Physical therapy for nocturnal lower limb cramping: A case report

Background and Purpose: Nocturnal lower limb cramps are sudden, intensely painful, and can decrease sleep, increase anxiety, and reduce quality of life. The purpose of this case report is to describe the effectiveness of an evidence-based physical therapy intervention for a person with lower limb cramps. Case Description: The patient was a 34-year-old female who presented with idiopathic bilateral lower limb foot pain and cramps. Intervention: Rehabilitation addressed muscle strength, joint mobility, soft tissue extensibility, and biomechanical influences during functional movement, for a total of seven sessions over seven weeks. Outcomes: The frequency and severity of cramps decreased from three to four times/night, lasting several minutes down to one episode/week, lasting less than a minute. Her Numeric Pain Rating Scale (NPRS) score at worst decreased from 6/10 at the initial examination to 0/10 upon discharge. Lower extremity strength and functional mobility outcomes also exhibited improvement over the course of care. The patient’s Lower Extremity Functional Scale (LEFS) score decreased from 87.5% to 80.0%, indicating greater disability, though this did not reach minimal detectable change levels. Discussion: While her cramping and resulting pain improved, perceived participation restrictions persisted. Lack of improvement in the participation measure may have been related to the lack of a structured biopsychosocial approach to the rehabilitation process.