Are athletes winning the war on cramp?

Muscle cramp continues to be a major performance-limiting issue for endurance athletes, especially those competing in hot and humid climates, according to a recent survey by hydration experts Precision Hydration.

1 in 4 athletes questioned said they suffer with cramp ‘often’, with more runners suffering regularly (36%) than cyclists (32%) and triathletes (28%). Only 18% of athletes responded that they “rarely” have issues with cramp, highlighting just how prevalent the problem is.

The survey also suggested that men suffer more than women (with 27% of men saying they suffered ‘often’ vs 14% of female respondents) and that age can also have an impact, with nearly twice as many athletes over the age of 35 reporting regular cramp than those under 35.

The potential role of hydration (and, more specifically, sodium depletion) in these episodes of cramp was illustrated by both the facts that respondents reported increased issues in the heat and that sweatier athletes seem to cramp up more often. The percentage of athletes with a ‘very high’ sweat rate reporting cramping up ‘often’ was 34% vs just 7% of athletes with a ‘low’ sweat rate.

And it’s not like athletes aren’t doing anything to combat the issue. 93% of athletes claimed to have tried at least two common methods for combating cramp, with stretching, sports massage and changing up their nutrition plan being the most popular tactics.

Many of the respondents seem to have had success avoiding/reducing cramp by taking in additional sodium and electrolytes, with 90% of athletes who used PH’s strongest electrolyte drink - which has 3x more sodium than typical supplements - claiming that it helped alleviate/remove their problems with cramp.

Here's a summary of the key findings;

· 82% of athletes said they suffered from cramp ‘sometimes’ or ‘often’, highlighting that cramp is a widespread issue for endurance athletes.
· 61% of respondents said their issues with cramp were increased in hot/humid conditions. This might suggest that hydration, and specifically sodium depletion, is playing a major role in endurance athletes’ cramps.
· Sweatier athletes apparently cramp up more often. The % of athletes with a ‘very high’ sweat rate reported cramping up ‘often’ was 34% vs just 7% of athletes with a ‘low’ sweat rate. Further evidence of the role of hydration perhaps?
· Athletes racing ultra-distances suffer more often than those racing shorter distances – for example 29% of athletes competing for 4+ hours suffer regularly from cramps vs ’just’ 22% athletes racing less than 1 hour.
· 93% of athletes have tried at least two common methods for combating cramp.
· 4 out of 5 athletes surveyed have tried using used electrolyte supplements to combat cramp, with 90% of athletes who used PH’s 1,500mg/l drink saying that it helped them reduce or avoid their cramping issues.

Andy Blow, Founder of Precision Hydration and former cramp-sufferer, said: “Despite the fact that muscle cramps are a very common phenomenon, no-one really knows the full story behind them yet. But our survey results, the anecdotal evidence we’ve collected through years of working with athletes suffering with cramp, and at least some of the scientific literature, suggest that sodium depletion caused by sweating - and not replacing what’s lost in that sweat - is a major cause of exercise-related muscle cramps.”

The science behind muscle cramp...

In the research world there are essentially two competing theories of what causes Exercise Associated Muscle Cramp. The ‘Dehydration/Electrolyte Theory’ which speculates that if you lose a lot of sodium and don’t replace it (as is common when you sweat a lot) this can cause fluid shifts in the body that trigger a contraction of the interstitial fluid compartment around muscles and a misfiring of nerve impulses. resulting in cramp.

The ‘Neuromuscular Theory’ is more recent and proposes that muscles tend to cramp specifically when they are overworked and fatigued due to electrical misfiring. In more scientific terms, fatigue contributes to an imbalance between excitatory impulses from muscle spindles and inhibitory impulses from Golgi tendon organs and this results in a localised muscle cramp.

Blow suggested that “this topic isn't a binary ‘one or the other’ argument between two competing ideas, even though this is how cramping is often presented. Looking at the bigger picture and considering the merits of both theories and the actionable advice they have to offer seems most sensible.”

How to avoid cramping up...

Anyone looking to avoid cramping up would do well to test the following advice:

Try reducing fatigue;
As obvious as many of these may sound, try to make sure you tick all of the following boxes to ensure you’re not overloading your body excessively…
• Train specifically for the event(s) that tend to induce cramps - i.e. with the right mix of volume and intensity to prepare your muscles for what is going to be asked of them.
• Pace yourself appropriately based on fitness levels and environmental conditions to avoid overloading muscles prematurely.
• Taper into events so that you are fresh and well rested when you start.
• Make sure you’re adequately fuelled with plenty of carbohydrates on board before you start events and that you fuel adequately to avoid becoming glycogen depleted which can contribute to premature fatigue.

Try consuming additional sodium;
Definitely a good idea if your cramps tend to occur during or after periods of heavy sweating, in hot weather, or late on during longer activities.

Just make sure your sports drinks are strong enough to make a difference. Most are rather light on electrolytes (despite the claims they make on their labels), containing only about 300-500mg sodium per litre (32oz).

Human sweat, on average, comes in at over 950mg of sodium per litre (32oz), and Precision Hydration often measure athletes losing over 1,500mg per litre.

Look for upwards of 1,000mg sodium per litre in a drink and over 1,500mg per litre if you suspect you are a particularly ‘salty sweater’. A good way to see where this should fit in to the rest of your hydration strategy is by taking Precision Hydration's free online Sweat Test.

Take the extra sodium in the hours immediately before and during activities that normally result in cramping and see how you get on. You’ll know pretty quickly if this is effective or not, and can fine tune your dosage to balance cramp prevention with keeping your stomach happy over time (really excessive salt or sodium intake can cause nausea).

Other tactics worth trying;
Other strategies that are far from proven, but that either make intuitive sense or have been used by athletes in the war on cramp include…
• Sports massage and stretching of the affected muscles.
• Acupuncture.
• Thorough warm ups prior to cramp inducing activities.
• Mental relaxation techniques.
Although none of these are likely to offer a complete solution they are generally accessible, inexpensive and may even benefit performance in other ways, so there would seem to be little downside to giving them a try.