Cupping Therapy and Nocturnal Leg Cramps

Original Editor - Rujuta Naik

What Are Nocturnal Leg Cramps?[edit | edit source]

Nocturnal Leg Cramps (NLC) are muscle spasms that occur during the night, usually in the lower legs and feet. They can cause sudden, intense pain in the calf or foot muscles, and can last anywhere from a few seconds to several minutes.[1] While they are not typically considered a serious condition, NLC can be very uncomfortable and disruptive to sleep patterns. NLC is a common problem and can affect people of all ages, but is more common in adults over age 50. Risk factors for NLC include dehydration, electrolyte imbalance, varicose veins, chronic illnesses, and certain medications. Existing prevalence data suggest that 37–50% of older adults have Nocturnal leg cramps (NLC) commonly occurring in the calf, hamstrings, or foot which are characterized as intensely painful, involuntary muscle contractions lasting from mere seconds to a maximum of 10 min.[1]

Diagnostic Criteria for NLC[edit | edit source]

The patient's history is the key to identifying the possible cause of leg cramps. The diagnostic criteria for sleep-related leg cramps put forth by the American Academy of Sleep Medicine are as follows[2]:

  1. a painful sensation in the leg or foot may be caused by a sudden contraction of the muscles; the feeling of the muscle being hard or tight
  2. the painful muscle contractions in the legs or feet occur during sleep, although they may occur during wakefulness as well;
  3. by stretching the affected muscles, the pain is relieved
  4. the symptoms of leg cramps that occur during sleep are not better explained by another existing sleep disorder, medical or neurologic condition, medication use, or substance use disorder

Traditional Treatments for Nocturnal Leg Cramps[edit | edit source]

Aside from quinine and hydroquinone, the effectiveness of pharmacologic interventions is rather limited. Some common non-pharmacologic interventions have included physical exercise, relaxation techniques, improved foot placement, muscle stretching, massage, sensory nerve stimulation, footwear changes, weight loss, avoiding physical fatigue, heat therapy, compression garments, night ankle dorsiflexion splints and altered sleeping positions.[3]

What is Cupping Therapy?[edit | edit source]

Cupping therapy is a traditional Chinese healing practice that involves placing heated cups on the body to draw out toxins and improve local blood flow[4]. This therapy has been used for centuries to help with a wide variety of medical issues, including pain relief and chronic diseases. It works by creating negative pressure in a cup which helps to extract harmful substances from the body. Cupping is thought to work through the pain gate, conditioned pain modulation, and reflex zone theories. It is believed to help relieve muscle pain, reduce stiffness, and improve circulation[5]. Cupping is gaining more popularity as people explore alternative treatments and is being studied for its potential health benefits[6].

More information on cupping therapy can be retrieved from - Cupping Therapy

About Hot Water Cupping Therapy[edit | edit source]

Hot water cupping is a natural and alternative treatment used to manage nocturnal leg cramps (NLC). This treatment involves the application of cups containing warm water to the affected areas.

The process begins with a therapist filling a third of a cup with warm water, usually around 42-45°C. This water temperature should be monitored to ensure that it is not too hot as this may cause discomfort or burning sensations. Once the cup is in place, it will create suction which helps to draw out any stagnant or blocked energy and increase blood circulation to the affected area.[5]

The cups will be left in place for up to 10 minutes, after which they can be removed.

Method of Application[edit | edit source]

In order to treat nocturnal leg cramps, a combination of a traditional regimen and hot water cupping was used. This intervention was conducted over the course of 4 weeks with 3 sessions done per week.

The steps of the intervention were as follows:

1. Ankle toe movements: 15 repetitions

2. Heel slides: 15 repetitions

3. Hot water cupping: 15 minutes

4. Stretching of gastrocnemius and soleus: Twice for 60 seconds

5. Calf release

Hot water cupping was selected as part of the treatment plan due to the chronic nature of the condition. Hot water (45-50 degrees Celsius) was poured into the cup and placed upside down over the calf area. Two vacuum cups were used for each leg; one cup was approximately 1.5 inches below the popliteal crease, while the other was vacuumed slightly below the central calf area. A vacuum of two sucks was created through the use of a manual pump, and the cups were kept in place for 15 minutes per session.


Mechanism of effect[edit | edit source]

Hot water cupping is believed to improve the overall health of patients with nocturnal leg cramps (NLC). The exact mechanism of the long-term effect is still being studied, but it is thought to be caused by the combined action of heat application and vacuum suction.

The hot water causes an increase in blood flow to the area, which can increase opioid production. This, in turn, helps to stimulate the peripheral nervous system, which helps to reduce or eliminate muscle spasms and pain. The increased blood flow also helps to flush out toxins that can build up in the muscle tissue and cause further problems[7].

In addition to this, the vacuum created by the suction of the cups can help to loosen stiff muscles, release trapped toxins, and encourage relaxation. The combination of these effects can help to reduce or even eliminate the pain associated with NLC[7].

It is important to note that hot water cupping should not be used as a replacement for traditional treatments for NLC, such as medications and physical therapy. Instead, it should be used as an additional treatment option that can help to provide some relief from the symptoms of NLC.

References[edit | edit source]

  1. 1.0 1.1 Hallegraeff J, de Greef M. Pilot testing a stretching regimen for prevention of night time nocturnal leg cramps. Geriatric Nursing. 2020 Mar 1;41(2):105-9.
  2. Monderer RS, Wu WP, Thorpy MJ. Nocturnal leg cramps. Current neurology and neuroscience reports. 2010 Jan 1;10(1):53-9.
  3. Blyton F, Chuter V, Walter KE, Burns J. Non-drug therapies for lower limb muscle cramps. Cochrane Database Syst Rev. 2012 Jan 1;1(1).
  4. Yoo SS., Tausk F. Cupping: east meets west. Int J Dermatol. 2004;43:664-665.9
  5. 5.0 5.1 Al-Shidhani A, Al-Mahrezi A. The role of cupping therapy in pain management: A literature review. Pain Management-Practices, Novel Therapies and Bioactives. 2020 Sep 25.
  6. Ahmedi M, Siddiqui MR. The value of wet cupping as a therapy in modern medicine an Islamic perspective. Webmedcentral 2014;5(12).WMC004785.
  7. 7.0 7.1 Chirali, Ilkay Z. Traditional Chinese medicine cupping therapy. Elsevier Health Sciences. 2014;11,14,127,129.