Today my son came home after basketball practice with calf pain after a severe cramp stopped him from playing and left him on the ground for a few minutes. What would cause such a sudden cramp? Can it be prevented? Will it happen again?

Such muscle cramps are common in both recreational and competitive athletes of all ages. The causes we think of most have never been proven with clinical research and as a result, prevention and treatment ideas are not always successful. Coming up with a good plan to prevent them is key to keep you in your game (and my son on the court).

Causes of muscle cramps

Knee PainWhile there is no clear cause, the dehydration and electrolyte imbalance theory is the most common. Studies have shown most athletes do not drink enough water to replace the amount they lose. The dehydration takes fluid out of the spaces between the muscle fibers, resulting in more pressure on the motor nerve fibers, causing them to become too sensitive. In turn, the nerves over-stimulate the muscle and lead to over-contraction of the muscle. This makes sense to many physicians, physical therapists, and trainers. While this concept may be true, the treatment using hydration and electrolyte replacement doesn’t always work with 69% of athletes still reporting symptoms in one study.

Another possible cause is that of muscle overuse and fatigue, and its effect on neurological pathways in the muscles. Stimulatory and inhibitory nerves usually work together causing controlled muscle contractions, however with cramping, the inhibitory signals seem to be decreased, resulting in overstimulation and cramping.

Treatment of muscle cramps

The easiest initial treatment is fluids. Sports drinks usually have a good combination of fluid and electrolytes. Currently, the National Athletic Trainer’s Association recommends adding salt to sports drinks to help. Remember fluids and electrolytes are not immediately absorbed and can take at least 10-15 minutes to get into your system. IV fluids bypasses the need for your stomach to absorb and may speed recovery.

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Stretching and sometimes even beta-blockers have shown strong evidence to help cramping. Personally I support the stretching route before any medications should be considered.

Prevention of muscle cramps

Despite the lack of clear evidence, appropriate hydration and electrolyte replacement is one of the best prevention plans for anyone susceptible to cramping. Drinking up to a liter (about a quart) of water at least 1 hour before activity can ensure most of the fuild and electrolytes have been absorbed and are ready to help prevent cramping.

Exercise and conditioning may help delay fatigue and onset of cramping. Plyometric exercises seem to benefit neuromuscular adaptation and help improve neurological function.

In summary, regardless of your sport, sport specific conditioning, endurance training, and proper hydration before and during activity are likely your best answers to prevent cramping and keep you at the top of your game.

Miller KC et al.: Exercise-Assocated Muscle Cramps. Sports Health 2(4):279-283, 2010.