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Nov 212013

My left leg was locked up and wouldn’t bend anymore. This was at mile 14 at the 2012 Route 66 Marathon. I limped, shuffle ran and walked. Then at mile 23, the leg let loose, and I finished with a steady run.

Cramps are one of those dreaded race setbacks. It can shut us down. But what causes them? And often more pressingly, what cures them?

It may surprise you that the scientific community isn’t really sure what causes exercise-associated muscle cramping (EAMC), but there are several theories and plenty of anecdotes.

One of the dogmas about EAMC that seems to be falling apart is the classic hydration and electrolyte connection. Hydration doesn’t seem to play a part in EAMC as much as we thought. And electrolyte intake during a race to balance out that loss in sweat is not as clear cut. I’m not saying avoid water or electrolytes. It’s just that their connection with EAMC seems to be more indirect. I should also point out that the condition of exercise-associated hyponatremia (EAH), too much water to sodium, should not be ignored.

One of current theories on EAMC is that neuromuscular fatigue is the culprit. It seems that the reflexes that normally prevent a muscle from cramping become tired, and the inhibition becomes less strong allowing excitatory impulses to become dominant.


There are several things that seem to cause EAMC. The first is undertraining. Needless to say if you are competing in an event and have not fully trained, you might end up with cramping. The second is competing at a faster pace than you have trained for. Again, you are fatiguing the neuromuscular reflex going at a faster pace than you are used to. The third is sustained muscle contraction with muscles in a shortened position. The repetitively used muscles in a small arc of motion are the ones that usually cramp. For runners, additional causes seem to be the change in form that occurs over a race due to fatigue as well as having limits in hip extension. Lastly, a past history of muscle cramps seems to predispose one to future muscle cramps.

Some of the solutions to the above are:

1. Train properly. I seem to avidly avoid this due to my schedule and thus tend to stiffen up at longer miles.

2. Go at a pace you’ve trained for. This is the purpose of a wide variety of paces from sprints, tempos, fartleks to long-slow distance.

3. A certain amount of mobility practice allows you to increase your arc of motion.

4. Elongated stretching when cramps occur seems to help.

5. Practice keeping an upright posture and good form throughout your training. Furthermore, remind yourself about these toward the end of the event.

6. Work on hip extension. This is why it is such a focus in our clinic from mobility to endurance.

7. You can’t change the past but be aware you might be at risk with a history of previous EAMC episodes.

One interesting phenomenon is the reduction of EAMC with pickle juice, mustard or salt packets. I first had pickle juice at aid stations during cycling events and brought that over to running. Mustard packets are easier to carry and seem to help too. At first I thought it might be due to an electrolyte effect or a reduction in inflammation due to the mustard’s turmeric. But the reduction in certain EAMC is so quick, often within 40 seconds, that it seems to be a neurological reflex. It is unclear exactly why, but it might be due to the acidity of the vinegar or saltiness stimulating the tongue or stomach receptors. I have been known to raid a Sonic for salt packets and mustard packets the day before a race. As with most things, this solution is not 100%.

Another cramping that one will hear about is the infamous side stitch. This seems to be a cramping of the diaphragm and intercostal muscles. A deep breath-in and hold can help. Or a slow breath-out with pursed lips can ease it. A light pressure against the rib cage can help as well.

Another thought on EAMC is that it can be due to microtearing of the connective tissue, not necessarily muscle. This can be imagined in a quad pull or the side stich mentioned above.

In addition, I have found with myself and patients that compression socks or tight as well as therapeutic taping can help with calf or thigh cramps. There can be other things involved, but compression garments can be a solution. One way they possibly work is reducing the workload of the muscle and limiting microtearing of tissue.

Sleep, managing stress and limiting anxiety can also play a part in not overtaxing the nervous system before a race. Some professional athletes even go to the trouble of limiting noise and light while traveling to avoid amping up the nervous system.

Other forms of cramps such as menstrual cramps or leg cramping at night have different causes and treatments than EAMC. In some of these cases, certain minerals can help such as magnesium due to its involvement in muscle contraction or potassium due to its involvement in nerve firing. In other cases, certain diseases or medications might be the issue. You should seek a medical evaluation if having cramping that is not exercise-associated.

In summary, EAMC seems to be linked to a neurological reflex. The Central Governor theory hypothesizes that the body limits how much you can do as a protective mechanism. This can be altered through improved training, proper pacing and sometimes a nerve receptor reset with salt, sugar or vinegar. Hydration and electrolytes are important for other bodily functions in the right balance of not too much and not too little but don’t seem to be directly involved in EAMC other than the reflex effect mentioned above. Compression garments seem to help recovery both during and after an event, and they might reduce cramping. However, most of compression garments effects are anecdotal and have yet to be fully researched. Reducing stress might help reduce overall neurological load before a race. Other forms of cramping, especially without activity, might be due to a pathology or medication and should be discussed with your physician.

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