you will see the most improvements with regular stretching of your plantar fascia and calf.

Seated Plantar Fascia Stretch

Perform this exercise first thing in the morning before stepping out of your bed.  Sit on the side of your bed with your leg crossed over the other.  Grasp your heel with one hand.  Grasp the toes with your other hand.  Pull your toes back towards the top of your foot until you feel a mild to moderate stretch in the bottom of your foot.  Hold this stretch for 30 seconds and perform 3 repetitions.

Calf Muscle Stretch

Your plantar fascia is continuous with your Achilles tendon and calf muscle.  Therefore stretching is directed towards both of these areas.   Stand with your affected foot back.  Your heel remains in contact with the floor.  Lean towards the wall or a counter.  Keep your knee straight to stretch the larger gastrocnemius muscle.  Slightly bend your knee to stretch the deeper soleus muscle.  Stretch both muscles.  Hold each stretch for 30 seconds and perform 3 repetitions.

High-Load Heel Raises

This exercise is a hybrid stretching and strengthening exercise.  It utilizes the higher load of your body weight to stretch your plantar fascia.  It also provides a stimulus for the tissue to become stronger. This exercise is more effective if you have been experiencing heel pain for 3 months or longer.  Finally, expect some pain initially when performing this exercise.

Stand with both feet on a step with your heels hanging off the edge.  Place a small towel roll under your toes.  Rise up onto both toes over a period of approximately 3 seconds.  Remove your unaffected foot from the step once at the top of the movement.  Hold this position for 2 seconds.  Slowly lower your affected heel over a period of approximately 3 seconds.  Place your unaffected foot back on the step and repeat the sequence.  Perform 3 sets of 12 repetitions every other day.  Progress the exercise by incorporating a backpack with weights.

Closing Thoughts on Plantar Fasciitis Stretches

It is common for plantar fasciitis to last up to one year.  Thankfully, performing regular plantar fascia stretches will alleviate pain and speed up your recovery.  If you are experiencing heel pain, start with these 3 stretches.  Perform the first 2 daily, and the high-load heel raises every other day.

Your physical therapist can also design an individualized exercise program tailored to your unique needs.  Give us a call if you would like help getting started.

Plantar Fasciitis: The Role of Physical Therapy

Plantar fasciitis is one of the most commonly treated types of foot pain in physical therapy.  Overuse or repetitive stress to the bottom aspect of the foot is the most common cause.  It typically affects younger females however males are also likely to have symptoms. Older individuals are at risk for developing plantar fasciitis as well as athletes.  Individuals with an elevated body mass index are prone to heel pain and other foot conditions. Typically symptoms of plantar fasciitis will include pain on the bottom of the foot upon standing after prolonged inactivity or after an increase in activity.  This is common when runners increase their distances.  Symptoms may include chronic heel pain leading up to plantar fasciitis or chronic calf tightness.

What is Plantar Fasciitis?

The plantar fascia is a thick band of connective tissue that spans the bottom of the foot. It runs from the calcaneus (heel bone) down towards the toes.  The plantar fascia assists in walking by providing stability to the ankle and foot. In cases of plantar fasciitis, the tissue is “overloaded”.  This may cause pain that is most pronounced when standing for prolonged periods of time or upon standing after prolonged sitting. Chronic calf tightness or flat feet may be risk factors for developing plantar fasciitis.  However, any activity that increases the force on this structure may cause symptoms.

What can a Physical Therapist do for you?

Techniques utilized by a physical therapist can significantly decrease plantar fasciitis related symptoms. Some of these techniques include manual therapy to increase the ankle range of motion.  Improving ankle/foot range of motion through patient-specific exercise is also important. Your physical therapist may recommend exercises that reduce the load on the foot to start, including bike riding or swimming. Various athletic taping techniques have been proven to help reduce the load on the foot and allow the plantar fascia time to “rest”. These taping techniques have been shown to be an effective form of care in treating plantar fasciitis. Your physical therapist may also be able to assist you in an orthotic recommendation. Orthotics may be especially effective for individuals who respond well to taping techniques.

manual therapy for plantar fasciitis

Balance exercises are incorporated as symptoms improve.  Exercises to target hip and knee strength and range of motion impairments may also assist in improving symptoms. Calf and heel cord stretching is another effective method to reduce symptoms. These techniques will help progress a patient back to their sport or daily function without pain and allow for pain-free activity and improve your overall quality of life.  Talk to your physical therapist to see if your plantar fasciitis symptoms can be alleviated by some of these treatment options.

plantar fasciitis exercise

Conclusion

Plantar fasciitis is a common form of foot pain that impacts many lives and limits function.  Plantar fasciitis symptoms may resolve on its own over time, sometimes up to one year.  However, treatment by a physical therapist may assist alleviating pain at a rapid pace. No one treatment works best for everyone.  A physical therapist can assist you in determining the treatment plan that is going to be the most effective for you to reach your goals. There are many other forms of foot pain that may mimic plantar fasciitis. Your physical therapist can help in screening for these other types of injuries. Come to talk to your physical therapist today!

Written by Dr. Steve Ferro, PT, DPT, OCS

References

1.Martin R, Davenport T, Reishl, S, et al. Heel Pain–Plantar Fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy. 2014;44(11):A1-A33. DOI: 10.2519/jospt.2014.0303.

2.Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. American Family Physician. 2005;72:2237–2242.

3.Pollack Y, Sashua K, Kalichman L. Manual therapy for plantar heel pain. The Foot. 2018;34:11-16. DOI: 10.1016/j.foot.2017.08.001.

4.Stecco C, Corradin N, Macchi V, et al. Plantar fascia anatomy and its relationship with Achilles tendon and paratenon.  Journal of Anatomy. 2013;223(6):665-76. DOI: 10.1111/joa.12111.

Ankle Sprains: Diagnosis, Treatment and Return to Sport

What are Ankle Sprains?

Ankle sprains are one of the most common injuries that people experience.  These injuries account for one million physician visits each year.  Lateral ankle sprains, also known as inversion sprains, are the most common.  They are particularly common in sports.  Forty percent of all traumatic ankle sprains occur during sports.  However, only 50% seek medical attention. The lack of medical care results in an increased risk for developing chronic ankle stability.  There are 3 different grades of ankle sprains, which progressively worsen with each grade.  Healing times vary from a couple of days to up to 6 months depending on severity.

Grades of lateral ankle sprain

What are Lateral Ankle Sprains?

Lateral ankle sprains occur when the outside of the ankle is stressed .  This usually occurs when the ankle is forcefully turned inward. This can happen when stepping on an uneven surface or landing awkwardly after jumping. The lateral ankle sprain typically occurs with stress to 1 of the 3 ligaments that stabilize the outside of the ankle. Depending on whether the foot is up (dorsiflexed), neutral, or down (plantarflexed) different parts of lateral ankle ligaments can be injured.

Lateral ankle sprains

How does a Physical Therapist Diagnose a Lateral Ankle Sprain?

A physical therapist can use tests and measures to diagnose ankle sprains. Typically this will involve checking ROM (range of motion) and strength of the ankle and lower leg.   Additionally, special tests and joint mobilization testing  can bias the ligaments to determine which are involved.  Movement analysis such as the FMS (functional movement screen), hop testing, and running/agility tests can also be used to help determine some of the impairments that may have contributed to the ankle sprain.  If you are seeing a physical therapist with direct access (seeing a PT first without going to a physician) they will perform other tests and screening procedures to make sure physical therapy is appropriate.  If your physical therapist feels you need different services, he or she will direct you to the best healthcare provider.

How are Ankle Sprains Treated?

Depending where you are at in the recovery phase and your goals, a physical therapist will approach your care differently. Early in treatment crutches or a boot may be used and a physical therapist will focus more on pain, swelling and maintaining motion and strength.   As your recovery progresses, your treatment will progress to more active treatments.  This will include manual therapy to improve ankle motion,  proprioceptive training, training for return to activity and strengthening exercises targeting areas that the therapist has found to be weak.

How do you Know you are Ready to Return to Sports?

Physical therapists have a great deal of experience in determining if you are ready to return to sports, work, and other activities.   A few of the tests a physical therapist can use to determine if you are ready to go back to your sport are the FMS, Y-Balance test, hop testing, tuck jump assessment, and the Landing Error Scoring System.  A physical therapist can also give you recommendations on footwear and proper training tips to help avoid ankle sprains in the future.  Contact your physical therapist to learn more about managing ankles sprains.

References

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  4. McGuine TA,Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med 2006;34:1103–11
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