Why does flexing my ankle cause the worst pain ever in my upper calf?

August 16, 2023 11:53 PM

My body has started doing this horrible new thing where sometimes when I am lying down in bed and flex my ankle (pulling my toes up towards my head), the top of my calf muscle (behind and below my knee) explodes into a spasm of THE WORST PAIN I HAVE EVER FELT IN MY LIFE like uncontrollably thrashing around screaming for a minute or two bad. This is a relatively new development but has happened 3 times in the past couple of months. What might be causing this and what sort of exercises can I do to prevent it from ever happening again? My Google-fu is failing me to even find the name of the condition. Thanks.
posted by Jacqueline to Health & Fitness (31 answers total)

Potassium deficiency is the usual first suspect. Try eating more bananas and see if that helps?
posted by pompomtom at 12:09 AM on August 17, 2023 [1 favorite]

Response by poster: I eat lots of potassium and also take a multivitamin.

It's not a normal random leg cramp, it only happens when I flex my ankle a certain way.

I've been flexing my ankle like that to pop it, stretch, etc. my entire life (I'm 45) but this occasional extremely painful muscle spasm response is new within the past few months.

I will go see a doctor about it but I just moved so I don't know how long it will take to find a new PCP. In the interim, I'm hoping there's some sort of preemptive stretching or something I can do.

Even just getting the name of what this condition is called would help. I have Googled it as best I can but all I get are pages about ankle pain. While the pain is CAUSED by flexing my ankle, 100% of the pain actually HAPPENS in my upper calf muscle. So clearly something is pulling on something.
posted by Jacqueline at 12:17 AM on August 17, 2023

I get something that sounds very similar that I'd get when I'd morning stretch and flex my feet down, pointed toes. It took me awhile before I started remembering to pull my toes up when I do a cat stretch and it hasn't recurred. I know that NGA NGA NGA pain though, if you look at the mechanics, it's not so much a "stretch" and is more of a clenching of the calf muscle, and pointing toes up noticeably doesn't clench the top of my calf. My overall theory is that feet and calves are some of the most familiar parts of the body and your brain simply knows how to take it too far. Also similar to you, it started in my 40s (I stretched with pointed toes FOREVER before this).

So try pointing your toes up in the other direction. Bonus is that you get to stretch your Achilles tendon.
posted by rhizome at 12:28 AM on August 17, 2023 [2 favorites]

Best answer: Sounds like a charley horse?
posted by tristeza at 12:29 AM on August 17, 2023 [8 favorites]

Please, prioritize seeing a doctor. "Tennis leg" causes calf pain with the kind of ankle flexing you describe, but usually has an initial tear to the gastrocnemius (main calf muscle). If you don't remember having injured your leg, calf pain from pointing your toes up can be a sign of deep vein thrombosis development. 'THE WORST PAIN I HAVE EVER FELT IN MY LIFE' = see a doctor, even if it's not constant.
posted by Iris Gambol at 12:30 AM on August 17, 2023 [8 favorites]

Response by poster: To clarify, the ankle flexing motion is something I do dozens of times a day in a variety of postions, have been doing it for decades, and it's such an ingrained habit that I barely even realize when I'm doing it. So it's definitely not a did a weird thing, got a weird pain situation.

The painful exploding calf muscle spasm is new and has only happened a few times, but every single time so far it's happened when I flexed my ankle while lying half asleep in bed. I just figured that pattern out tonight.
posted by Jacqueline at 12:30 AM on August 17, 2023

Homan's Sign Test in DVT, and the other conditions associated with a positive sign.
posted by Iris Gambol at 12:34 AM on August 17, 2023 [1 favorite]

Response by poster: Tennis leg sounds very close except there's no bruising, and the extreme pain at the writhing and screaming level only lasts a few minutes before settling back to an "ow I pulled a muscle" level until I fall asleep.

But then in the morning I wake up normal? Whereas it sounds like tennis leg is a lasting injury? The page you linked recommends using crutches until you can see a doctor, but I'm waking up fine the next day.

I've been immediately treating it with massage, ice, methocarbamol, and acetaminophen whenever it happens (and I take NSAID etodolac twice daily regardless for my psoriatic arthritis) so maybe I've just been accidentally treating it correctly each time and that's why it heals so quickly?

Because the next day it's like it never happened at all! Like it goes away so quickly that I forget about it until the next time it happens and I have to explain my sudden screaming to my terrified husband with "my leg is doing that thing again."
posted by Jacqueline at 12:42 AM on August 17, 2023

For what it's worth, I was getting this occasionally - horrible calf cramp, literally rolling around and whimpering, just horrendously painful - when I was half asleep and rolling over. The pain was so bad it would sort of ache for half a day afterwards

In my case I think it was just cramp due to tight calves, caused by weight lifting and not stretching properly afterwards. I haven't had one in years now, since I took a lifting break and became much better about stretching.

See a doctor just to be safe, but it's not necessarily something serious.
posted by stillnocturnal at 12:46 AM on August 17, 2023 [2 favorites]

I get something very like that at night in bed when I've exposed myself to certain kinds of treated wood during the day — mainly telephone poles and some boat docks.

I also have a number of autoimmune problems including psoriasis, celiac disease, and pernicious anemia, and I think mine is triggered by autoimmunity.

I don’t have as much pain as you do however, though it is pretty bad.
posted by jamjam at 1:01 AM on August 17, 2023

Response by poster: "Sounds like a charley horse?"

Oh wow I'd heard of those but didn't know they could be this painful. But after reading up on them, it turns out several other people have also described them as the worst pain they ever felt, so yeah that could fit.

My husband has tried to massage my calf muscle while it was still happening and the "rock hard" description from the charley horse articles also fit.

Yeah the more I read about it, the more it sounds like I'm having charley horse cramps. The always happening at night when nearly asleep then back to normal the next day seem to be the distinguishing features not present in the other possible conditions mentioned.

So apparently I'm just old and these awful nighttime leg cramps are just a normal, common experience for old people that no one knows how to prevent. What the fuck, this flesh prison is such a burden.
posted by Jacqueline at 1:05 AM on August 17, 2023 [18 favorites]

I was getting this pretty regularly, but I haven’t had it happen at all since I started taking a calcium, magnesium and zinc supplement every night at bed time. I like the Bluebonnet brand.
posted by MexicanYenta at 2:23 AM on August 17, 2023

It's not clear to me if you know that when you have a charley horse you grab your toes and pull them toward yourself as hard as you can. Instant relief.
posted by cda at 3:03 AM on August 17, 2023 [10 favorites]

I get them periodically - yep, charley horse. Terribly painful. I’ve discovered that I get them more frequently if I’ve been wearing shoes with heels a lot over the course of a week. Along with the suggestions for good nutrition above, I can also prevent myself from getting them if I use an incline board / calf stretcher consistently. Just a few reps of 10-12 slow lifts and lowering. It helps with strength and range of motion in the muscles in the calf and foot.
posted by Silvery Fish at 3:21 AM on August 17, 2023

I can also prevent myself from getting them if I use an incline board / calf stretcher consistently

You can also use a bottom stair if you have one around your house. ;)
posted by dancinglamb at 3:34 AM on August 17, 2023 [2 favorites]

> Please, prioritize seeing a doctor

With the strong possibility of DVT, the answer should be: "ER. Now."
posted by yclipse at 3:49 AM on August 17, 2023 [4 favorites]

To eliminate a potential contributing factor, you could try to remember which shoes you wore on the days you got leg cramps at night. (For me it turned out to be comfortable Keens sandals, which was too counterintuitive for me to even consider at first.)
posted by meijusa at 3:51 AM on August 17, 2023 [1 favorite]

Hydration may be a factor. A doctor once suggested a couple of ounces of diluted Gatorade at bedtime.
posted by SemiSalt at 4:49 AM on August 17, 2023 [1 favorite]

If it does turn out to be a charley horse, I've found that potassium doesn't help me with muscle cramps, but magnesium supplements do, quite effectively and almost immediately.
posted by Wilbefort at 4:59 AM on August 17, 2023 [1 favorite]

My thought, not to minimize DVT, is that if this has been ongoing for a couple of months with no other signs of DVT, and has been treated with calf massage (which you are REALLY not supposed to do with DVT) with no adverse consequences then it seems unlikely to be a DVT. I'd also imagine that if the pain occurs once in a particular positions, cramps the muscle very tightly and then releases and can't be replicated until the next time, it's unlikely to be DVT, particularly if we're talking about something that has persisted unchanging over time.

I know that deep vein thrombosis can be tricky and hidden but this doesn't sound like one, and I say this as someone who has been to the ER with calf pain several times.

If this started within the last couple of weeks and was happening consistently, especially if you are taking birth control pills, had an extended period of leg pressure or immobility or flew anywhere, then yes, an ER visit might be in order.
posted by Frowner at 5:03 AM on August 17, 2023 [7 favorites]

these awful nighttime leg cramps are just a normal, common experience for old people

and nobody knows for sure why they happen. I've not had the self-tearing muscle and subsequent haematoma reported by that YouTuber but can confirm that the pain involved is as bad as the worst I've ever felt.

My personal superstitious precautions for warding them off include not letting myself get badly thirsty while exercising, doing regular stretching sessions, and making sure I don't get low on vitamin D or magnesium.

When they've happened, I've found that the most rapid release available involves persuading somebody else to haul my toes toward my kneecap while I hyperextend the affected leg in such a way as to push my heel as far away from the rest of me as I possibly can.

Most recent one actually happened while I was face down on a massage table; my myotherapist had just put my foot into a slightly unusual position and all of a sudden BAM. She grabbed hold of the spasming calf and just squeezed with all the force her amazing hands could muster. I just lay there sobbing helplessly until it stopped, which it did about as fast as it ever has before.

It was actually really interesting to experience a sudden unambiguous 10 on the pain scale in a state of otherwise total relaxation and I'm almost (but not quite!) looking forward to my next cramp just to see if I can summon the same state of consciousness again. I'm curious to learn whether adding "don't fight it, just be until it stops" to my repertoire of responses is going to be at all useful. Assuming, that is, that it's actually achievable.
posted by flabdablet at 5:11 AM on August 17, 2023 [4 favorites]

I went through a very painful bout of plantar fasciitis last year and the area you're describing was heavily involved. The more I stretched my calves, the better my feet felt. I know you didn't indicate any foot issues, but the stretch that helped the most (and that I still do regularly) was to stand near a wall and put the toes of one foot up against the wall, and then to lean forward into the wall. Doing this stretch regularly during the day could maybe help prevent the night cramps.
posted by SeedStitch at 5:16 AM on August 17, 2023

I've gotten these occasionally for many years (since my late 20s), with the exact same trigger and no injury. It hasn't lead to anything more serious for me. I've gotten in the habit of not stretching while in bed to avoid it, and that pretty much took care of it. I've gotten them occasionally at other times but far more rarely. I found that the most effective way to relieve the pain is immediately jumping out of bed and putting all your weight on the cramping leg, as counter-intuitive as that sounds.
posted by randomnity at 6:12 AM on August 17, 2023 [6 favorites]

Yes, I was coming in to say exactly what randomnity just did. Something about standing that puts your foot/ankle in that same position but without engaging the muscles is the best thing I've found to help stop it once it has started.
posted by solotoro at 6:48 AM on August 17, 2023 [2 favorites]

When you sit in a chair, do you tuck your ankle from one leg under your other leg, such that there is mild pressure on the lower part of your leg? I used to do that as a long-carried-over habit from my childhood, and discovered that the lancing, not-muscle-based, otherwise sourceless pain I'd sometimes get, exactly what you're describing, was a result of compressed nerves that I'd apparently just... slowly compressed over the years.

A combination of basic stretching and disciplining myself to break that habitual motion and not to sit in a way that put any compression on my lower legs solved that problem entirely for me in a small number of weeks. It hasn't recurred in years.
posted by mhoye at 7:45 AM on August 17, 2023

I get foot and leg cramps if I flex in some way that annoys my foot. In addition to potassium, magnesium helps.
posted by theora55 at 7:49 AM on August 17, 2023

Also came here to suggest magnesium as a low-cost possible solution.
posted by i_am_joe's_spleen at 1:32 PM on August 17, 2023 [1 favorite]

It does sound like a charley horse to me - I definitely get similar things sometimes, and for me it seems to be related to shoes (specifically, it happens more when I switch up the shoes I wear from one day to the next). Sometimes it's the calf like you describe, and sometimes it seems to be more centered in a way the makes my big toe want to violently curl under my foot. By far the best way to stop the spasm almost immediately, for me, is to stand up and put my feet flat on the floor (preferably hard floor, not carpet, and if you have a shoe or slipper on at the time, take it off). It's super annoying when it happens when I'm trying to go to bed, but the relief from putting weight on it is pretty instant.
posted by aecorwin at 3:04 PM on August 17, 2023

Response by poster: For those concerned about DVT urging me to go to the ER, I have since done a bunch of reading about DVT, charley horse cramps, and how to tell the difference, and I am now 99.99% certain that what I've been experiencing is indeed just charley horse cramps. All the symptoms fit.
posted by Jacqueline at 4:55 PM on August 18, 2023

Great ideas here! I am now in my fifties, and have had the same calf lockup. Thanks to OP and community.
posted by drowsy at 8:25 AM on August 19, 2023

Another prevention suggestion from my physio - roll your feet on a spiky ball before bed. I’ve been doing it while brushing my teeth and it really helps as a prevention method.
posted by ec2y at 11:33 PM on August 21, 2023