Cramping during exercise - what do we know?

Muscle cramping during exercise: causes, solutions, and questions remaining.

A review article by Maughan and Shirreffs, in Sports Medicine, 2019.

Cramping. Goodness me. Who knew that in this day and age we would still know so little about this topic.

As always, I’d encourage you to read the full paper here (free to download). In which case, no need to read on!

If you don’t make it to the paper, here are the key takeaway quotes from the paper:
– exercise-associated muscle cramp is a relatively common occurrence in a range of sport and exercise activities
– cramps typically occur spontaneously and may or may not occur predictably
– the causes, and therefore the treatment options, remain uncertain
– two main hypotheses have been proposed and continue to be debated: a disturbance of water and salt balance, and a neurological cause resulting in sustained abnormal discharge of motor drive to the afflicted muscles. Neither can fully explain the nature of exercise-associated muscle cramp
– scientific evidence in support of the ‘electrolyte depletion’ and ‘dehydration’ hypotheses for the cause of exercise-associated muscle cramp comes mainly from anecdotal clinical observations (i.e not a good source of evidence)
– rather than focusing on an either/or approach, there are good reasons to suggest that different mechanisms may apply in different situations
– the placebo effect and athlete belief may play a powerful role
– there is no conclusive support for any of the proposed mechanisms
– preventive and treatment strategies are not uniformly effective

Back to me again:

So what does this all mean?
It means, once again, that we still know very little about this topic. It is possible that large fluid losses, exercise in the heat, fatigue, large sodium losses in sweat and a neurological component can all be contributing factors.

So what do I do?
1. Be well conditioned for the work you are asking of yourself (this helps to reduce the effect of fatigue)
2. Be adequately hydrated and consume adequate sodium (a sports dietitian can help with this)
3. And just in case there is a placebo effect – make sure you have a strong belief that the above 2 points will work!