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Exercise-associated Muscle Cramps

Author: CHKD Sports Medicine
Published Date: Wednesday, November 30, 2016

By: Jon Williams, MS, VATL, ATC, CSCS

At some point in time, most athletes have experienced the excruciating pain of a muscle cramp. As frequently as they occur, you’ll see an equal number of remedies ranging from the latest stretching techniques to jars of pickle juice. Everyone seemingly has a different treatment or technique boasted as a miracle cure. Large corporations are not immune as many advertise pre-, post-, and everything in between drinks. Many of these solutions, however, fall short of providing the relief promised.

Commonly referred to as “heat cramps,” most researchers have adopted a more fitting name, calling them exercise associated muscle cramping (EAMC). While that may seem to be making a simple condition into something more complex, there is good reason for the name. Athletes don’t necessarily have to be overheated for cramping to occur. Studies have shown that heat alone is not enough to cause cramps. In reality, no single cause exists for EAMC, but instead consists of a mix of multiple factors including electrolyte imbalance, dehydration and neuromuscular fatigue. Since no one factor causes EAMC, it only makes sense that multiple steps are be required to prevent or stop them.

An Ounce of Prevention is better…

As with most injuries, prevention is much easier than the alternative. Most researchers do agree that certain steps will minimize the risk of developing EAMC during your activity.

Proper conditioning and stretching are the first steps to preventing cramps. Athletes should also prepare at the same level of exertion that they’ll experience in competition. These strategies are just as important and often overlooked in favor of rehydration and electrolyte supplementation.

Nutrition should be carefully planned and monitored during competitive periods. Athletes should do their best to maintain good nutritional habits all of the time, but especially in the day(s) leading up to competition. Foods rich with electrolytes such as bananas, oranges (or juices), tomatoes, sweet potatoes, crackers or pretzels should be used as snacks. Sports drinks can also be used as needed.

Finally, athletes need to stay hydrated. Proper hydration should occur on a daily basis, not an hour prior to game time. Athletes can monitor this by paying attention to the color of their urine (clear to straw colored is best) and closely monitoring weight changes. Daily fluctuations are mostly water loss and should be replaced. Fluid intake during activity varies greatly from person to person, but it’s generally accepted that 7-10 ounces of water every 10-20 minutes is necessary to maintaining proper hydration.

…Than a Pound of Cure

Unfortunately, treating EAMC can be difficult. Not only are they extremely painful, but it’s not possible to quickly reverse the cause in the typical field setting. A few strategies are agreed upon, but should be noted that returning to play will likely result in a reoccurrence.

Light stretching is the fastest way to provide relief for EAMC. It can be combined with ice application and massage, but stretching should remain the primary treatment. Providing water and/or electrolytes to rehydrate the athlete will begin to reverse the conditions that caused the cramps. Some will use water, while others will use a sports drink (or even pickle juice), but it’s important to begin replacing fluids immediately. One point to consider with sports drinks is that while beneficial, don’t expect immediate results. It can take up to 60 minutes before the body is able to absorb the electrolytes being ingested.

Summary:

1. Exercise associated muscle cramping is caused by electrolyte imbalance, dehydration and fatigue.

2. Prevention is more effective than treating cramps; proper warm-up, diet and hydration.

3. Light stretching is the most effective relief for cramping.

References:

  1. Bergeron MF. Muscle Cramps during Exercise-Is It Fatigue or Electrolyte Deficit? Current Sports Medicine Reports. 2008;7(Suppl. 1).
  2. Bergeron MF. Hydration in the Pediatric Athlete — How to Guide Your Patients. Current Sports Medicine Reports. 2015;14(4):288-293.
  3. Casa DJ, Armstrong LE, Hillman SK, et al. National Athletic Trainers’ Association Position Statement: Fluid Replacement for Athletes. journal of Athletic Training. 2000;32(2):212-224.
  4. Miller KC, Knight KL, Williams RB. Athletic Trainers’ Perceptions of Pickle Juice’s Effects on Exercise Associated Muscle Cramps. Athletic Therapy Today. 2008;13(5):31-34.
  5. Plagued by Muscle Cramps? USA Swimming. http://www.usaswimming.org/viewnewsarticle.aspx?tabid=1. Accessed September 15, 2016.

About CHKD Sports Medicine

CHKD's sports medicine program offers the most comprehensive care for your young athlete. From diagnosis and treatment to customized rehabilitation plans, we specialize in physical therapy and injury prevention programs for active children and teens. Our team is composed of pediatric orthopedic surgeons, sports medicine specialists, physician assistants, certified athletic trainers and pediatric sports medicine physical therapists.