Every athlete knows how it feels to have feet that feel like blocks of pine and a back so stiff that you might as well dress up in medieval armour without losing any flexibility. Although everyone from enthusiasts to top athletes suffer from muscle pain, the inclination is individual, and depends on exercising and living habits. A muscle cramp is a painful and involuntary muscle contraction. Cramps occur most commonly in the back, calves and hamstrings, but any muscle can be affected.
It is curious that the formation mechanism for such a common annoyance hasn’t been diagnosed completely, even though it is one of the most common nuisances of athletes. Their formation mechanisms and causes are still studied, but it is known that the most common predisposing factors are hard or a new type of strain, muscle fatigue, weak overall condition and malfunctions in fluid balance and neuromuscular junctions. This gives us the insight that muscle cramps occur more easily when training while being tired and dehydrated, and after a hard training session.
The current perception is that cramps are a result of a disorder between muscles and nerves. When the muscle is working at extreme levels, its ability to relax decreases. In a cramp the muscle is stuck in its contraction phase. A contracted muscle does not receive oxygen and cannot get rid of substances, which leads to pain. The culprit behind this situation is the central unit of the body, i.e. the brain, which sends out incorrect contraction and relaxation signals through the nervous system. Metaphorically, it all looks like an Indian traffic jam, where vehicles travel from every direction without a clear logical order. A cramp is the result of an information overload caused by the nervous system.
The neuromuscular theory explains why exceptional strain or muscle work while being tired increases the chances of muscle and nervous system malfunctions. For example a fitness jogger, who participates in a marathon or a football match, which after its full 90 minute length continues with overtime. The bodies of the players have adapted to the actual playing time, but the overtime pushes the body’s physiological functions to overtime as well. Combined with dehydration and changes in salt balance, the neuromuscular activity knocks down players – twisting on the field in agony caused by muscle cramps – or forces the marathon runner to stretch his calves in the middle of the race. Muscle cramps are especially common before the competition season, when the peak fitness level hasn’t been reached yet.
There are two types of people who suffer from muscle cramps more than others: old people and athletes. Old people’s muscle cramps are caused by the loss of muscle mass and changes in tissue properties. In addition, some old people have a medication that predisposes them to muscle cramps, such as fluid outlet medicines and heart medicines. Healthy people and athletes usually suffer from harmless muscle cramps, and blood tests or imaging examinations find a reason for them, such as salt or mineral deficiencies. Athletes usually think that their cramps are caused by salt balance disorders. However, blood tests rarely show clear changes in the mineral or salt balance, if the diet is varied and the protective nutrient intake is sufficient.
As a sports doctor, if I had an ace up my sleeve, which could tell how to prevent muscle cramps for certain, I would show it to the world without hesitating. If you do, however, suffer from starting muscle problems, keep in mind that reasonableness and rehabilitation are better alternatives than suffering and hardiness. By reasonableness I mean that the amount and effect of training should be right. A good warm-up, progressive increase in training amounts and careful recovery with proper cool-down and stretching prevents trouble. Cold and draft is worth avoiding. Compression accessories do wonders in improving the strain tolerance and recovery. I use Zero Point compression accessories when I train and I know a lot of athletes who have experienced compression accessories helpful for preventing muscle problems. They use them outside training as well, e.g. on longer game trips and flights in order to prevent the feet from getting tired or swollen, and to keep circulation disorders away.
The most effective first aid for a muscle cramp is light counter stretching and massage, which improves the local metabolism of the muscle. A heating bath is good for a contracting muscle, on the other hand, a cold treatment is even better, if the muscle is sore.
When talking about cramps, I can’t emphasize enough the importance of hydration. It should be started early on in order to avoid dehydration altogether. The sensation of thirst starts at a dehydration level of two percent, which means that you should start drinking before you get thirsty. The urine should be clear. It’s a sign that the liquid intake is sufficient. It may be useful to ensure the salt balance by adding a little bit of table salt (one teaspoon per litre) to the water or by consuming pickled cucumbers or bananas if the load is exceptionally long (e.g. marathon) or the circumstances are exceptional (e.g. extreme heat). Obviously only sporting while being sober makes sense. Alcohol causes dehydration and muscle cramps. Almost everyone knows this, but how many people know that smoking also predisposes you to muscle cramps? Nicotine binds to the receptors in the nerve muscle junctions and changes the way the cells work.
A lot can be done to prevent muscle problems. The most important advice I have is that the training should be interrupted immediately if a cramp strikes. A muscle cramp is often the first symptom of a rupture and the body’s way of hinting that the tissue does not bend more than its volume allows. Getting a cramping calf into shape is a whole lot faster than fixing a broken Achilles tendon.