Physiotherapists and Sports Therapists alike have for many years struggled to explain what cramp is to their clients. After all the text books state that cramp is “not fully understood.” However, new recent insight, backed up by our clinical experience may well have an answer… or part of one at least!
This Blog has been inspired by my old croc swimming buddies who seem to drop like flies during our training sessions with cramp. Admittedly we are all past our best in terms of swimming prowess (sorry lads!) but it can’t all be just old age, I mean we’re not that old. Surely there was a time when sufferers of cramps didn’t get cramp, or at least not as much, and now they get more. So what’s changed?
What Is Cramp?
Lets look to the dictionary for a definition of cramp: “A painful involuntary contraction of a muscle or muscles, typically caused by fatigue or strain.” That’s not a bad starter for 10. Strain is certainly a key component. At the clinic we often see people who have had muscles strains and continue to run through them. This leads to what we in the trade call a secondary protective spasm. That is to say that the body tightens up the muscles around the damaged tissue to prevent any further damage. This is one of the many reasons why you shouldn’t train through cramp. See my marathon story later on for what not to do!
The fatigue element is more interesting. Fatigue can of course lead to strain. But what makes one muscle fatigue more than others? We have 2 of most of the muscles that cramp. One on each side. So why has only one cramped? More of that later. The muscles we most commonly get cramp in are calves and hamstrings. We also see cramp in the quadriceps on the front of your thigh. Almost exclusively and uniquely we see cramp in the muscles of the forearm. Technically speaking you can get cramp in pretty much any muscle as it’s just simply the muscle tiring out – but why?
What Should I Do When I Get It?
Whatever you feel is right! Everyone gets cramp in different ways. Some people find stretching helps. Some people find not moving helps. Some people find moving in completely the opposite direction will help. I found in my recent personal experience doing last years marathon – stretch the muscles as you run. It did make for entertaining viewing in the last 4 miles and I got a sympathetic cheer from Zoe Ball for my troubles. I wasn’t stopping running for fear of never getting going again!
What Can I Do To Avoid It?
Whilst we don’t fully understand cramp and there is very little conclusive evidence for anything it does seem that hydration levels and electrolyte levels play a part. (For the very keen among you have a look at this link to understand the Sodium / Potassium pump and it’s role in muscle contraction). My own personal world of pain earlier this year was caused, I think, by a lack of hydration. Those cursed cups! I was getting more down my front than in my body – even though I took one every single mile.
By electrolytes we’re talking sodium, potassium and magnesium. The elements that help muscles to work. You may already know the most convenient source of sodium is salt. So if you’re doing lots of endurance exercise you can drop a bit of salt into your sports drink to help – you’d be surprised how much you can get in before you can taste it. Especially if you’ve got a very sweet one. A high source of potassium is bananas (they also contain a good amount of magnesium) so it may be worth using a banana pre exercise to get some carbs in and to help with the electrolyte levels. As for sources of magnesium these include green leafy veg, fish, yoghurt and best of all – dark chocolate! Whoop whoop – all in the name of health!
Stress! Is a massive factor in cramp. Ever wondered why sometimes at night your calves cramp for no particular reason? Even if you’ve done no exercise. Surely the muscles are not over working. If you are having problems at night with cramping, particularly calves, think back to your day. How stressful has it been? How stressful is life currently? See if there’s a pattern to more stressful days and when you get the cramps at night. There’s more on the psychological aspect of injury in our article 50 Shades of Pain.
Lactic acid is also mentioned in some texts as a cause. But for me that sits in with the fatiguing muscles. If the muscles are tight and fatiguing the body doesn’t process the lactic acid from anaerobic respiration as well. So again we’re back to why are the fatigued muscles…
What’s The New Approach?
The new approach is looking at muscles together rather than in isolation. By this I mean rather than saying I get cramp in this muscle it must be overworking. We ask the question why is it over working? It could be that an agonist muscle (in English a muscle that does the same job) is not doing what it should and causing the muscle in question to have to do too much work.
For example you primary hip extensor (that’s muscles that push you off the ground when walking and particularly running) should be your gluteus maximus – the good old bum muscle. If this is not firing properly that means that the secondary hip extensors, namely the hamstrings, have more work to do. As a result, they tired out, tighten and you get cramp. We see this a lot in the clinic. On doing our Glute test people can start to get the cramp like symptoms. We do a bit of our jiggery pokery to get the glute firing properly again and hey presto no cramp in the hamstring when we retest. It can, though not always, be that simple.
Further afield it could be a muscle that is tight that is affecting the nerve that gives you the cramp sensation. In the example above it could be the tightness in the hamstrings is not causing cramp in the hamstrings itself but the tension this places on the nerve which runs through the hamstrings into the calf (sciatic into tibial) gives you the cramp in the calf. Same principle, release the reason for the cramp and hey presto no more cramp.
So there you have it. You’re now up to date. A few tips on how to avoid cramp. If you have any more ideas then let us know. There’s lots of information out there but I’ve just tried to present the most widely accepted theories.
If you have been suffering long term with cramps then there is hope. It’s normally quite straight forward to work out the source of the cramp with the correct understanding of the muscles and nerves and how they interact. If you’d like to get your cramp sorted, you know where we are: .
This post first appeared on our Swindon site.