Cramping 101

Treatment and Prevention

September 19th, 2020

One minute you’re dancing away to an absolute banger and next minute BAM! You’re rolling on the floor with a painful little leg spasm. Eeep! Welcome to the wonderful world of muscle cramps.

Whilst it may seem funny to watch someone else experience them, they certainly aren’t so nice to experience yourself!. Muscle cramps are sudden painful involuntary muscle contractions and today we are going to explore & bust some commonly founded myths surrounding them. 

So, let’s start off by understanding the basis of a cramp..…

Muscle cramps are the sudden, involuntary contractions of a muscle. They are temporary in nature and non- damaging to the muscle but can cause some pretty nasty pain and a sense of paralysis/immobility to the affected muscle.

The onset of a cramp is pretty sudden, and in many cases is unexpected and tends to lasts less than 60 seconds. But some cramps can continue for minutes, hours or in some circumstances even days. Some reports even suggest that 40% of people who suffer from regular cramps experience extreme pain. 

Different types of cramps

So there are many different types of cramps, but they can mostly be divided into 4 different categories:

• Exercise-associated muscle cramps

• Nocturnal (night-time) cramps

• Smooth muscle cramps (menstrual or endometriosis related)

• Treatment-related cramps (medication related)

Today we are talking about exercise associated muscle cramps which we will refer to simply as muscle cramps or EAMCs for the remainder of this blog.

How common are muscle cramps?

Well muscle cramps during exercise are very common, even in elite athletes. Muscles that cramp the most often are the calves, thighs, and arches of the foot. 

How do muscle cramps even occur?

In simplistic terms: there is thought there to be excitability of the central & peripheral nervous system and skeletal muscle which leads to rapid contraction of the muscle. If there is not a co-ordinated effort of your nerves to relax your muscle, then the muscle contraction may not cease, and therefore lead to a cramp.

In medical terms (skip this paragraph if you don’t have a biomedical background or are not interested in the technicalities):

In a fatigued muscle there is a decreased input from the Golgi Tendon Organs (which are responsible in helping our muscle relax) and there is over-activity of the muscle spindles which encourage our muscles to contract. So, muscle cramps occur when the Golgi Tendon Organs cannot stop the over-activity of muscle spindles, causing the muscle to contract uncontrollably. At a cellular level we see a negative change in the sodium-potassium gradient at the calcium pumps cause the calcium ions to remain in the myofibrils. This forces the muscle fibres to stay contracted (myosin proteins attached to the actin filaments) and results in a cramp. The cramp eases as calcium is slowly pushed back into storage via the adenosine triphosphate (ATP) molecules. Knowing the muscle physiology is important as it helps guide us on how we can best treat and prevent muscle cramping.

FIG 2&3: NEUROMUSCULAR THEORY OF CRAMPS

Myth busters

There are quite a few popular and unfounded theories as to the cause of cramps that have been debunked over time. Let’s take a quick look at them: 

1. Dehydration/excessive sweating: There are now many studies which have shown that athletes suffering exercise associated muscle cramps were not dehydrated. There were also not experiencing loss of serum electrolytes (e.g. sodium) concentration at the time of the cramp.

2. Hot Conditions: whilst muscle cramps can occur in the heat, they also have been known to occur in cold conditions as well. Furthermore, there is no evidence to suggest icing or cooling the affected limb will ease the cramp.

3. Low sodium concentration in the blood: this has been controversial, but there there are now enough studies that show sodium levels (salt) are not associated with EAMC, but may be associated with generalised muscle cramping at rest. So if you suffer from exercise related muscles cramps you can take solace in leaving the salt tablets to the side. However the jury is still not in as to whether sodium levels in the blood is associated with generalised muscle cramping at rest.

4. Magnesium: similar to the electrolyte/sodium concentration levels, taking magnesium supplements has not been shown to prevent or improve exercise related muscle cramps. However over the counter medications/sprays may still have a role in night time cramps.

Pre-disposing factors to cramping

There are however a few common factors that do predispose us to cramping, including some that are amendable to physio. These pre-disposing factors are:

• Muscle fatigue

• Previous or current injury: if the area is weak, it is more prone to fatigue and as a result more prone to cramping!

• Male gender

• Increasing age

There isn’t a great deal we can change about the age & gender situation, but there certainly is a lot we can do to help with the fatigue & treatment of past/current injuries! We will chat about this later on.

What to do When You Cramp

Help – you’ve started cramping, what do you do? 

1. Passive stretching: Well 9 times out of 10 our body naturally goes to do the right movement, and in this case the easiest way to relieve it is by stretching it out. Stretching forces the Golgi tendon to sense a change in muscle length and forces relaxation of the fibres.

2. Pickle Juice: Ok so here’s the confusing thing – whilst low salt levels have been proven to not cause EAMCs (discussed earlier in myth busters), quickly drinking salty type drinks such as pickle juice or tonic water when a muscle cramp occurs has been shown to be quite effective in relieving them. The quick influx in sodium forces the muscle to temporarily relax it’s contracted state. It’s important to note that these drinks don’t appear to prevent another cramp from occurring when one has occurred.

3. Massage: soft tissue release can provide an external form of relaxation to the cramped muscle but isn’t helpful in preventing it from cramping again

4. Contracting the opposite muscle group: This works on our Golgi tendon. Contraction of our antagonist muscle group forces relaxation in our cramping muscle. For example, if our hamstrings are cramping we could contract the quads to assist in relieving the cramp. 

How to Prevent a Cramp

Ok – you’re a cramp sufferer. And you know how to manage your cramps, but the good news is you can actually do a bit to help prevent them in the first place. Here’s some helpful ways to prevent exercise associated muscle cramps:

1. Get strong! The evidence suggests that muscle cramping occurs because of fatigue in the muscle. So by improving muscular condition and endurance you can reduce the chance of the cramp occurring.  Specifically, there is some evidence to suggest plyometrics (jumping/hopping) and eccentric strength training has the greatest ability to improve neuromuscular control which may be beneficial in reducing exercise associated muscular cramps.

2. Recovery: there’s not a great deal of evidence to suggest recovery is helpful, purely because it hasn’t been researched in great depth. However there are some pretty reasonable thoughts that suggest a poor night’s sleep and high stress levels will contribute to muscular fatigue and predispose and athlete to cramps. So make sure you get in your solid 8 hours of sleep & work on some meditation and self care to keep the stresses low. Catch up on my recovery blogs to learn more about the best ways to recover in the links below this article. 

3. Medications: if this is an ongoing issue, you can chat to your doctor about medications which may reduce the frequency or intensity of your cramps.

Quite often if an athlete is experiencing repeated episodes of cramps, I’ll suggest they seek the advice of their local doctor. Further assessments may be required including scans or blood tests to rule out any non-muscular causes.

So if you suffer with recurrent cramps, reach out to your doctor to establish why they are occurring and take the appropriate steps to prevent them!

Wanting tailored guidance and rehabilitation for your injuries?

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Until next time, train safe. 

The Pole Physio

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Disclaimer: This information is not tailored to you as an individual and do not constitute as medical advice. If you have medical or injury concerns, then please individually consult with a medical professional.

Related Blogs:

• Train Hard. Rest & Recover Even Harder

• 17 Scientific Ways to Speed up Recovery

• 100 points of Recovery

References:

• Miller KC, Mack GW, Knight KL, et al. Reflex inhibition of electrically induced muscle cramps in hypohydrated humans. Med Sci Sports Exerc. 2010;42(5):953-961.

• Miller KC, Mack G, Knight KL. Electrolyte and plasma changes after ingestion of pickle juice, water, and a common carbohydrate-electrolyte solution. J Athl Train. 2009;44(5):454-461.

• Minetto MA, Holobar A, Botter A, Ravenni R, Farina D. Mechanisms of cramp contractions: peripheral or central generation?. J Physiol. 2011;589(Pt 23):5759-5773.

• Schwellnus MP. Cause of exercise-associated muscle cramps (EAMC)--altered neuromuscular control, dehydration or electrolyte depletion?. Br J Sports Med. 2009;43(6):401-408.

• Shang G, Collins M, Schwellnus MP. Factors associated with a self-reported history of exercise-associated muscle cramps in Ironman triathletes: a case-control study. Clin J Sport Med. 2011;21(3):204-210.