AN ATHLETE'S NIGHTMARE-MUSCLE CRAMPS

Through the history of sport, one ailment has plagued physically active people above all others: muscle cramps. As common as cramps are, no one knows exactly what causes them. In this column, I will take a look at what muscle cramps are, several theories that attempt to explain how they are caused, and discuss prevention and treatment options.

Muscle cramping is a painful, involuntary muscle spasm that regularly frustrates athletes. Muscle cramps can be classified into three main categories: congenital abnormalities, acquired medical diseases and specific acquired skeletal-muscle cramp syndromes.

The most common are the acquired skeletal-muscle cramp syndromes. These are exercise-associated muscle cramps (EAMC), which are the most common among athletes; occupational cramps, such as writer's cramp; nocturnal calf muscle cramps - cramps that occur at night, mostly in the elderly and pregnancy-associated cramps.

Although it is important to keep all four types in mind when dealing with cramping, EAMC are the most commonly experienced by athletes. There are several risk factors for EAMC, including older age, a long history of running, a higher body mass index, poor stretching, irregular stretching and a family history of muscle cramping. In most cases, the cramp occurs as a result of repetitive exercise. When a muscle cramp occurs, the athlete will have extreme pain, the muscle will be involuntarily contracting, and the athlete will not be able to use the muscle group.

The cause of EAMC has been researched for the past 50 years, however there has yet to be one factor identified as the sole problem. There are currently four theories that attempt to explain muscle cramping: the electrolyte theory, the dehydration theory, the environmental theory and the sustained alpha motor neuron theory.

The electrolyte theory is based on muscle spasms in persons who have decreased concentration of electrolytes such as potassium, sodium, magnesium or calcium. The dehydration theory is one of the most commonly used to explain EAMC. When an individual is dehydrated, the decrease in body mass, blood volume and plasma volume leads to muscle cramping. The environmental theory is based on the fact that when athletes are exposed to extreme environmental conditions, such as high heat and humidity, they are more susceptible to cramps. The most recent explanation for muscle cramps is the sustained alpha motor neuron contraction. These sustained muscle contractions occur secondary to muscle fatigue.

Prevention is the best treatment for muscle cramping. The most common preventive measures include proper conditioning, stretching and maintaining adequate nutrition and hydration. Being properly conditioned is a key factor. When a muscle is not properly conditioned and stretched, it will have an earlier onset of fatigue. This may lead to the increased activity of alpha motor neuron activity and thus lead to cramping.

Proper diet and hydration are also strongly emphasized preventive techniques. A balanced diet ensures that the athlete will take in enough nutrients so that he or she will not be deficient in any of the electrolytes needed to maintain normal muscle function. If the athlete is still cramping on a balanced diet, he or she should be encouraged to eat more potassium-rich foods and to lightly salt them.

Although prevention is truly the best medicine for muscle cramps, the truth is that many athletes will follow the above guidelines fully yet cramp up anyway. Once an athlete has begun to cramp, that individual will not be able to perform at his or her optimum until the cramp has been treated. Common treatments for acute EAMC are icing, stretching, massaging and replenishment of fluids through the use of water or sports drinks.

What if this fails? Pickle juice has been used to prevent and treat muscle cramps for decades, if not longer. Other health care professionals also treat muscle cramps with mustard. Exactly how it works remains a mystery, but the key ingredient seems to be vinegar, because vinegar alone and mustard have yielded results similar to pickle juice.

When all of the previously mentioned preventive techniques have been tried and fail, the University of Northern Iowa uses the following treatment: Add two ounces of pickle juice to the athlete's pre-game or pre-practice regimen 10 minutes before activity starts. Two ounces of pickle juice also seems to be effective in treating acute cramps that occur during competition or practice. Generally, the cramps will subside within 30 seconds.

Dr. Robert E. Agee of the Alabama Sports Medicine Institute treats EAMC with mustard. An athlete who begins to cramp is given one packet of mustard, washed down with water, every two minutes until the muscle cramp is gone.

No formal research has been conducted to identify if, why or how mustard or pickle juice works. For this reason an athlete cannot simply prepare for a game or thwart cramps by downing a few gulps of pickle juice or eating mustard without first addressing conditioning, stretching and diet.

Whether you employ old standbys as treatments or newer methods, the emphasis should always be what is most effective - and safe - for the athlete.

Laura Ramus, PT, ATC, is the athletic trainer and strength and conditioning coach for the WNBA Champion Detroit Shock. Since 1994, she has a/spj served as the manager of sports medicine for St. John Hospital in Detroit. For more information, log onto her Website www.girlscanjump.com.

Copyright Ashton International Media, Inc. Apr 2004
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