PMID- 33998664 OWN - NLM STAT- MEDLINE DCOM- 20210617 LR - 20230825 IS - 1469-493X (Electronic) IS - 1361-6137 (Linking) VI - 5 IP - 5 DP - 2021 May 17 TI - Non-drug therapies for the secondary prevention of lower limb muscle cramps. PG - CD008496 LID - 10.1002/14651858.CD008496.pub3 [doi] LID - CD008496 AB - BACKGROUND: Lower limb muscle cramps are common and painful. They can limit exercise participation, and reduce quality of sleep, and quality of life. Many interventions are available for lower limb cramps; some are controversial or could cause harm, and often, people experience no benefit from the interventions used. This is an update of a Cochrane Review first published in 2012. We updated the review to incorporate new evidence. OBJECTIVES: To assess the effects of non-drug, non-invasive therapies for lower limb muscle cramps. SEARCH METHODS: In August 2018 and May 2020, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and reference lists of included studies. We imposed no restrictions by language or publication date. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) of non-drug, non-invasive interventions tested over at least four weeks, for lower limb muscle cramps in any group of people, except pregnant women. The primary outcome was cramp frequency. Secondary outcomes were cramp pain severity, cramp duration, health-related quality of life, quality of sleep, participation in activities of daily living, proportion of participants reporting lower limb muscle cramps, and adverse events. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed risk of bias, and cross-checked data extraction and analyses according to standard Cochrane procedures. MAIN RESULTS: We included three trials, with 201 participants, all 50 years of age and older; none had neurological disease. All trials evaluated a form of stretching for lower limb muscle cramps. A combination of daily calf and hamstring stretching for six weeks may reduce the severity of night-time lower limb muscle cramps (measured on a 10 cm visual analogue scale (VAS) where 0 = no pain and 10 cm = worst pain imaginable) in people aged 55 years and older, compared to no intervention (mean difference (MD) -1.30, 95% confidence interval (CI) -1.74 to -0.86; 1 RCT, 80 participants; low-certainty evidence). The certainty of evidence was very low for cramp frequency (change in number of cramps per night from week zero to week six) comparing the stretching group and the no intervention group (MD -1.2, 95% CI -1.8 to -0.6; 80 participants; very low-certainty evidence). Calf stretching alone for 12 weeks may make little to no difference to the frequency of night-time lower limb muscle cramps in people aged 60 years and older (stretching group median number of cramps in the last four weeks (Md) 4, interquartile range (IQR) 8; N = 48; sham stretching group Md 3, IQR 7.63; N = 46) (U = 973.5, z = -0.995, P = 0.32, r = 0.10; 1 RCT, 94 participants; low-certainty evidence). This trial did not report cramp severity. The evidence is very uncertain about the effects of a combination of daily calf, quadriceps, and hamstring stretching on the frequency and severity of leg cramps in 50- to 60-year-old women with metabolic syndrome (N = 24). It was not possible to fully analyse the frequency data and the scale used to measure cramp severity is not validated. No study reported health-related quality of life, quality of sleep, or participation in activities of daily living. No participant in these three studies reported adverse events. The evidence for adverse events was of moderate certainty as the studies were too small to detect uncommon events. In two of the three studies, outcomes were at risk of recall bias, and tools used to measure outcomes were not validated. Due to limitations in study designs that led to risks of bias, and imprecise findings with wide CIs, we cannot be certain that findings of future studies will be similar to those presented in this review. AUTHORS' CONCLUSIONS: A combination of daily calf and hamstring stretching for six weeks may reduce the severity of night-time lower limb muscle cramps in people aged 55 years and older, but the effect on cramp frequency is uncertain. Calf stretching alone compared to sham stretching for 12 weeks may make little or no difference to the frequency of night-time lower limb muscle cramps in people aged 60 years and older. The evidence is very uncertain about the effects of a combination of daily calf, quadriceps, and hamstring stretching on the frequency and severity of leg cramps in 50- to 60-year-old women with metabolic syndrome. Overall, use of unvalidated outcome measures and inconsistent diagnostic criteria make it difficult to compare the studies and apply findings to clinical practice. Given the prevalence and impact of lower limb muscle cramps, there is a pressing need to carefully evaluate many of the commonly recommended and emerging non-drug therapies in well-designed RCTs across all types of lower limb muscle cramps. A specific cramp outcome tool should be developed and validated for use in future research. CI - Copyright (c) 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. FAU - Hawke, Fiona AU - Hawke F AD - School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, Australia. FAU - Sadler, Sean G AU - Sadler SG AD - School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, Australia. FAU - Katzberg, Hans Dieter AU - Katzberg HD AD - Department of Neuromuscular Medicine, University of Toronto, Toronto General Hospital / UHN, Toronto, Canada. FAU - Pourkazemi, Fereshteh AU - Pourkazemi F AD - University of Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, Australia. FAU - Chuter, Vivienne AU - Chuter V AD - School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, Australia. FAU - Burns, Joshua AU - Burns J AD - University of Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, Australia. AD - The Children's Hospital at Westmead, Sydney, Australia. LA - eng SI - ClinicalTrials.gov/NCT03864770 PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20210517 PL - England TA - Cochrane Database Syst Rev JT - The Cochrane database of systematic reviews JID - 100909747 RN - 0 (Muscle Relaxants, Central) RN - A7V27PHC7A (Quinine) SB - IM UOF - Cochrane Database Syst Rev. 2012 Jan 18;1:CD008496. PMID: 22258986 MH - Activities of Daily Living MH - Age Factors MH - Aged MH - Bias MH - Female MH - Hamstring Muscles MH - Humans MH - Leg MH - *Lower Extremity MH - Male MH - Middle Aged MH - Muscle Cramp/*prevention & control MH - Muscle Relaxants, Central/therapeutic use MH - *Muscle Stretching Exercises MH - Pain Measurement MH - Quinine/therapeutic use MH - Randomized Controlled Trials as Topic MH - Secondary Prevention/*methods PMC - PMC8127570 COIS- FH: none known; FH is a podiatrist and manages people with muscle cramps. SS: none known; SS is a podiatrist and manages people with muscle cramps. HK: non known; HK is a neurologist and manages people with muscle cramps. VC: none known; VC is a podiatrist and manages people with muscle cramps. JB receives research funding from NIH (National Institute of Neurological Diseases and Stroke and National Center for Advancing Translational Sciences, Inherited Neuropathies Consortium, Rare Disease Clinical Research Network #2U54NS065712), Charcot-Marie Tooth Association of Australia, Charcot-Marie Tooth Association (USA), Diabetes Australia, Multiple Sclerosis Research Australia, Sydney Southeast Asia Centre, New Zealand Neuromuscular Research Foundation Trust, Elizabeth Lottie May Rosenthal Bone Bequest and Perpetual Limited. JB is a podiatrist and manages people with muscle cramps. EDAT- 2021/05/18 06:00 MHDA- 2021/06/22 06:00 PMCR- 2022/05/17 CRDT- 2021/05/17 08:54 PHST- 2021/05/17 08:54 [entrez] PHST- 2021/05/18 06:00 [pubmed] PHST- 2021/06/22 06:00 [medline] PHST- 2022/05/17 00:00 [pmc-release] AID - CD008496.pub3 [pii] AID - 10.1002/14651858.CD008496.pub3 [doi] PST - epublish SO - Cochrane Database Syst Rev. 2021 May 17;5(5):CD008496. doi: 10.1002/14651858.CD008496.pub3.