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18 ASK AN EXPERT OhCramps Most of us know the feeling; you are happily running along and the next minute you are forced to a dead stop. The pain in one of your muscles is excruciating and when you look down at your legs, you see a muscle spasm the size of a golf ball. Does this sound familiar? Want to know why it happens? How to prevent it? David van Wyk shares his views with us. Exercise Associated Muscle Cramping (EAMC) is defined as a painful, spasmodic and involuntary contraction of skeletal muscle that occurs during or immediately after exercise. The most scientifically based hypothesis for EAMC is the ‘muscle fatigue hypothesis’ of Professor Martin Schwellnus from the Sports Science Institute of South Africa. According to a study of over 1 300 marathon runners done by Schwellnus and colleagues in 1996, certain risk factors for EAMC were identified. These include: Old age. Long history of running. High body mass index. Short daily stretching time or irregular stretching habits. A positive family history of cramping. More recently (2008), Schwellnus and his colleagues outlined the three most important risk factors for EAMC, namely: A previous history of EAMC. Exercising at a higher relative intensity or duration, when compared to normal training. Participating in sports that take place in hot and humid conditions. This could explain why not all runners suffer from EAMC during running. The above factors could lead to premature muscle fatigue, which again leads to altered neuromuscular control at the spinal level through abnormal reflex activity. Altered neuromuscular control results in a disruption of muscle coordination and control and the involved muscle cramps. It is also well documented that the muscles most prone to cramping are those that span across two joints, such as the quadriceps (figure 1), hamstrings (figure 2) and calves (figure 3). 1 2 3 There are four other schools of thought for causing EAMC, but these hypotheses have little scientific support. 1 ELECTROLYTE DEPLETION THEORY This theory suggests that abnormalities in electrolytes such as sodium chloride, magnesium, calcium, potassium and phosphate could result in skeletal muscle cramping. ISSUE 4 SEPTEMBER 2009 / www.modernathlete.co.za 2 DEHYDRATION THEORY The earliest studies linking dehydration and cramping were done on mine workers, cane-cutters and firemen, but no reliable methods were used to test this theory. 3 METABOLIC ABNORMALITY THEORY Various inherited metabolic abnormalities are associated with skeletal muscle cramping during exercise. These include abnormalities in carbohydrate and fat metabolism and acquired medical diseases such as diarrhoea, diabetes, thyroid disease and so forth. There is, however, little support that EAMC is caused by these abnormalities. 4 ENVIRONMENTAL THEORY This theory is based on the term ’heat cramps‘ as stated in one of the pioneering research studies on cramps. More recently, running in hot, humid environments has been determined to result in secondary physiological changes, which can cause EAMC, but heat alone is not a direct cause of EAMC. // The most effective immediate management of EAMC is rest and passive stretching for 30 to 60 seconds or until the cramping ceases. // WHAT CAN YOU DO TO MANAGE AN ACUTE EPISODE OF EAMC? EAMC can almost always be anticipated if the involved muscle starts to twitch whilst running. By running a bit slower, the cramp can be avoided. However, if cramping does occur without warning, the most effective immediate management of EAMC is rest and passive stretching for 30 to 60 seconds or until the cramping ceases. Icing the area for ten minutes may also be beneficial, but avoid massaging the muscle as it will be too painful. HOW CAN EAMC BE AVOIDED? The key to preventing EAMC is to reduce the risk of premature muscle fatigue. A few rules for this have been laid out below. Don’t over train and don’t participate in high intensity and/or long duration exercises if you are not used to them. Make sure you are well conditioned before taking on strenuous races. Limit participating in hot and humid conditions. Make sure your nutrition is adequate (carbohydrate, electrolytes and fluid) to prevent premature muscle fatigue during exercise. If you are prone to recurrent EAMC, run at a lower intensity for a shorter duration and seek medical advice. Mineral and electrolyte supplements such as calcium, magnesium, potassium and phosphates will only be of value if you have a deficiency. Flexibility training of the most likely muscles to cramp, such as the hamstrings, quads and calves, is also very important. Stretch at least twice a day; hold a passive stretch for 30 seconds and repeat three times. DAVID VAN WYK Modern Athlete Expert qualifications: BPhyst (UP), MPhil (Sports Physiotherapy) (UCT) Sources: Clinics in Sport Medicine Images: Frank H Netter, Exercise Pro V4
TOWEL HAMSTRING STRETCH Lie on your back holding a towel looped under your foot with your knee straight, as shown. Gently pull your leg up. Repeat with other leg. Special instructions: Maintain a straight knee. Perform one set of three repetitions, twice a day. Hold this stretch for 30 seconds. Exercise programme for flexibility training to avoid muscle cramping RUNNER STRETCH Stand facing a wall, hands on wall. Step forward with the foot of the uninvolved leg, leaning your hips toward the wall. Keep your rear leg straight with your heel on floor. Special instructions: Perform one set of three repetitions, twice a day. Hold this stretch for 30 seconds. SOLEUS STRETCH Stand with your left leg in front of your right leg. Face the wall with your hands on the wall for support. Slowly bend your knees, keeping heels on floor, as shown, until you feel a stretch. Repeat with right leg in front. Special instructions: Perform one set of three repetitions, twice a day. Hold this stretch for 30 seconds. STANDING qUAD STRETCH DD-1829_DSM - PeptoPro - Modern Athlete (Half Page) - CON.indd 1 2009/09/01 01:24:59 PM 19 Stand on your uninvolved leg, using a table or a chair for balance. Bend the knee of your involved leg. Grasp your foot with your hand and gently pull up towards buttocks. Hold and repeat. Special instructions: Keep thigh straight in line with body, do not bend at hip. Perform one set of three repetitions, twice a day. Hold this stretch for 30 seconds.
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