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Sports Medicine
Sports Medicine: Cramping Your Style
By Dr. Neil McLaughlinJuly August 2010
You are out for a run on a beautiful sunny day when suddenly it strikes---the calf cramp from hell. Your muscles involuntarily seize up and you are paralyzed with pain. Don't panic. While a muscle cramp is an involuntary and forceful contraction of the muscle that will not relax, the fortunate news is most cramps will resolve spontaneously and do not cause permanent damage.
There is no single cause for muscle cramps, so prevention and treatment can be confusing. Normally when we run, bike, or swim our muscles contract and relax automatically with coordinated and fluid movement. A sudden cramp disrupts the pattern and leaves the athlete unable to move. Below are some of the major causes and recommendations for treatment and prevention--some backed by research and others more anecdotal in nature.
First of all, proper hydration before, during, and after exercise is paramount. One of the problems of proper hydration is that athletes have different rates of sweating which will affect the loss of water and electrolytes from the body. My wife and I can run together and I will be totally soaked in sweat at the end of the run while she has barely sweated at all. Obviously, our hydration and replenishment needs are not equal. That being said, here are some general hydration guidelines:
* Keep track of your body weight prior to and after exercise because every pound lost is equivalent to 16 oz. of fluid lost. This also includes loss of sodium and potassium that help regulate body fluids.
* Unless you have a family history of high blood pressure, salt is not bad for endurance athletes, so don't avoid salt in your diet and it is okay to heed cravings for it.
* Urine output and clarity can be another indicator of your hydration status. You should be urinating regularly and it should be clear; if not, you are most likely dehydrated and more susceptible to cramping.
Additional nutritional tips: Potassium can be obtained from bananas and other fruits and juices, potatoes, and pinto and kidney beans. There is a multitude of sports drinks to pick from as well to meet hydration needs, but it is important to experiment with them in training to make sure you choose one that does not upset your stomach.
Other nutritional considerations related to cramping are vitamin and mineral deficiencies. Vitamin B (particularly B1, B5, B6) can affect nerve function related to normal muscle contraction. A good diet including grains, legumes, nuts, seeds, fruit, eggs, dairy, and fish will provide the necessary amounts. Calcium and magnesium are also important to muscle function. Dairy, dark leafy greens (kale, collard), broccoli, legumes, and whole grains will get the job done for these minerals.
Medications and Side Effects
Diuretics can cause the loss of potassium, calcium, and magnesium all affecting proper muscle function. If you are taking any medications you should review the potential side effects. Another medical consideration is poor circulation (claudication) or blood clots that can mimic the pain of cramping, but is a much more serious health condition. We have treated national caliber triathletes who have developed these conditions, so it is not just a disease of the unhealthy.
In summary, most cramps will subside spontaneously but there are some preventive measures and remedies you can try. Never start a strenuous workout without being properly hydrated before you start. If you are susceptible to cramps, try a good pre-stretch routine concentrating on the calves and hamstrings--most prevalent to cramping during workouts. Warm up before increasing the intensity of your workout. Avoid the hottest, most humid times of the day for training as it is almost impossible to keep up with the fluid and electrolyte loss through sweating that will occur.
The overall key to avoiding cramps is to be preventive. A good diet with a focus on hydration all the time is the best approach. Once cramping has initiated all you can do is try to ride it out. A little extra time devoted to warming up and stretching is worth the effort. Don't let cramping influence or cramp your running or style!
Dr. Neil McLaughlin is a Certified Chiropractic Sports Physician; he practices at Commonwealth Chiropractic Center of Reston, VA. For more information 703-742-7856 or www.cccreston.com.
Say "No!" to Quinine
Doctors have long prescribed quinine to treat different forms of cramps but please note this: the FDA only approves the use of quinine for the treatment of malaria. In 2008 there were 1,500 cases of confirmed malaria in the U.S., yet more than 124,000 people received up to 300,000 prescriptions for Qualaquin (quinine). Some of the more serious side effects of quinine are Thrombocytopenia (decreased blood platelets), cardiac problems (abnormal arrhythmias), and kidney failure, all potential life threatening conditions. Multiple studies have not been able to confirm the effectiveness of this drug. That being said, do not stop taking quinine if it has been prescribed to you until you have consulted with your physician.