Monday, May 26, 2008

Muscle Cramps

This is the time of year when I get a lot of email from athletes describing how they just did their first races of the season and were going great until a cramp came on. Should they eat more bananas, is the most common question.

That cramps are more common in the first races of the year and not in the late season probably tells us something. No matter how hard you've been training this spring the workouts are not as hard as the races are. The body simply isn't in race shape yet. By the end of the season the body has adapted to the stresses of racing and is less inclined to cramping.

But for a few athletes the problem continues throughout the year. There is no more perplexing problem for these athletes than their susceptibility to cramping. Muscles seem to knot up at the worst possible times during their important and hard-fought competitions.

The real problem is that no one really knows what causes them. There are just theories. The most popular ones are that muscle cramps result from dehydration or electrolyte imbalances. These arguments seem to make sense—at least on the surface. Cramps are most common in the heat when low body-fluid levels and the possible decrease in body salts are likely to occur.

But the research doesn’t always support these explanations. For example, in the mid-1980s 82 male runners were tested before and after a marathon for certain blood parameters considered likely causes of muscle cramps. Fifteen of the runners experienced cramps after 18 miles of the race. There was no difference, either before or after the race, in terms of blood levels of sodium, potassium, bicarbonate, hemoglobin or hematocrit. There were also no differences in blood volume between the crampers and the non-crampers. Nor were there any significant differences in the way the two groups trained.

For very long events, those lasting more than about four hours, a bit more is known. A few studies have linked these cramps to hyponatremia—low sodium levels. This condition may result from drinking large volumes of fluids that are low in sodium and may be aggravated by starting the event with low levels of sodium. Since serious athletes are particularly good at avoiding the use of salt on food, they may be highly susceptible to hyponatremia. The day before and the morning of a very long race it may be a good idea to use salt more liberally to increase the body’s levels. The sports drink used for the race should also provide adequate levels of sodium. For long races, eating salty foods may also help prevent not only cramping, but also the life-threatening symptoms of hyponatremia.

It’s interesting to note that athletes are not the only people who experience muscle cramping. Workers in occupations that require chronic use of a muscle, especially one that crosses two joints, but don’t sweat profusely as athletes do, are also susceptible. A good example is musicians who are known to cramp in the hands and arms.

So if it isn’t dehydration or electrolyte imbalance, what causes cramping? Other theories are emerging. One is that poor posture or inefficient biomechanics are a cause. Poor movement patterns may cause a disturbance in the activity of the Golgi tendon organs. These are “strain gauges” built into the tendon to prevent muscle tears. When activated, these organs cause the threatened muscle to relax while stimulating the antagonistic muscle—the one that moves the joint in the opposite way—to fire. There may be some quirk of body mechanics that upsets a Golgi device and sets off the cramping pattern.

If this is the cause, prevention may involve improving biomechanics, and regular stretching and strengthening of muscles that seem to cramp along with their antagonistic muscles.

Another theory is that they result from burning protein for fuel in the absence of readily available carbohydrate. In fact, one study supports such a notion. In this research, muscle cramps occurred in subjects who reached the highest levels of ammonia release during exercise. High ammonia levels indicate that protein is being used to fuel the muscles during exercise. This may indicate a need for greater carbohydrate stores before, and better replacement of those stores during intense and long-lasting exercise.

When you feel a cramp coming on there are two ways to deal with it. One is to reduce the intensity and slow down—not a popular option in an important race. Another is to alternately stretch and relax the effected muscle group while continuing to move. This is difficult if not impossible to do in some sports such as running and with certain muscles. Actually there is a third option which some athletes swear by—pinching the upper lip. Strange, but true.


At May 28, 2008 7:38 PM , Blogger FP said...

Does anyone have thoughts on what causes stitches, in addition to cramps? In every race I've done, as soon as I come off the bike, I'm doubled over, going at 1/3 my race pace, and retching. I've tried everything from more to less fluid, more to less electrolyte, controlling my breathing on the last stages of the bike, to going easy on the swim. Are the reasons for stitching similar to those for cramping?

At May 28, 2008 8:37 PM , Blogger Joe Friel said...

FP--Tell you what, I'll post something I wrote a long time ago on this. Check my next posting on this blog.

At May 30, 2008 1:53 PM , Blogger Nate said...

I've been getting them during intense swim sessions. Any ideas or cures? It's not so scary when I'm in the pool but I'm doing alcatraz next week and I don't want to get a stitch in the bay.

At May 30, 2008 2:37 PM , Blogger Joe Friel said...

nate--You're getting cramps while swimming, not stitches, right? More than likely cramps in the feet or calves? That seems to be common in triathletes when swimming. I'm not aware of a cause or a preventive measure other than perhaps lots of race-intense swim training.

At June 3, 2008 8:43 AM , Blogger Nate said...

I've been getting stiches. Before it was on my right side.

I just ran a 10k on Sunday and I had a stitch on my left side the entire race.

I can still feel it when I walk around at the office or get out of bed in the morning.

At June 4, 2008 9:03 AM , Anonymous DBrott said...

My experience would seem to add credibility to the Golgi tendon organ theory.

In both ski marathons and long hill-climb cycling races, I consistently cramp several hours into the project. The severe and essentially sudden cramp is always on the hamstrings or leg adductors ... the opposite muscle of what is really doing the work.

Being familiar with the dehydration, protein, and salt theories, I've taken rigorous counter measures in the past without resolving the problem.

Biomechanics is the most likely culprit, from the sound of it.

At June 4, 2008 10:06 AM , Anonymous John Martinez said...

Nate (and Joe)

"Stitches" or side cramps are a catch-all term that gets used too often. I've seen a lot of different causes, and admittedly, some athletes we haven't been able to figure out a cause for their "side-stitch".

I've found that there typically a number of muscle trigger points in the back (iliocostalis thoracis and multifidus) and abdominal muscles (external and internal obliques) that refer pain into the abdomen, so working with a medical professional that is adapt at finding these trigger points is helpful.

Sometimes we'll see a nerve entrapment as one of the cutaneous nerves exits through the abdominal wall. Another cause in rare cases is a "slipping rib" or Tietze's Syndrome.

Finally, I had one case that presented as a "side stitch" and hiccuping during exercise that was apparently caused by a H. pylori bacterial infection of the stomach (associated with stomach ulcers). A two week treatment of antibiotics and stomach acid pills and the symptoms resolved. Go figure... ;-)

Hope this helps,


At June 12, 2008 11:23 PM , Anonymous Karl McCracken said...

I was getting BAD cramps in intense swim sessions - calves, foot arch, hamstrings and quads. Usually just after a turn in the deep end of the pool. (Glug glug glug . . .)

This was scary enough for a visit to see my doctor, who prescribed a one-month course of quinine. This seemed to fix the problem - for a while. Two months down the line, I got a couple of slight cramps on a 51/2 hour bike workout. Maybe it's time for me to go & see the doc' again.

At July 5, 2009 11:43 AM , Blogger amora said...

Slipping rib is quite different from Tietze's syndrome. In slipping rib, the rib moves. In Tietze's, the rib cartilage swells, but does not move. Source:

At December 5, 2009 11:13 AM , Anonymous Anonymous said...

Hey are you a professional journalist? This article is very well written, as compared to most other blogs i saw today….
anyhow thanks for the good read!


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