Exercise-associated Muscle Cramps Research Articles

Effects of TRPV1 and TRPA1 activators on the cramp threshold frequency: a randomized, double-blind placebo-controlled trial.

Previous data indicate that a strong sensory input from orally administered TRPV1 and TRPA1 activators alleviates muscle cramps in foot muscles by reducing the α-motor neuron hyperexcitability. We investigated if TRP activators increase the cramp threshold frequency of the medial gastrocnemius. We randomly assigned 22 healthy male participants to an intervention (IG) and a control group (CG). While participants of the IG ingested a mixture of TRPV1 and TRPA1 activators, the CG received a placebo. We tested the cramp threshold frequency (CTF), the cramp intensity (EMG activity), and the perceived pain of electrically induced muscle cramps before (pre), and 15min, 4, 8, and 24h after either treatment. We further measured the maximal isometric force of knee extensors at pre, 4, and 24h to assess potential side-effects on the force output. When we included all measurement time points, no group-by-time interaction was observed for the CTF. However, when only pre and 15min values were incorporated, a significant interaction, with a slightly greater CTF increase in IG (3.1±1.5) compared to the CG (2.0±1.5), was observed. No significant group by time interaction was found for the cramp intensity, the perceived pain, and the maximal isometric force. Our data indicate that orally administered TRPV1 and TRPA1 activators exert a small short-term effect on the CTF, but not on the other parameters tested. Future studies need to investigate whether such small CTF increments are sufficient to prevent exercise-associated muscle cramps.

Exercise Associated Muscle Cramps - A Current Perspective

Exercise Associated Muscle Cramps - A Current Perspective

A narrative review of exercise-associated muscle cramps: Factors that contribute to neuromuscular fatigue and management implications.

Although exercise-associated muscle cramps (EAMC) are highly prevalent among athletic populations, the etiology and most effective management strategies are still unclear. The aims of this narrative review are 3-fold: (1) briefly summarize the evidence regarding EAMC etiology; (2) describe the risk factors and possible physiological mechanisms associated with neuromuscular fatigue and EAMC; and (3) report the current evidence regarding prevention of, and treatment for, EAMC. Based on the findings of several large prospective and experimental investigations, the available evidence indicates that EAMC is multifactorial in nature and stems from an imbalance between excitatory drive from muscle spindles and inhibitory drive from Golgi tendon organs to the alpha motor neurons rather than dehydration or electrolyte deficits. This imbalance is believed to stem from neuromuscular overload and fatigue. In concert with these findings, the most successful treatment for an acute bout of EAMC is stretching, whereas auspicious methods of prevention include efforts that delay exercise-induced fatigue. Muscle Nerve 54: 177-185, 2016.

Genetics of Musculoskeletal Exercise-Related Phenotypes.

Genetic factors have been shown to associate with various exercise-related phenotypes, including exercise performance, adaptation to training and sports injuries. The genes implicated in the pathogenesis of musculoskeletal soft-tissue injuries all code for either structural components or regulatory components of the extracellular matrix. It has been hypothesized that these genetic associations with injuries are due to genetically regulated changes in mechanical properties of musculoskeletal soft tissue. Thus, the objective of this review is to highlight the research which has advanced our understanding of how genetic variation within these structural genes affects the properties of our connective tissue. The genetics of various exercise-related phenotypes, such as range of motion, endurance performance and exercise-associated muscle cramps, are reviewed. Lastly, a model is presented where genetic variations within a collagen-encoding gene result in a continuum of phenotype ranging from a normal tissue to a seriously deleterious or lethal disorder.

Does a Reduction in Serum Sodium Concentration or Serum Potassium Concentration Increase the Prevalence of Exercise-Associated Muscle Cramps?

Although exercise-associated muscle cramps (EAMC) are common in ultradistance runners and athletes in general, their etiology remains unclear. EAMC are painful, sudden, involuntary contractions of skeletal muscle occurring during or after exercise and are recognized by visible bulging or knotting of the whole, or part of, a muscle. Many clinicians believe EAMC occur after an imbalance in electrolyte concentrations, specifically serum sodium concentration ([Na+]s) and serum potassium concentration ([K+]s). Studies that have established a link between EAMC occurrence and serum electrolyte concentrations after an athletic event are unhelpful. Focused Clinical Question: Are [Na+]s and [K+]s different in athletes who experience EAMC than noncrampers?

Associations between poor oral health and reinjuries in male elite soccer players: a cross-sectional self-report study.

BackgroundAlthough it is well known that oral pathogens can enter the systemic circulation and cause disease, it is largely unknown if poor oral health increases the risk of sports injuries. The purpose of this study is to investigate the association between poor oral health and reinjuries in male elite soccer players, adjusted for psychosocial problems and player characteristics.Methods184 Players in premier league soccer clubs and 31 elite, junior soccer players in the Netherlands, Belgium and England, were enrolled in a retrospective cross-sectional study. The Sports Injury Risk Indicator, a self assessed questionnaire, was used to obtain information on reinjuries, age and player position, oral health and psychosocial problems. The number of different types of oral health problems was used as an indicator of poor oral health. (SumDental, range 0–2: 0 = no oral health problems, 1 = one type of oral health problem and 2 = two or more types of oral health problems). Multivariable logistic regression was used to investigate whether SumDental was associated with reinjuries, after adjustment for psychosocial problems and player characteristics.Results37% of the players reported no oral health problems, 43% reported one type of oral health problem and 20% reported two or more types of oral health problems. After full adjustment for age, player position and psychosocial problems (i.e. injury anxiety, psychophysical stress, unhealthy eating habits and dissatisfaction with trainer/team), poor oral health (SumDental) was positively associated with all kind of reinjuries whether analyzed as a continuous variable or as a categorical variable. The fully adjusted odds ratios for SumDental analyzed as a continuous variable were: in relation to repeated exercise-associated muscle cramps: 1.82 (95% confidence interval (CI): 1.07, 3.12), in relation to muscle or tendon reinjury 1.57 (95% CI: 1.01, 2.45) and in relation to multiple types of reinjury 1.88 (95% CI: 1.19, 2.97).ConclusionThe results from this study justify a thorough examination of the effects of oral health problems on the injury risk of playing elite soccer.

Exercise associated muscle cramps: Discussion on causes, prevention and treatment

Summary Objective To discuss the causes, prevention and treatment of exercise associated muscle cramps (EAMC) according to the level of evidence of the available literature, in order to present some evidence-based guidelines for athletes, coaches and health professionals. News Since it appears fundamental for sports medicine physicians and sports health professionals to be able to manage and prevent EAMC, although pathophysiology and causes of EAMC are discussed, clear understanding of EAMC causes seems important in order to treat and prevent EAMC. Perspectives and projects The present review evaluated the available literature on EAMC based on their level of evidence to present some evidence-based guidelines for sports professionals. Fifty articles were selected: 24 after full-text reading and 26 articles after screening selected articles references. Level of evidence was from 1 (n = 3), 2 (n = 8), 3 (n = 10), 4 (n = 13), and 5 (n = 16). Conclusions The “Altered neuromuscular control theory” seems to be the most scientifically acceptable theory, and suggests that EAMC are caused by an imbalance between increased afferent activity (e.g. muscle spindle, Ia) and decreased inhibitory afferent activity (e.g. Golgi tendon organs, Ib) which leads to increased α-motor neuron activity and muscle cramping, especially with muscle contraction in a shortened position. EAMC prevention measures should take into account the preparation of muscle to exercise (adapted training) and the respect of muscle fatigue during exercise (warm-up before exercise, well-controlled effort and rest during exercise). EAMC treatments should be non-pharmacological and should play a role on neuromuscular control (rest and/or stretching).

Heat-related illness in sports and exercise.

Exertional heat-related illness (EHRI) is comprised of several states that afflict physically active persons when exercising during conditions of high environmental heat stress. Certain forms of EHRI may become life threatening if not treated. Exertional heat stroke (EHS), characterized by a core body temperature of >40° C and mental status changes, is the most severe form of EHRI. EHS must be treated immediately with rapid body cooling to reduce morbidity and mortality. Many EHRI cases are preventable by following heat acclimatization guidelines, modifying sports and exercise sessions during conditions of high environmental heat stress, maintaining adequate hydration, avoiding exertion in the heat when ill, and by educating sports medicine personnel, coaches, parents, and athletes on the early recognition and prevention of EHRI. Heat exhaustion, exercise-associated collapse, exercise-associated muscle cramps, exercise-associated hyponatremia, and exertional rhabdomyolysis are also described.

Predictors of Calf Cramping in Rugby League

Exercise-associated muscle cramps (EAMC) in the calf are common in rugby league. To date, the etiology and predictors of calf cramping are poorly understood. The aim of this study was to undertake a prospective investigation to identify predictors of calf cramping in rugby league players. Demographic and anthropometric data and calf cramp and injury history were collected in the preseason. Hydration status, number of games played, and calf cramps were recorded on game days. Male rugby league players (n = 103, mean age 18.8 ± 4.1 years) were classified as either EAMC (experienced at least 1 incident of calf cramps in the season) or no EAMC (no calf cramps). The following were investigated as possible predictors of EAMC using logistic regression modeling: competition level, age, ethnicity, playing position, history of cramping, precramping, low back pain, foot orthotic usage, foot posture, foot strike, muscle flexibility, calf girth, hydration status, and number of games played. Half the players, n = 52, experienced at least 1 incidence of calf cramping. Playing in a senior competition level (odds ratio: 0.21; 95% confidence interval: 0.06-0.75; p = 0.016), a history of calf cramping (10.85; 2.16-54.44; p = 0.004), and a history of low back pain resulting in missed field minutes (4.50, 1.37-14.79; p = 0.013) were found to predict EAMC. This study suggests that there is a high incidence of calf cramping in rugby league, especially at senior competition levels, and supports preseason screening in senior players to idetify those at risk of calf cramping and the development of possible preventative strategies.

Electrolyte and Plasma Responses After Pickle Juice, Mustard, and Deionized Water Ingestion in Dehydrated Humans.

Context : Some athletes ingest pickle juice (PJ) or mustard to treat exercise-associated muscle cramps (EAMCs). Clinicians warn against this because they are concerned it will exacerbate exercise-induced hypertonicity or cause hyperkalemia. Few researchers have examined plasma responses after PJ or mustard ingestion in dehydrated, exercised individuals. Objective : To determine if ingesting PJ, mustard, or deionized water (DIW) while hypohydrated affects plasma sodium (Na+) concentration ([Na+]p), plasma potassium (K+) concentration ([K+]p), plasma osmolality (OSMp), or percentage changes in plasma volume or Na+ content. Design : Crossover study. Setting : Laboratory. Patients or Other Participants : A total of 9 physically active, nonacclimated individuals (age = 25 ± 2 years, height = 175.5 ± 9.0 cm, mass = 78.6 ± 13.8 kg). Intervention(s) : Participants exercised vigorously for 2 hours (temperature = 37°C ± 1°C, relative humidity = 24% ± 4%). After a 30-minute rest, a baseline blood sample was collected, and they ingested 1 mL/kg body mass of PJ or DIW. For the mustard trial, participants ingested a mass of mustard containing a similar amount of Na+ as for the PJ trial. Postingestion blood samples were collected at 5, 15, 30, and 60 minutes. Main Outcome Measure(s) : The dependent variables were [Na+]p, [K+]p, OSMp, and percentage change in plasma Na+ content and plasma volume. Results : Participants became 2.9% ± 0.6% hypohydrated and lost 96.8 ± 27.1 mmol (conventional unit = 96.8 ± 27.1 mEq) of Na+, 8.4 ± 2 mmol (conventional unit = 8.4 ± 2 mEq) of K+, and 2.03 ± 0.44 L of fluid due to exercise-induced sweating. They ingested approximately 79 mL of PJ or DIW or 135.24 ± 22.8 g of mustard. Despite ingesting approximately 1.5 g of Na+ in the PJ and mustard trials, no changes occurred within 60 minutes postingestion for [Na+]p, [K+]p, OSMp, or percentage changes in plasma volume or Na+ content (P > .05). Conclusions : Ingesting a small bolus of PJ or large mass of mustard after dehydration did not exacerbate exercise-induced hypertonicity or cause hyperkalemia. Consuming small volumes of PJ or mustard did not fully replenish electrolytes and fluid losses. Additional research on plasma responses pre-ingestion and postingestion to these treatments in individuals experiencing acute EAMCs is needed.

Significant and serious dehydration does not affect skeletal muscle cramp threshold frequency

ObjectiveMany clinicians believe that exercise-associated muscle cramps (EAMC) occur because of dehydration. Experimental research supporting this theory is lacking. Mild hypohydration (3% body mass loss) does not alter threshold frequency...

Plasma Potassium Concentration and Content Changes After Banana Ingestion in Exercised Men

Individuals prone to exercise-associated muscle cramps (EAMCs) are instructed to eat bananas because of their high potassium (K(+)) concentration and carbohydrate content and the perception that K(+) imbalances and fatigue contribute to the genesis of EAMCs. No data exist about the effect of bananas on plasma K(+) concentration ([K(+)](p)) or plasma glucose concentration ([glucose](p)) after exercise in the heat. To determine whether ingesting 0, 1, or 2 servings of bananas after 60 minutes of moderate to vigorous exercise in the heat alters [K(+)](p) or [glucose](p) and whether changes in [K(+)](p) result from hypotonic fluid effluxes or K(+) ion changes. Crossover study. Laboratory. Nine euhydrated men (age = 27 ± 4 years, height = 180.3 ± 8.4 cm, mass = 84.9 ± 26.1 kg, urine specific gravity ≤ 1.006) without EAMCs volunteered. On 3 separate days, participants completed 60 minutes of moderate to vigorous cycling (temperature = 36.4°C ± 1.1°C, relative humidity = 19.4% ± 2.5%) and then ate 0 g (0 servings), 150 g (1 serving), or 300 g (2 servings) of bananas. Blood samples were collected at 3, 5, 15, 30, and 60 minutes postingestion. The [K(+)](p), changes in plasma K(+) content, plasma volume changes, and [glucose](p). The [K(+)](p) differed between conditions at 60 minutes; 2 servings (4.6 ± 0.3 mmol/L [conventional unit = 4.6 ± 0.3 mEq/L]) was greater than 1 serving (4.5 ± 0.2 mmol/L [conventional unit = 4.5 ± 0.2 mEq/L]) and 0 servings (4.4 ± 0.3 mmol/L [conventional unit = 4.4 ± 0.3 mEq/L]) (P < .05). The [K(+)](p) was greater at 60 minutes than at 3 and 5 minutes in the 1-serving condition and was greater at 30 and 60 minutes than at 3 and 5 minutes in the 2-servings condition (P < .05). Percentage change in K(+) content was greater only at 30 and 60 minutes postingestion than at baseline in the 2-servings condition (4.4% ± 3.7% and 5.8% ± 2.3% increase, respectively) (P < .05). The plasma volume changes among conditions were unremarkable. The [glucose](p) was greater in the 2-servings condition than in all other conditions at 15, 30, and 60 minutes (P < .05). The effect of banana ingestion on EAMCs is unknown; however, these data suggested bananas are unlikely to relieve EAMCs by increasing extracellular [K(+)] or [glucose](p). The increases in [K(+)](p) were marginal and within normal clinical values. The changes in [K(+)](p), plasma K(+) content, and [glucose](p) do not occur quickly enough to treat acute EAMCs, especially if they develop near the end of competition.

Magnesium for skeletal muscle cramps

Skeletal muscle cramps are common and often presented to physicians in association with pregnancy, advanced age, exercise or disorders of the motor neuron (such as amyotrophic lateral sclerosis). Magnesium supplements are marketed for the prophylaxis of cramps but the efficacy of magnesium for this indication has never been evaluated by systematic review. To assess the effects of magnesium supplementation compared to no treatment, placebo control or other cramp therapies in people with skeletal muscle cramps. We searched the Cochrane Neuromuscular Disease Group Specialized Register (11 October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 3), MEDLINE (January 1966 to September 2011), EMBASE (January 1980 to September 2011), LILACS (January 1982 to September 2011), CINAHL Plus (January 1937 to September 2011), AMED (January 1985 to October 2011) and SPORTDiscus (January 1975 to September 2011). Randomized controlled trials (RCTs) of magnesium supplementation (in any form) to prevent skeletal muscle cramps in any patient group (i.e. all clinical presentations of cramp). We considered comparisons of magnesium with no treatment, placebo control, or other therapy. Two authors independently selected trials for inclusion and extracted data. Two authors assessed risk of bias. We attempted to contact all study authors and obtained patient level data for three of the included trials, one of which was unpublished. All data on adverse effects were collected from the included RCTs. We identified seven trials (five parallel, two cross-over) enrolling a total of 406 individuals amongst whom 118 cross-over participants additionally served as their own controls. Three trials enrolled women with pregnancy-associated leg cramps (N = 202) and four trials enrolled idiopathic cramp sufferers (N = 322 including cross-over controls). Magnesium was compared to placebo in six trials and to no treatment in one trial.For idiopathic cramps (largely older adults presumed to have nocturnal leg cramps), differences in measures of cramp frequency, magnesium versus placebo, were small, not statistically significant, and without heterogeneity (I(2) = 0%). This includes the primary endpoint, percentage change from baseline in the number of cramps per week at four weeks (-3.93%, 95% confidence interval (CI) -21.12% to 13.26%, moderate quality evidence) and the difference in the number of cramps per week at four weeks (0.01 cramps/week, 95% CI -0.52 to 0.55, moderate quality evidence). The percentage of individuals experiencing a 25% or better reduction in cramp rate from baseline was also no different, being 8% lower in the magnesium group (95% CI -28% to 12%, moderate quality evidence). Similarly, no statistically significant difference was found at four weeks in measures of cramp intensity (moderate quality evidence) or cramp duration (low quality evidence).Meta-analysis was not possible for trials of pregnancy-associated leg cramps. The single study comparing magnesium to no treatment failed to find statistically significant benefit on a three-point ordinal scale of overall treatment efficacy. The two trials comparing magnesium to placebo differed in that one trial found no benefit on frequency or intensity measures while the other found benefit for both.Withdrawals due to adverse events were not significantly different than placebo. While we could not determine the number of subjects with minor adverse events, studies of oral magnesium generally described potential side effects as similar in frequency to placebo. It is unlikely that magnesium supplementation provides clinically meaningful cramp prophylaxis to older adults experiencing skeletal muscle cramps. In contrast, for those experiencing pregnancy-associated rest cramps the literature is conflicting and further research in this patient population is needed. We found no randomized controlled trials evaluating magnesium for exercise-associated muscle cramps or disease state-associated muscle cramps (for example amyotrophic lateral sclerosis/motor neuron disease).

Intravenous fluid use in athletes.

Context:Time allowing, euhydration can be achieved in the vast majority of individuals by drinking and eating normal beverages and meals. Important to the competitive athlete is prevention and treatment of dehydration and exercise-associated muscle cramps, as they are linked to a decline in athletic performance. Intravenous (IV) prehydration and rehydration has been proposed as an ergogenic aid to achieve euhydration more effectively and efficiently.Evidence Acquisition:PubMed database was searched in November 2011 for all English-language articles related to IV utilization in sport using the keywords intravenous, fluid requirements, rehydration, hydration, athlete, sport, exercise, volume expansion, and performance.Results:Limited evidence exists for prehydration with IV fluids. Although anecdotal evidence does exist, at this time there are no high-level studies confirming that IV prehydration prevents dehydration or the onset of exercise-associated muscle cramps. Currently, there are no published studies describing IV fluid use during the course of an event, at intermission, or after the event as an ergogenic aid.Conclusion:The use of IV fluid may be beneficial for a subset of fluid-sensitive athletes; this should be reserved for high-level athletes with strong histories of symptoms in well-monitored settings. Volume expanders may also be beneficial for some athletes. IV fluids and plasma binders are not allowed in World Anti-Doping Agency–governed competitions. Routine IV therapy cannot be recommended as best practice for the majority of athletes.

Exertional Rhabdomyolysis in a Collegiate American Football Player After Preventive Cold-Water Immersion: A Case Report

To describe a case of exertional rhabdomyolysis in a collegiate American football player after preventive coldwater immersion. A healthy man (19 years old) participated in full-contact football practice followed by conditioning (2.5 hours). After practice, he entered a coach-mandated postpractice cold-water immersion and had no signs of heat illness before developing leg cramps, for which he presented to the athletic training staff. After 10 minutes of repeated stretching, massage, and replacement of electrolyte-filled fluids, he was transported to the emergency room. Laboratory tests indicated a creatine kinase (CK) level of 2545 IU/L (normal range, 45-260 IU/L), CK-myoglobin fraction of 8.5 ng/mL (normal < 6.7 ng/mL), and CK-myoglobin relative index of 30% (normal range, 25%-30%). Myoglobin was measured at 499 ng/mL (normal = 80 ng/mL). The attending physician treated the athlete with intravenous fluids. Exercise-associated muscle cramps, dehydration, exertional rhabdomyolysis. The patient was treated with rest and rehydration. One week after the incident, he began biking and swimming. Eighteen days later, the patient continued to demonstrate elevated CK levels (527 IU/L) but described no other symptoms and was allowed to return to football practice as tolerated. Two months after the incident, his CK level remained high (1900 IU/L). The athlete demonstrated no signs of heat illness upon entering the cold-water immersion but experienced severe leg cramping after immersion, resulting in a diagnosis of exertional rhabdomyolysis. Previously described cases have not linked cold-water immersion with the pathogenesis of rhabdomyolysis. In this football player, CK levels appeared to be a poor indicator of rhabdomyolysis. Our patient demonstrated no other signs of the illness weeks after the incident, yet his elevated CK levels persisted. Cold-water immersion immediately after exercise should be monitored by the athletic training staff and may not be appropriate to prevent muscle damage, given the lack of supporting evidence.

Factors Associated With a Self-Reported History of Exercise-Associated Muscle Cramps in Ironman Triathletes: A Case–Control Study

Factors Associated With a Self-Reported History of Exercise-Associated Muscle Cramps in Ironman Triathletes: A Case–Control Study

Severe Muscle Cramping of Trunk and Lower Extremities in a Collegiate Football Player

HISTORY: A healthy male (19 years old) participated in full-contact football practice followed by conditioning (2.5 hrs). Post practice, the athlete entered a coach-mandated cool water immersion tub to improve recovery, but exhibited no signs of heat illness. The athlete presented to the athletic training staff with bilateral hamstring and quadriceps cramping following the cold water immersion. The athletic training staff treated the athlete with stretching, massage, and rehydration, with a common carbohydrate-electrolyte drink containing extra electrolytes, for approximately 10 minutes. The cramping continued to progress down to his lower legs. The pain and cramping failed to subside and progressed to the athlete's low and mid back and then he was transported to the emergency department for further treatment. PHYSICAL EXAMINATION: Exercise associated muscle cramps were obviously recognized; however the prolonged nature led the clinicians to suspect additional systemic injury which could not be deduced on the sidelines. DIFFERENTIAL DIAGNOSIS: 1. Exercise associated muscle cramps 2. Dehydration 3. Exertional rhabdomyolysis TEST AND RESULTS: Laboratory tests indicated a CK level of 2,545 IU/L, CK-MB fraction of 8.5 ng/mL and CK-MB relative index was 30%. Serum myoglobin was measured at 499 ng/mL. Lab results indicated that the pH of the urine sample was 7 and the urinalysis was unremarkable for myoglobinuria. All other laboratory markers were unremarkable. FINAL/WORKING DIAGNOSIS: Exertional rhabdomyolysis TREATMENT AND OUTCOMES: 1. The athlete was admitted and immediately treated with intravenous fluids (½ normal saline pneumolysin 20meqs KCL [potassium chloride]) to run at 200 cc per hour until the morning. 2. Lab results on the following day indicated elevated CK levels (2,668 IU/L), but serum myoglobin declining (190 ng/mL). 3. The physician ordered continued rest and rehydration following discharge. 4. One week following the incident the athlete returned to biking and swimming. 5. Eighteen days following, the athlete continued to demonstrate elevated CK levels (527 IU/L), but described no other symptoms and returned to football practice as tolerated. 6. Two months post incident, a comparison blood sample indicated a continued high level of CK (1900 IU/L).

Factors Associated With a Self-Reported History of Exercise-Associated Muscle Cramps in Ironman Triathletes: A Case–Control Study

Exercise-associated muscle cramping (EAMC) is a common medical condition in endurance athletes. The exact cause of and risk factors for EAMC are still being investigated. The main objective of this study was to investigate factors that are associated with a self-reported history of EAMC in Ironman triathletes. Case-control study. Field study at an international Ironman Triathlon. Triathletes participating in an Ironman Triathlon were recruited as subjects. A previously validated prerace questionnaire was completed by 433 subjects who were divided into subjects who reported a history of EAMC (EAMC group = 216) and those who no reported history of EAMC (CON group = 217). Training, anthropometric, injury and performance, and other variables that were related to the history of EAMC. Compared with the CON group, triathletes in the EAMC group were significantly taller and heavier, had faster Ironman race times despite being of similar caliber (past personal best times), and predicted and achieved a faster overall time during the Ironman Triathlon. There was an association among a positive family history for EAMC, a history of tendon and/or ligament injuries, and a self-reported history of EAMC. There is evidence from this study that a history of EAMC is associated with (1) exercising at a higher intensity during a race that may result in premature muscle fatigue, (2) an inherited risk (positive family history), and (3) a history of tendon and/or ligament injury.

Increased running speed and pre-race muscle damage as risk factors for exercise-associated muscle cramps in a 56 km ultra-marathon: a prospective cohort study

BackgroundDespite the high prevalence of exercise-associated muscle cramping (EAMC) in endurance runners, the aetiology and risk factors for this condition are not fully understood.PurposeThe purpose of this prospective cohort study...

Three Percent Hypohydration Does Not Affect Threshold Frequency of Electrically Induced Cramps

Dehydration is hypothesized to cause exercise-associated muscle cramps. The theory states that dehydration contracts the interstitial space, thereby increasing the pressure on nerve terminals and cramps ensue. Research supporting this theory is often observational, and fatigue is rarely controlled. Inducing cramps with electrical stimulation minimizes many of the confounding factors associated with exercise-induced cramps (e.g., fatigue, metabolites). Thus, our goal was to minimize fatigue and determine whether hypohydration decreases the electrical stimuli required to elicit cramping (termed "threshold frequency"). Ten males cycled for 30-min bouts with their nondominant leg at 41°C and 15% relative humidity until they lost ~3% of their body mass (~2 h). Dominant leg flexor hallucis brevis muscle cramps were induced before and after hypohydration, and threshold frequency was recorded. Plasma osmolality (OSMp) characterized hydration status. Total sweat electrolytes (Na+, K+, Mg2+, and Ca2+) lost during exercise was calculated. Subjects repeated the protocol 1 wk later. Subjects were hypohydrated after exercise (preexercise OSMp = 282.5 T 1 mOsm·kg−¹ H2O, postexercise OSMp = 295.1 ± 1 mOsm·kg−¹ H2O, P < 0.001). Subjects lost 3.0% ± 0.1% of their body mass, 144.9 ± 9.8 mmol of Na+, 11.2 ± 0.4 mmol of K+, 3.3 ± 0.3 mmol of Mg2+, and 3.1 ± 0.1 mmol of Ca2+. Mild hypohydration with minimal neuromuscular fatigue did not affect threshold frequency (euhydrated = 23.7 ± 1.5 Hz, hypohydrated = 21.3 ± 1.4 Hz; F1,9 = 2.81, P = 0.12). Mild hypohydration with minimal neuromuscular fatigue does not seem to predispose individuals to cramping. Thus, cramps may be more associated with neuromuscular fatigue than dehydration/electrolyte losses. Health care professionals may have more success preventing exercise-associated muscle cramp by focusing on strategies that minimize neuromuscular fatigue rather than dehydration. However, the effect of greater fluid losses on cramp threshold frequency is unknown and merits further research.