Sunday, December 5, 2010

Cramps (mainly in sport)

We have all experienced that excruciating knot of painful involuntary muscle spasm that can stop us dead in your tracks. About two out of three fit and active people have experienced the cramp. It commonly occurs in the calf, thigh or foot. It can happen in both cool and warm environments.

What triggers a cramp?

Nobody knows for sure. Surprisingly, this topic is poorly covered in most sports medicine books and is not well researched. It has long been suspected that the most common causes in athletes are dehydration, heavy salt losses or, more recently, just plain muscle fatigue leading to a loss of muscle control.

Heavy sweating can cause significant sodium (salt) losses from the body, and this may trigger a cramp if the sodium isn’t replaced during the activity. To combat the threat of cramp, athletes add some extra salt to their meals and take a sports drink throughout training and competition. One study of a tennis player who regularly got cramps revealed that he lost more sodium through sweat than he ate in his diet. By taking a sports drink and increasing the sodium in his diet, he was able to reduce the cramps to rare occurrences.

More recently, studies have shown there are no differences in blood sodium levels or levels of hydration in crampers compared to non-crampers leading to the view that cramping is due to a tired muscle losing coordination of its contractions. If low levels of salt in the body are the cause of cramp it does not explain why only certain muscles get cramp or why rest or stretching the afflicted muscle often “cures” the cramp. The best explanation to date is that muscle cramp is due to a tiring muscle losing its ability to control its contractions and going into involuntary spasms.

The best advice we have

The truth is that we don’t fully understand muscle cramp, nor know the best advice to help avoid the cramp. You may have your own solutions that work for your body. Until we know more, the sensible advice is:

1. Drink plenty of fluids during activity to avoid dehydration. A dehydrated body seems to be more prone to cramping.

2. If you lose a lot of sweat during exercise, especially over an hour or more, try a sports drink to help replace the lost sodium.

3. Be fit. Cramps are less common in fit people.

4. Eat well. Cut the saturated fats that clogs arteries. Cramps can occur in muscles that have a reduced blood supply due toas a result of narrowed arteries.

5. Stretch before and after exercise. If you suffer night cramps, stretch before going to bed.

6. Be untrendy and wear loose, comfortable clothes. Tight -fitting clothes can reduce blood flow to muscles, making them more susceptible to cramps.

7. Acclimatise to the environment in which you perform, especially when moving from cool to warm climates.

Stretch the point

If you do get a cramp, stretching the cramped muscle is the best way to reduce the pain. If it happens in the calf, grab the toes and ball of your foot and pull them towards the kneecap, or get someone to do it for you as shown in the pic. This helps the muscle to relax. Applying ice can also stop the spasm and reduce the pain.

What does it all mean?

If you have access to millions then please start the International Research Unit for Cramp and Stitch. We need it because we know stuff-all about the nuisance pain we all experience. Because humans evolved in a warm environment, it is often said that salt depletion is unlikely to be the cause of cramp in most people, but there have been reported cases of “whole body” cramps in athletes where salt depletion is a more likely cause. Otherwise, it seems that looking after yourself may be your best bet against cramp. If you would like a bit more on the topic, here is a lengthy discussion [].

References: British Journal of Sports Medicine 2009; 43: 401-408

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