Thursday, March 23, 2023

Preventing Cramps in High Intensity Athletics, The Science Is Frustrating

Muscle cramps cause immediate and total disability. Let's review why they may happen and the limited data on how to limit them. This data is not encouraging. 

What is a muscle cramp? An involuntary and painful muscle contraction.

Why do they occur? "The specific etiology is not well understood."

Specifics:

"Exercise-associated muscle cramps are the most frequent condition requiring medical/therapeutic intervention during sports."

"Heat-associated muscle cramping is often seen during sports and rigorous exercise or physical activity. In this situation, large losses of sweat and electrolytes are believed to be the underlying pathologic mechanism."

"About 80% of the affected muscle area is the calf."

"In healthy and sporting subjects there is no direct relationship between the depletion of fluids and the alteration of electrolyte balance as a definite cause of cramps."

"(Regarding patients with disease) Predisposing factors could include electrolyte disturbances or neurological disorders, hormonal and metabolic disorders, and compressions of nerve roots or compressed arterial vessels. Other predisposing factors could be related to the constant consumption of drugs, such as diuretics, beta-blockers, and statins."

"Stretching before physical activity does not prevent the appearance of a probable cramp."

Prevention:

"Prevention in healthy subjects could involve correct heating before physical activity and adequate hydration. For the different pathologies also characterized by the appearance of cramps, there are no accepted guidelines as valid on the pharmacological approach in any pathological state."

"The prevention of cramps through the intake of magnesium in healthy people, in neurological patients or in pregnant women, is not confirmed in the literature."

"However, the patient should be informed that despite the availability of a vast number of medications, their efficacy is low and unpredictable."

Electrolyte solutions may be preferred over water intake. "The study, published in the Journal of the International Society of Sports Nutrition, found that people who drank electrolyte enhanced water during and after exercise were less susceptible to muscle cramps than those who drank pure water."

Are there two types

"Skeletal muscle overload and fatigue can prompt muscle cramping locally in the overworked muscle fibers, and these cramps can be treated effectively with passive stretching and massage or by modifying the exercise intensity and load. In contrast, extensive sweating and a consequent significant whole-body exchangeable sodium deficit caused by insufficient dietary sodium intake to offset sweat sodium losses can lead to a contracted interstitial fluid compartment and more widespread skeletal muscle cramping, even when there is minimal or no muscle overload and fatigue."

"The information presented here supports the contention that there are two primary categories of exercise-associated muscle cramps - those related to muscle overload and fatigue and those skeletal muscle cramps associated with a sweat-induced sodium deficit (exertional heat cramps)."

Summary: 

  • Two theories exist - muscle fatigue and "dehydration"
  • Cramps are among the most common conditions treated. 
  • The literature is limited on prevention
  • Neither magnesium nor other meds are well-proven
  • For those thought to be "salty sweaters" salt and water replenishment make the most sense.
Here is the AI take:

Leg cramps can be a common problem for athletes, especially those who participate in high-intensity or endurance activities. Here are some approaches that can help prevent leg cramps:

  1. Stay Hydrated: Dehydration is a leading cause of leg cramps, so it's essential to stay hydrated before, during, and after exercise. Make sure to drink plenty of fluids, including water and sports drinks, to replenish lost fluids and electrolytes.

  2. Stretch and Warm-Up: Stretching and warming up your muscles before exercising can help prevent muscle cramps. Make sure to focus on stretching the muscles in your legs, including your calves and hamstrings.

  3. Gradual Increase in Exercise Intensity: Gradually increasing the intensity of your workouts can help prevent leg cramps. If you're just starting out or returning to exercise after a break, take it slow and gradually build up your endurance and intensity over time.

  4. Proper Footwear: Make sure to wear comfortable and supportive shoes that fit properly. Ill-fitting shoes or shoes that lack support can contribute to muscle cramps.

  5. Adequate Nutrition: Eating a healthy and balanced diet can help prevent leg cramps. Make sure to consume enough carbohydrates, protein, and other nutrients to fuel your body during exercise.

  6. Massage: Massaging your legs before and after exercise can help prevent leg cramps. Use a foam roller or massage ball to target the muscles in your legs.

  7. Rest and Recovery: Make sure to give your body enough time to rest and recover between workouts. Overtraining can increase the risk of muscle cramps and other injuries.

By following these approaches, athletes can reduce the risk of leg cramps and perform at their best during their workouts and competitions.

I have email out to a lead researcher in the field and will add his comments if I get a response.