Exercise-Associated Muscle Cramps: Causes, Treatment, and Prevention
Abstract
Context:
Exercise-associated muscle cramps (EAMC) are a common condition experienced by recreational and competitive athletes. Despite their commonality and prevalence, their cause remains unknown. Theories for the cause of EAMC are primarily based on anecdotal and observational studies rather than sound experimental evidence. Without a clear cause, treatments and prevention strategies for EAMC are often unsuccessful.
Evidence Acquisition:
A search of Medline (EBSCO), SPORTDiscus, and Silverplatter (CINHAL) was undertaken for journal articles written in English between the years 1955 and 2008. Additional references were collected by a careful analysis of the citations of others’ research and textbooks.
Results:
Dehydration/electrolyte and neuromuscular causes are the most widely discussed theories for the cause of EAMC; however, strong experimental evidence for either theory is lacking.
Conclusions:
EAMC are likely due to several factors coalescing to cause EAMC. The variety of treatments and prevention strategies for EAMC are evidence of the uncertainty in their cause. Acute EAMC treatment should focus on moderate static stretching of the affected muscle followed by a proper medical history to determine any predisposing conditions that may have triggered the onset of EAMC. Based on physical findings, prevention programs should be implemented to include fluid and electrolyte balance strategies and/or neuromuscular training.
Get full access to this article
View all access and purchase options for this article.
References
1. Baldissera F, Cavallari P, Dworzak F. Motor neuron “bistability”: a pathogenetic mechanism for cramps and myokymia. Brain. 1994;117:929-939.
2. Bartolozzi A, Godek S, Greene R, Burkholder R, Dorshimer G. Blood electrolytes in NFL players while experiencing EAMC compared to when they are not cramping after similar practice conditions. Med Sci Sports Exerc. 2007;39:S15.
3. Bentley S. Exercise-induced muscle cramp: proposed mechanisms and management. Sports Med. 1996;21:409-420.
4. Bergeron M. Exertional heat cramps. In:Armstrong L, ed. Exertional Heat Illnesses. Champaign, IL: Human Kinetics; 2003:91-102.
5. Bergeron M. Exertional heat cramps: recovery and return to play. J Sport Rehabil. 2007;16:190-196.
6. Bergeron M. Heat cramps during tennis: a case report. Int J Sport Nutr. 1996;6:62-68.
7. Bergeron M. Heat cramps: fluid and electrolyte challenges during tennis in the heat. J Sci Med Sport. 2003;6:19-27.
8. Bergeron M. Muscle cramps during exercise: is it fatigue or electrolyte deficit? Curr Sports Med Rep. 2008;7:S50-S55.
9. Binkley H, Beckett J, Casa D, Kleiner D, Plummer P. National Athletic Trainers’ Association position statement: exertional heat illnesses. J Athl Train. 2002;37:329-343.
10. Brooks G, Fahey T, Baldwin K. Exercise Physiology: Human Bioenergetics and Its Applications. Boston: McGraw-Hill; 2005.
11. Brubaker D, Whitesel J, Barth B. Quinine sulfate: a treatment for recurrent muscle spasms. Athl Train (Greenville, NC). 1985;20:121-123.
12. Bye A, Kan A. Cramps following exercise. Aust Paediatr J. 1988;24:258-259.
13. Casa D, Armstrong L, Hillman S, et al. National Athletic Trainers’ Association position statement: fluid replacement for athletes. J Athl Train. 2000;35:212-224.
14. Chimera N, Swanik K, Swanik C, Straub S. Effects of plyometric training on muscle activation strategies and performance in female athletes. J Athl Train. 2004;39:24-31.
15. Convertino V. Blood volume: its adaptation to endurance training. Med Sci Sports Exerc. 1991;23:1338-1348.
16. Cooper E, Ferrara M, Broglio S. Exertional heat illness and environmental conditions during a single football season in the Southeast. J Athl Train. 2006;41:332-336.
17. Daniell H. Simple cure for nocturnal leg cramps. N Eng J Med. 1979;301:216.
18. Dickhuth H, Rocker K, Niess A, Horstmann T, Mayer F, Striegel H. Exercise-induced, persistent and generalized muscle cramps. J Sports Med Phys Fitness. 2002;42:92-94.
19. Diener H, Dethlefsen U, Dethlefsen-Gruber S, Verbeek P. Effectiveness of quinine in treating muscle cramps: a double-blind, placebo-controlled parallel-group, multicentre trial. Int J Clin Pract. 2002;56:243-246.
20. Eichner E. Heat cramps: salt is simplest, most effective antidote. Sports Med Dig. 1999;21:88.
21. Eichner E. Treatment of suspected heat illness. Int J Sports Med. 1998;19:S150-S153.
22. Fowkes G, Bartolozzi A, Peduzzi C, Burkholder R, Dorshimer G. A comparison of blood measures while NFL players are experiencing EAMC and after IV treatment when EAMC are alleviated. J Athl Train. 2008;43:S61.
23. Galloway S. Dehydration, rehydration, and exercise in the heat: rehydration strategies for athletic competition. Can J Appl Physiol. 1999;24:188-200.
24. Gersh M, ed. Electrotherapy in Rehabilitation. Philadelphia, PA: FA Davis Co; 1992.
25. Hakkinen K, Komi P. Fatiguability in voluntary and reflex contraction after conditioning of human skeletal muscle. Electromyogr Clin Neurophysiol. 1985;25:319-330.
26. Hayward L, Wesselmann U, Rymer W. Effects of muscle fatigue on mechanically sensitive afferents of slow conduction velocity in the cat triceps surae. J Neurophysiol. 1991;65:360-370.
27. Helin P. Physiotherapy and electromyography in muscle cramp. Br J Sports Med. 1985;19:230-231.
28. Hutton R, Nelson D. Stretch sensitivity of golgi tendon organs in fatigued gastrocnemius muscle. Med Sci Sports Exerc. 1986;18:69-74.
29. Jones B, Rock P, Smith L, et al. Medical complaints after a marathon run in cool weather. Phys Sportsmed. 1985;13:103-110.
30. Jung A, Bishop P, Al-Nawwas A, Dale R. Influence of hydration and electrolyte supplementation on incidence and time to onset of exercise-associated muscle cramps. J Athl Train. 2005;40:71-75.
31. Kandel E, Schwartz J, Jessell T. Principles of Neural Science. 3rd ed. Norwalk, CT: Appleton & Lange; 1996.
32. Kantarowski P, Hiller W, Garrett W. Cramping studies in 2600 endurance athletes. Med Sci Sports Exerc. 1990;22:S104.
33. Khan S, Burne J. Reflex inhibition of normal cramp following electrical stimulation of the muscle tendon. J Neurophysiol. 2007;98:1102-1107.
34. Layzer RB. The origin of muscle fasciculations and cramps. Muscle Nerve. 1994;17:1243-1249.
35. Levin S. Investigating the cause of muscle cramps. Phys Sportsmed. 1993;21:111-113.
36. Manjra S, Schwellnus M, Noakes T. Risk factors for exercise associated muscle cramping (EAMC) in marathon runners. Med Sci Sports Exerc. 1996;28:S167.
37. Maquirriain J, Merello M. The athlete with muscular cramps: clinical approach. J Am Acad Orthop Surg. 2007;15:425-431.
38. Maughan R. Exercise induced muscle cramp: a prospective biochemical study in marathon runners. J Sports Sci. 1986;4:31-34.
39. Miller K, Knight K. Pain and soreness associated with a percutaneous electrical stimulation muscle cramping protocol. Muscle Nerve. 2007;36:711-714.
40. Miller T, Layzer RB. Muscle cramps. Muscle Nerve. 2005;32:431-442.
41. Moss K. Some effects of high air temperatures and muscular exertion upon colliers. Proc R Soc Lond B Biol Sci. 1923;95:181-200.
42. Nelson D, Hutton R. Dynamic and static stretch responses in muscle spindle receptors in fatigued muscle. Med Sci Sports Exerc. 1985;17:445-450.
43. Norris F, Gasteiger E, Chatfield P. An electromyographic study of induced and spontaneous muscle cramps. Electroencephalogr Clin Neurophysiol. 1956;9:139-147.
44. Obi T, Mizoguchi K, Matsuoka H, Takatsu M, Nishimura Y. Muscle cramp as the result of impaired GABA function: an electrophysiological and pharmacological observation. Muscle Nerve. 1993;16:1228-1231.
45. Ramsey F, Schafer D. Drawing statistical conclusions. In: The Statistical Sleuth: A Course in Data Analysis Methods. 2nd ed. Pacific Grove, CA: Duxbury; 2002:1-27.
46. Rehrer N, Smets A, Reynaert H, Goes E, De Meirleir K. Effect of exercise on portal vein blood flow in man. Med Sci Sports Exerc. 2001;31:701-715.
47. Riley J, Antony S. Leg cramps: differential diagnosis and management. Am Fam Physician. 1995;52(6):1794-1798.
48. Ross B, Thomas C. Human motor unit activity during induced muscle cramp. Brain. 1995;118:983-993.
49. Sawka M, Burke L, Eichner E, Maughan R, Montain S, Stachenfeld N. ACSM position stand: exercise and fluid replacement. Med Sci Sports Exerc. 2007;39:377-390.
50. Schwellnus M. Cause of exercise associated muscle cramps (EAMC)-Altered neuromuscular control, dehydration, or electrolyte depletion? Br J Sports Med. 2009;43:401-408.
51. Schwellnus M, Derman E, Noakes T. Aetiology of skeletal muscle “cramps” during exercise: a novel hypothesis. J Sports Sci. 1997;15:277-285.
52. Schwellnus M, Nicol J, Laubscher R, Noakes T. Serum electrolyte concentrations and hydration status are not associated with exercise associated muscle cramping (EAMC) in distance runners. Br J Sports Med. 2004;38:488-492.
53. Serrao M, Arendt-Nielsen L, Ge H, Pierelli F, Sandrini G, Farina D. Experimental muscle pain decreases the frequency threshold of electrically elicited muscle cramps. Exp Brain Res. 2007;182:301-308.
54. Stofan J, Zachwieja J, Horswill C, Murray R, Anderson S, Eichner E. Sweat and sodium losses in NCAA football players: a precursor to heat cramps? Int J Sport Nutr Exerc Metab. 2005;15:641-652.
55. Stone M, Edwards J, Babington J, Ingersoll C, Palmieri R. Reliability of an electrical method to induce muscle cramp. Muscle Nerve. 2003;27:122-123.
56. Stone M, Edwards J, Stemmans C, Ingersoll C, Palmieri R, Krause B. Certified athletic trainers’ perceptions of exercise associated muscle cramps. J Sport Rehabil. 2003;12:333-342.
57. Sulzer N, Schwellnus M, Noakes T. Serum electrolytes in Ironman triathletes with exercise associated muscle cramping. Med Sci Sports Exerc. 2005;37:1081-1085.
58. Swanik C, Lephart SM, Giannantonio F, Fu F. Reestablishing neuromuscular control in the ACL injured athlete. J Sport Rehabil. 1997;6:182-206.
59. Swanik K, Lephart S, Swanik C, Lephart S, Stone D, Fu F. The effects of shoulder plyometric training on proprioception and muscle performance characteristics. J Shoulder Elbow Surg. 2002;11:579-586.
60. Talbott J. Heat cramps. Medicine. 1935;14:323-376.
61. Vist G, Maughan R. The effect of osmolality and carbohydrate content on the rate of gastric emptying of liquids in man. J Physiol. 1995;486:523-531.
62. Wilk K, Voight M, Keirns M, Gambetta V, Andrews J, Dillman C. Stretch-shortening drills for the upper extremities: theory and clinical application. J Orthop Sports Phys Ther. 1993;17:225-239.
Cite article
Cite article
Cite article
OR
Download to reference manager
If you have citation software installed, you can download article citation data to the citation manager of your choice
Information, rights and permissions
Information
Published In
Article first published online: July 1, 2010
Issue published: July/August 2010
Keywords
PubMed: 23015948
Authors
Metrics and citations
Metrics
Journals metrics
This article was published in Sports Health: A Multidisciplinary Approach.
VIEW ALL JOURNAL METRICSArticle usage*
Total views and downloads: 2532
*Article usage tracking started in December 2016
Altmetric
See the impact this article is making through the number of times it’s been read, and the Altmetric Score.
Learn more about the Altmetric Scores
Articles citing this one
Receive email alerts when this article is cited
Web of Science: 0
Crossref: 0
-
Prevalence, Clinical Characteristics, and Self-Reported Treatment of E...
-
Hamstring Muscle Cramp Visualized on Bone Single-Photon Emission Compu...
-
Primary care approach to calf cramps
-
Evidence that variations in pretraining hydration status are related t...
-
Effectiveness of Mouth Rinsing versus Ingesting Pickle Juice for Allev...
-
Apparent temperature and heat‐related illnesses during international a...
-
Exercise-Associated Muscle Cramps in the Tennis Player
-
Muscles
-
Common Misconceptions in Classic and Exertional Heat Stroke
-
Muscle cramps: A comparison of the two-leading hypothesis
-
Les crampes musculaires associées aux exercices (CMAE) : revue de litt...
-
Acute Passive Static Stretching and Cramp Threshold Frequency
-
Sports Nutrition Myths That Deserve to Die but Live On
-
A narrative review of exercise-associated muscle cramps: Factors that ...
-
Epidemiology of Exertional Heat Illnesses in Youth, High School, and C...
-
Myths and Misconceptions About Exercise-Associated Muscle Cramping
-
Exertional Heat Illness
-
Evaluation and Treatment of Heat- and Altitude-Related Illness
-
Associations between poor oral health and reinjuries in male elite soc...
-
Sports Injuries
-
Neural Mechanisms of Muscle Cramp
-
Exercise associated muscle cramps: Discussion on causes, prevention an...
-
Heat Stress and Thermal Strain Challenges in Running
-
Spierkrampen
-
A Promising Approach to Effectively Reduce Cramp Susceptibility in Hum...
-
Voluntary Inducement of Triceps Surae Muscle Cramping
Figures and tables
Figures & Media
Tables
View Options
Get access
Access options
If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:
loading institutional access options
AOSSM members can access this journal content using society membership credentials.
AOSSM members can access this journal content using society membership credentials.
Alternatively, view purchase options below:
Purchase 24 hour online access to view and download content.
Access journal content via a DeepDyve subscription or find out more about this option.
