The Cramping Crisis

Whether you are a marathon runner, mountain biker or rugby player, this phenomenon rears its ugly head at the most inopportune times.

Dr Green, Event Chief Medical Officer for Mediclinic Southern Africa, explains some current updates and to help athletes differentiate fact from fallacy.

What exactly is an exercise associated muscle cramp ?

Exercise-associated muscle cramps (EAMCs) are involuntary, painful muscle contractions that commonly affect endurance athletes. While often transient, they can significantly disrupt performance and recovery. Recent evidence suggests that EAMCs are multifactorial, with neuromuscular fatigue emerging as a central factor.

What actually happens to the muscle ?

The prevailing theory holds that EAMCs result from an imbalance between excitatory input from muscle spindles and inhibitory input from Golgi tendon organs, leading to hyperexcitability of alpha motor neurons. This imbalance is primarily driven by neuromuscular overload and fatigue, rather than dehydration or electrolyte imbalances, which were previously considered primary causes.

Who is at risk for developing cramps during exercise?

• Neuromuscular fatigue: Prolonged or intense exercise increases susceptibility.
• Environmental conditions: Hot and humid climates can exacerbate fatigue.
• Training status: Inadequate acclimatization or conditioning.
• Muscle length: Contractions in shortened muscle positions are more prone to cramping.
• Previous cramping episodes: History of EAMCs increases the likelihood of recurrence.

How does one treat cramping?

Immediate relief from EAMCs can often be achieved through the following actions:

• Stretching: Gentle static stretching of the affected muscle.
• Massage: Light massage to alleviate muscle tension.
• Cooling: Applying ice to reduce inflammation.

These interventions help restore neuromuscular balance and alleviate discomfort.

Can I prevent getting severe cramps during exercise ?

Preventative strategies focus on reducing neuromuscular fatigue and include:

• Adequate warm-up: Engaging in dynamic stretching and light aerobic activity before exercise.
• Training modifications: Gradual progression in intensity and duration to build endurance.
• Recovery protocols: Incorporating rest and active recovery to prevent overtraining.

These individualised approaches are more effective than generalised recommendations such as increased fluid or electrolyte intake.

What’s the take home message?

EAMCs are complex phenomena influenced by various intrinsic and extrinsic factors. A nuanced understanding of their pathophysiology and risk factors enables sports medicine professionals to develop tailored prevention and treatment strategies, enhancing athlete performance and well-being.

Dr Green emphasises that for cyclists, “Do not underestimate the importance and role of appropriate conditioning, professional bike set up, training and race nutrition planning in endurance events.”