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Exercise associated muscle cramps

Cramping during exercise is a common and frustrating complaint. Most people would be familiar with the unpleasant experience of a cramp (whether during exercise or not), but despite the prevalence of cramps, the actual cause is not well understood.

What are cramps?

Painful, involuntary contractions of skeletal muscle. Essentially your muscle(s) contracting excessively when you don’t want it to. If they occur during or after exercise we can refer to them as exercise-associated muscle cramps.

The severity can be variable- from a sense of ‘near cramping’, localised cramping that is self-limiting, to the more severe ‘whole body’ cramping that is difficult to settle. In more severe cases, cramps can also be associated with systemic features such as confusion, dizziness, collapse, and nausea.

What causes cramps?

It is important to first point out that cramps are a symptom, rather than a diagnosis. While most cramps are completely harmless, they may be the result of an underlying medical condition (e.g. muscle, nerve, hormone related) or certain medications.

What should I do if I am having trouble with cramps?

Given there are a number of causes of cramps, it is advisable to see a doctor to first confirm the cause and exclude the uncommon medical causes. Going through each of these is out of the scope of this article and diagnosis requires consultation with a doctor.

Once these are excluded, a diagnosis of exercise-associated muscle cramps is usually concluded.

So what causes exercise-associated muscle cramps?

This is not well understood and has been debated over the years. Current thinking is that exercise-associated muscle cramps are caused by an imbalance between the excitatory drive from muscle and inhibitory drive from the nervous system. This imbalance is believed to stem from neuromuscular overload and fatigue, which is why you tend to cramp when you are fatigued, not early on during exercise.

Dehydration and electrolyte depletion are also potential causes, but there has been a shift towards neuromuscular fatigue theory in recent years.

Is exercise associating cramping common?

Yes, particularly in endurance events. Some studies have quoted that 39% of marathon runners and 78% of triathletes will experience cramps at some point in their sporting life.

What can I do to stop cramping during exercise?

Again this is best discussed with a doctor, as it will depend on your particular circumstances.

When you actually have a cramp, the best way to get rid of it is to stop whatever you are doing (or decrease the intensity) and stretch the muscle affected. Certain unusual drinks (either gargled or swallowed) have been shown to help stop cramps, in particular, pickle juice has been well publicised (you may have seen Australian Rules Footballers gargling this on the bench in the third and fourth quarters of matches).

Other interventions that may assist include making sure you are well prepared/fit enough for whatever exercise or event you are completing, and any injuries you are carrying are addressed. Plus address any ‘medical’ causes that were mentioned earlier.

So in summary, cramps are more complicated than most people think and aren’t purely related to hydration or electrolyte (‘salts’) levels. Focusing on your physical preparedness is important, and of course, if you are not sure about what to do, consult you can consult a doctor, including sport and exercise medicine physicians/registrars.

Learn more about Dr. Richard Saw by visiting http://opsmc.com.au/person/dr-richard-saw/

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