What is a Cramp?
Most of us have had one at some stage, and most of us will have heard of a remedy to cure them, however what does the evidence tell us in terms of what really works to manage muscle cramps. Firstly I think it’s important to understand what a cramp is. For us to move, our muscles need to contract. When this contraction is involuntary and sustained, it becomes a cramp. For those that have experienced this, they are aware of just how painful it can be. For athletes this can be quite limiting in terms of performance, and are typically felt during exertion. Other people experience cramping overnight which impacts on their sleep (see my blog on the importance of sleep to see why this is an issue).
Finding the Right Cure
If you search google or talk to your neighbour, you will find there are numerous cures for cramping, however few have been proven with quality research to determine their effectiveness. Now the reason that these cures exist is because at some stage they have worked for someone, however; just because something works for one person does not mean it will work for someone else. The reason for this is there are a range underlying causes of cramping. Cramps have been linked to magnesium deficiency, calcium, sodium, hydration status, glycogen storage, blood glucose levels and even genetics. Or as I discovered recently after running my first (and possibly last) half marathon, conditioning can be a major contributor to cramping. A number of theories have been tested to date, however with most of them, further research is required before any concrete recommendations can be made. Exercise associated muscle cramping has been investigated more than most, and the results point to a relationship between athletes sweat rates and sweat sodium concentrations. For athletes who have high sweat rates (greater than 1.2L/hr), or those who have particularly salty sweat, than sodium should be ingested whilst exercising. Sports drinks are formulated with this in mind. For those people who don’t consider themselves athletes, sports drinks are not usually recommended. There are now low kilojoule sports drinks which may be more appropriate in order to increase your sodium levels without the added kilojoules. One theory which is often mentioned (and marketed) as a strategy to assist with cramping is magnesium supplementation. Unfortunately there is very little evidence to support magnesium supplementation as a proven strategy for managing cramping. For pregnancy related cramping the results are conflicting. If you have been diagnosed with a magnesium deficiency, then magnesium supplementation may be an underlying cause of cramping, however for anyone without a deficiency, unfortunately magnesium supplements will only help in making your wallet lighter. Quinine was found to show some improvements in the frequency and intensity of cramping, however the side effects of quinine (mild– headache, confusion, tinnitus, gastrointestinal upset, vision disturbances; severe– thrombocytopenia, hemolytic uremic syndrome, disseminated intravascular coagulation, cardiac arrhythmia, death) are likely to outweigh the benefits of reduced cramping. Quinine is a medication used to treat malaria however is found in small quantities in tonic water. For athletes, the current available evidence suggests that adequate hydration and appropriate electrolyte replacement is critical. Conditioning of muscles appears to be an important factor, as cramping is more frequent as the level of exercise intensity increases. There has also been some encouraging research into pickle juice or vinegar for athletes experiencing exercise associated muscle cramping. The dose tested was 1ml of pickle juice for every kg of body weight, and was administered following the onset of a cramp. Maybe some pickle juice will become a stable part of the athletes kit bag. For those experiencing cramps during the night, a therapeutic dose of B vitamins appears to alleviate some cramping although this requires further research. A well balanced diet should ensure an adequate intake of B vitamins, however certain conditions can result in these being mal-absorbed, or used prematurely such as the need to metabolise excess alcohol. To have your diet assessed for adequate nutrient availability, go to https://cqnutrition.com.au/ to make an appointment. This can be done over the phone or via Skype. Beyond keeping well hydrated, maintaining a well balanced diet, and replacing any electrolyte losses during exercise, the recommendations appear to be light on solid evidence. This does not discount the method you may have found works for you. It just means that the world of research is lagging behind what you currently know works. If it works for you and is safe then there is no harm in maintaining your own strategy. Just be sure to maintain adequate hydration, keep up the electrolytes (particularly on hot days), and don’t participate in a half marathon without adequate training.