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This out-of-the-blue leg cramp is as intense as a kick from a palomino. "You'll be lying in bed or even asleep when you get this terrible knot-usually in the calf but sometimes in the thigh or the arch of your foot," says Steven Subotnick, D.P.M., a sports podiatrist in Hayward, California, and author of Sports and Exercise Injuries.

What causes a charley horse? It can be the result of sore muscles, a mineral deficiency or hormonal imbalance or even a process known as calcification, in which blood gets trapped in a muscle and hardens. No matter the cause, here's how to get fast relief.

Rub for relief. A little kneading may be all you need to pull in the reins on a charley horse. Always rub with the muscle, not across it. So for a charley horse in your calf, start behind the knee and rub toward the heel.

Stretch for success. If you get an exercise-related charley horse, it's best treated with a good stretch. If you should develop a charley horse in your thigh, here is a good method to treat it. Stand on the "good" leg and grasp the ankle of the leg that has the charley horse from behind. "Then slowly pull the ankle of the injured leg up toward your buttocks and hold it for 10 to 15 seconds," advises Craig Hersh, M.D., a sports injuries specialist at the Sports Medicine Center in Fort Lee, New Jersey. "Doing that provides a nice stretch."

Leg Cramps or Charley Horse: What's the Difference?

When your calf tightens up and the ache begins, you probably don't waste time wondering whether it's a leg cramp or a charley horse. But there is a difference. Leg cramps, especially in the elderly, often result when not enough blood gets to the muscles. A charley horse is likely to be caused by too much blood getting to the muscle (though there may be other causes as well).

Also, cramps and charley horses attack in different ways. " Leg cramps usually occur while you're walking and will come more gradually, building as you use the muscle more," says Steven Subotnick, D.P.M., a sports podiatrist in Hayward, California, and author of Sports and Exercise Injuries. "After a rest, the cramps will usually go away."

A charley horse, on the other hand, "comes more suddenly and isn't necessarily related to physical activity or using the muscle," says Dr. Subotnick.

So if you're just lying in bed and you suddenly feel that telltale tightening in your calf, it's probably a charley horse rather than a cramp.

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Avoid heat. While many muscle aches are best treated with a warm compress or heating pad, heat treatment is not recommended initially for a charley horse. Applying warmth can cause swelling or bring more blood to the muscle, which could increase the likelihood of calcification, adds Dr. Hersh.

Let gravity help. As with any type of leg cramp, encouraging blood flow away from the limbs and toward the heart can bring quicker relief and less throbbing. "Elevate the area you're rubbing, so gravity works with you," suggests Ed Moore, the massage therapist for the 1984 U.S. Olympic Cycling Team.

Take vitamin E and see. For frequent nighttime charley horses, a vitamin supplement may prevent recurrences. "If you get a charley horse at night, usually while you're lying in bed, then it may be a circulatory problem, which can be cured by taking a vitamin E supplement," says Dr. Subotnick. "If you're a woman going through menopause, taking 1,200 international units of vitamin E every day for two weeks will probably end the problem." Prolonged high dosages of vitamin E are not recommended, says Dr. Subotnick. After 14 days, he advises, reduce your vitamin E intake to 400 international units daily. And he says those not going through menopause should start with 600 international units and decrease to 400 international units after two weeks.

Or take more magnesium. If vitamin E doesn't bring relief, then perhaps you need to compensate for a mineral deficiency or hormonal imbalance. "If you get a steady kind of pain, then you probably need more magnesium in your diet, " says Dr. Subotnick. Good sources of magnesium include many kinds of fish (halibut and mackerel are tops), rice bran, tofu and spinach. And next time you have the munchies, try some dried pumpkin seeds: You get a lot of magnesium in a few quick bites.