Causes, Prevention, and Treatment of Cramping

cramp

 

By Chris Carmichael 

Endurance sports are all about pushing yourself and testing your limits. Sometimes your brain has to step in and protect you from yourself, like when you bonk and your brain conjures up nausea in an effort to get you to slow down and address the problem. Other times your body skips protection and moves straight to kicking the crap out of you in a creative and painful way, otherwise known as cramping.


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Muscle cramping is something cyclists deal with at all levels of the sport, yet they’re often talked about with a sense of mysticism, like there’s a cramp fairy who magically appears and zaps your hamstring just as you get up to sprint. Science offers a number of theories for the cause of cramps, two of which are particularly interesting for cyclists:

Neuromuscular Theory

As you pedal, the muscles in your legs contract and relax over and over again in rapid succession. At some point, those muscles start to fatigue and this theory of cramping says that the muscle spindles that stimulate contraction stay or become more excited, while the inhibitory feedback from the Golgi tendon organ (a structure that signals the brain about the force of muscle contractions) becomes suppressed. In other words, the horses start to stampede and the guy holding the reins lets go. The result is a long and incredibly powerful muscle contraction that’s completely involuntary.

Overload cramps may be fitness related, meaning you may be more vulnerable to them when you are less fit. Anecdotally, novice athletes tend to experience them more than veteran athletes, and longtime athletes often get them more frequently in the early season.

Exertion Theory

For a long time, athletes have defaulted to the exertion theory of cramping, which cites electrolyte depletion, dehydration, and/or heat stress as the cause of muscle cramps. There’s a lot of anecdotal evidence to support the theory, it generally seems to make sense, and cooling down and replenishing fluids and electrolytes tends to make the cramps go away; so the theory seems like a winner. Unfortunately, the science is problematic because it’s difficult to pinpoint a consistent cause-and-effect mechanism directly related to fluid loss, electrolyte imbalance, or core temperature. More likely, exertion cramps are caused by a combination of factors arising from fluid loss, electrolyte imbalance, and heat stress.

Though the exact mechanism for exertion cramps is inconclusive, there do seem to be some distinct differences between the characteristics of these cramps compared to neuromuscular cramps. Exertion cramps provide a little warning in the form of fasciculations, those small muscle twitches you can see and feel at the skin level. Once the cramping begins in earnest, however, it can spread to muscles that are not being directly stressed. In contrast, neuromuscular cramps are localized to the muscle that’s overloaded and provide no warning.



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Prevention

The big question is what to do about cramping, and this is where science collides with the real world. In the real world, the pragmatic view is that cramps are caused by a combination of stresses from heat, dehydration, electrolyte imbalance, and neuromuscular fatigue. They each contribute to varying degrees, depending on the conditions and how hard you’re pushing yourself. The reason I take an “all of the above” approach is because it works: when you minimize these stresses you experience fewer cramps.

Training and Pacing: When you’re more fit and you set a pace you can sustain, you’ll delay the onset of neuromuscular cramps, and you’ll also lower the heat stress you’re placing on yourself.

Nutrition/hydration strategy: Aim to replenish at least 80% of the fluid you lose per hour, and separate your nutrition from your hydration by drinking water and electrolyte drinks while getting calories from the food in your pockets. This allows you to increase fluid/electrolyte consumption with increased heat stress, without overloading the stomach with calories, which would lead to nausea, which would then reduce your fluid/electrolyte intake.

Temperature strategy: Overheating kills performance, puts tremendous stress on your body, and accelerates the loss of fluids and electrolytes. Ice socks, dousing yourself with water, and even slushy drinks can help reduce this stress.

Treatment

When cramping starts, it’s time to go to war. The cramps are caused by multiple factors, so you hit them all. As one of my coaches puts it, you don’t call in a sniper to find the one, you call in the bombers to level them all. Across the spectrum of events and athletes, the steps are the same:

Reduce intensity: Hide in the pack, stop taking pulls. This will reduce neuromuscular fatigue as well as the heat your producing through muscular work. If you’re by yourself, slow down. It’s better to slow down and avoid a cramp than cramp and stop altogether.

Cool down: Douse yourself with water, get into a cooler environment, or go sit in the creek. But if you have to make a choice, put water in you instead of on you.

Get more fluids: If you’re drinking sports drinks and/or eating regularly during your ride, you’re risks for hyponatremia are very low. It’s far more likely that additional fluids will help alleviate heat stress.

Get more electrolytes: Aim for 700-1000mg but be sure to consume at least 20 ounces of fluid (one water bottle) with it. For a quick fix at a convenience store, a bottle of V8 will do the trick.

Get more calories: Although caloric deficiency doesn’t seem to be directly related to muscle cramps, this is a good opportunity to achieve balanced replenishment.

Massage: If cramps have you sitting (writhing) by the side of the road, rubbing the affected muscle has been shown to be an effective way to get the involuntary contractions to stop.

The treatment for cramping is imprecise, but so is the reality of what’s causing them. And pragmatically we know that reducing the overall stress from exertion, heat, dehydration, and electrolyte imbalance is what gets athletes moving in the right direction, which is forward.

References:

Bergeron, Michael F. Current Sports Medicine Reports. 7(4):S50-S55, July/August 2008.

Miller KC, Stone MS, Huxel KC, Edwards JE. Sports Health. 2010 Jul;2(4):279-83.

(Article originally published in Road Bike Action Magazine)

43 Responses to “Causes, Prevention, and Treatment of Cramping”

  1. Mike Swope on

    Mustard works for me as a preventative 1.5 to 2 hours before race pace. At least 1/8 to 1/4 cup. I tried pickle juice and it helped a bit but this is better. Found it on Internet search and mentioned as old football practice trick. Additive to all the other tips you mentioned and more so in hot weather. Also stretching is a cramp stopper if you force hamstrings or calves to straighten they don’t cramp well and it forces them to ease off.

    Reply
  2. Denny H on

    Second on the mustard. Will work after cramps start. Ingest a couple of the hamburger joint squeeze packs of mustard and wash down with some fluid. Works wonders in a short time.

    Reply
  3. Ant on

    Mustard sounds interesting, for me regardless of the conditions, terrain, or food intake i’m prone to cramping at the 70km mark on the mountain bike and 110km mark on the road bike. For instant relief salt and vinegar crisps i carry in a zip lock bag already crushed up to conserve space or magnesium powder with water. For longer term maintenance I used tissue salts / based on the length of races and 24hour events i avoid electrolyte drinks due to sugar content and gut issues i get. Other electrolyte products i’ve not had much luck with. I believe everyone’s body composition is different and i have some mates who don’t cramp at all regardless of the intensity etc. Tissue salts taken before, and during an event seem to do the trick for me. Cramps are a curse, they are painful and frustrating to have when racing. Good luck!

    Reply
  4. Neil on

    My worst cramps happen well after the ride is over, usually at the dinner table. What is the cause and how can these be prevented ?

    Reply
    • ben on

      Try to take some calcium when you are taking your electrolytes. Tums is not the best but it works. I cramped much the same as you and my grandmother told me to try it. And it WORKED.

      Reply
  5. Paul Ross on

    I a unfortunately a cramped and am constantly in search of relief. My observations on me are that too much time at high intensity will cause them. Overheating accelerates it. More training at longer distances makes me more immune. The funny thing is it hits me even though I still have plenty of gas in the tank.

    I’ve tried drinking more, electrolytes, pickle juice (terrible) and all seem to have little discernible affect. Pacing seems to be my main way to stave them off.

    In a desperate move, I just purchased “stops cramps” which is some Amish homeopathic mix of Apple vinegar and garlic. If it works I’m psyched. If not im out $10.

    Reply
    • David Carrozza on

      Paul,

      First full disclosure, I’m the owner inventor of this company. But I’m just offering to send you our solution for overheating. You’ll experience a 15-25 degree skin temp drop over face, ears, neck and upper chest. We just finished a field study at UC Davis using this to document the performance and perceptual benefits of sustained cooling while cycling in the heat.
      If your interested or just want to know more you can email me at david@spruzzamist.com. Good luck with solving the cramps.

      Reply
      • Eric on

        I too have issues with cramping when I overheat cycling in the afternoons in So California. My daily schedule is such that my time to get out and cycle is early afternoons during the hottest part of the day. This is wonderful in the winter months and brutal during the heat of summer. My best prevention strategy is to load up on Hammer Endurolytes, but even these will fail when I get too hot. Secondly, I simply have to reduce pace. I’m very intriqued by any solution such as the SpruzzaMist that could help keep me cooler during these hot rides. Has anyone tried one of these??

        Reply
        • Eric on

          It is called SpruzzaMist and is available at http://www.spruzzamist.com according the inventor/owner of the company that posted above in this reply.

          It is hard to see because the links are formatted red and disappear into the red background….

          Reply
      • John on

        I live in Mississippi where we have summer temperatures in the 100′s and humidity in the 90′s, both very draining on the body. As an avid Mountain Bike Rider I highly recommend the SpruzzaMist. The woods we ride in are shady even in the middle of the day due to overgrowth which blocks both sun and air, so it’s like riding in a oven! Sweat just pours from your skin and your energy levels just constantly drop. But when I spray periodically with the Spruzzamist it makes a big difference. In addition to spraying my face and neck I also spray my wrists. Similar to Elephants faning thier ears by cooling the blood in thier vessels, spraying your wrists with Spruzzamist helps cool me down. I don’t have a problem with cramping at all.

        Reply
  6. Brian on

    I’m a cramper, and cramp at various stages of events depending on my average heart rate. 30k usually in the Birkie, and 70 miles last summer in a 100 mile mountain bike race. I too, have plenty of energy but have to slow down when this happend. I know how to feather cramps and never stop when I feel them coming on. I have found pickle juice to help, but if I stay over my LT, I’ll still get cramps. I have a sour stomache as well and have started using limited amounts of sports drinks and mostly water and solid food and that has helped. I can’t eat enough pickles to get juice so I just bought pickle juice from The Pickle Company. Just hope its dill pickle juice as I hate sweet pickles.

    Reply
    • ben on

      NTry to take some calcium when you are taking your electrolytes. Tums is not the best but it works. I cramped much the same as you and my grandmother told me to try it. And it WORKED.

      Reply
  7. Pete Beck on

    I have cramps after a hard workout. I’ve tried a lot of the remedies listed above and had limited success. The best results I’ve had came from a product from Highland’s. “Leg cramps”. I found it at my drug store and it’s done wonders for me. It relieves the cramping in about 5 min. in most cases.

    Reply
    • Ray Scott on

      For a quick fix I pop a couple 1000 mg tums and wash them down with water. If I am doing a long strenuous ride I take some Scaps. This is a buffered electrolyte that contains sodium chloride, sodium citrate, sodium phosphate and Potassium chloride. For light sweating (cool weather) 1 capsule every 2 hours, for moderate sweating (moderate weather) 1 capsule per hour (normal usage) For heavy sweating (very warm humid weather 1 capsule every half hour. Do not exceed 2 capsules per hour. They work great for me, are easy to digest and can be ordered online @www.succedscaps.com. For shorter intensive rides I just hydrate well with some Herbalife hydrate packets that dissolve in my water bottle. My wife is a supervisor for Herbalife so if you want to try some let me know. I use their 24 sports products and last year won all 3 gold medals in the Senior Olympics competition in my state plus set a state record for the 40K road race.

      Reply
  8. Tom on

    I cramp a lot, usually after workouts and at night, I have also noticed that my calves are constantly twitching, so much so that you can see the muscles firing all the time. My theory is that my muscles are fatigued from all this activity, making them more prone to cramps after working out. Has anyone heard of this and found solutions?
    I will try a lot of the solutions proposed here. Thanks!

    Reply
    • Hugo on

      You may have a magnesium deficiency, my muscles use to cramp all the time on bike rides and twitch when I was just relaxing and couldn’t explain it, then I stumbled across an article that talked about this very problem. You can either have blood work done to confirm your magnesium levels or just try taking a 400 mg magnesium supplement and see if improves your cramping. For me it was pretty apparent as soon as I started taking the supplement and working out. Good luck.

      Reply
  9. Larry Parker on

    I get cramps on the bike. I get cramps 3 hours later, at dinner or when I have been sitting watching TV. Calves, Leg adductors, hip flexors, Hamstrings, I have had them all, once in awhile at the same time! What seems to help me is strength training, plus stretching whenever we stop, and after the ride. Walking a mile or so after riding can really help. On long rides my weapon of choice is a combination of Endurolytes from Hammer and Vitamin B caps. I got through RAIN (165 miles) and ODRAM (145) without cramping and I credit the pills.

    It is an ongoing battle though. Other things have seemed to work for awhile, then not at all. Even the weight lifting seems to help only so much, and only for shorter harder rides, up to about 50 miles or so, before I have to worry about doing the other stuff.

    Reply
    • Stephen Timings on

      Walking works the little valve in your lower calf which pumps blood thus helping with lactic acid removal. If it works for you the problem may be overly hard rides for your fitness level excessively building up lactic levels.
      Anyway, for relief try a teaspoon of baking soda in a glass of water whenever you get or feel the cramps coming on. Good luck.

      Reply
  10. Joe Scully on

    For those that have cramping problems, I strongly recommend you really look at and evaluate your nutrition and hydration practices. What you eat and drink before, while on and after your ride, I am a believer it’s made all the difference in my results. After years of riding I could count on cramping at some point especially after multiple days of hard traning. Rarely does that happen now and it always comes back to I did not eat or drink enough. I spent 15 hours on the bike in humid Kansas with out a cramp and I felt great at the finish (I didn’t looks so great). One last point if you invest the time in to this I am quite sure your over all results will improve. CTS has partnerships with OSMO and ProBar they work well for me if you haven’t tryed them do! Stay safe have fun it’s just a bike ride.

    Reply
  11. Orlando on

    Beware of having a beer every night with dinner for a week. I’ve heard that your magnesium gets flushed out with the frequent visits to the urinal. I think I got a horrible hammy cramp from this (plus intense riding). Stupid! This laid me up for weeks which lasted into cold weather. That combination and a fear of re-cramping made me lose all of my fitness. Honestly, glad to hear that I’m not the only one. I think this is the start of a support group. :)~

    Reply
    • Geoffrey A on

      Beer might reduce Mg in your body, like you said.

      Also, glycogen synthesis is severely stunted by alcohol metabolism. Glycogen storage levels in the liver and the skeletal muscles are a really big factor in bike performance as you probably are aware. Also, your central nervous system puts the brakes on your power levels at your skeletal muscles, when blood glucose levels run too low due to depletion of liver glycogen storage.

      Think very carefully about drinking beer or any alcohol every day, even if just one glass, if your sporting performance matters to you.

      Reply
  12. Hugo on

    Find out if you have a magnesium deficiency, I did and suffered with cramps for years… it didn’t matter how much electrolytes I drank. Started taking a 400 mg supplement a day and that made all the difference. Now I’m able to enjoy long rides and hard efforts without the pain.

    Reply
    • Ray Scott on

      Will normal blood testing show if you have a magnesium deficiency? I go every 6 months and if so I would like my doc to know. Thanks.

      Reply
    • Paul Ross on

      I’m going to try this. Like I said above, this is my main nemesis on long rides despite my hydrating and taking nutrition with electrolytes. I just checked. i use e-gel and it has sodium and potassium but not Mg. I appreciate the advice and idea. I do sweat a lot and could be low in Mg. I checked my blood tests (I get these every 6 months because I’m on Simvastatin for cholesterol), but even though it tests quite a few things, it does not measure blood Mg levels. So, I’ll just try the 400mg and if it works, it works. Thanks/

      Reply
  13. Stephen Brixey on

    I am an expert at cramping. My legs can start cramping with stress no excercise. I’ve tried everything with little success. A friend told me to eat 1/2 cup of white rice a day. It actually works and is simple to do. You have nothing to lose.

    Reply
  14. Tom on

    I’m a cardiac patient, and I get severe adductor cramps all the time. Most of the time, however they’ll hit without warning when I try to get up out of a chair or off the couch 4-6, 8, 10 or even 12 hours after a ride! When the adductor seizes up, it is sheer agony for about 5 minutes, and they come in waves, usually 5 or 6, each one being worse than the previous wave. Have to get up somehow, and stand up super straight and stretch as hard as I can to straighten the adductors and hang on to that super stretch. Even a slight letup will bring on another wave! I have only cramped up once on the bike, and that was utter agony. I got off the bike in time, but had to sag in for the day. Then, about 4 hours later, BOTH adductors cramped up on me at the same time! They did it again about 3AM and again about 7AM…the next day; right out of nowhere.
    My cardiologist told me to try Co-Enzyme Q-10 and Magnesium supplements. The CoQ-10 I take twice a day, and the magnesium supplements the night before any ride of 25 miles or more and then during the ride, and immediately after the ride. Hasn’t STOPPED the cramping, but it has reduced the severity!

    Reply
  15. Bruce Wacker on

    I usually cramp about 3 hours into a MTB race. So I did an 8 hour race where the loop took about 45 minutes. Sure enough, hammies started cramping around 3 hours. I had a number of different electrolyte solutions in my camper which I took on each lap. Somebody even gave me some magnesium under the tongue on the course. At the end of a lap which was then more like an hour I’d try something different. The only thing that helped was standing in the pedals to stretch on the downhills. I’m convinced it is from overuse/under training and no amount of ingested magic helps. I also wonder about the post exercise adductor cramps, though. A slight over flexion and they come out of nowhere.

    Reply
  16. Randy Jackson on

    As someone stated above, there’s a lot of variance between people, particularly when it comes to sweating rates and electrolyte loss. I’m a pretty heavy “salter” when I sweat. Usually have plenty of white haze on my kit after longer, warmer rides.

    I used to cramp a lot, but a friend gave me this recipe a couple of years ago and I pretty much swear by it now. I mix a batch and keep it in the fridge.

    1 10-oz bottle of magnesium citrate (pharmacy/pharmacy section)
    10 oz of lemon juice
    10 tablespoons of non-iodized salt
    honey, probably half a cup or so

    Blend on low for a minute or two until the salt is dissolved. For rides, I put 2-3 tablespoons of the mix per water bottle, then fill with water, and take a flask of mix on rides for refilling bottles.

    I call the mix Drano, and if you take a swig of it straight, you’ll know why. Mixed at the ratio above, though, the taste is fine. A bit odd at first, but fine. Use in moderation, though. Mag citrate is a laxative. Not a problem for me when mixed with water as noted.

    Other things I’ve tried and had some success with to battle cramps: soy sauce packets; condiment salt packets (can be swallowed whole, but I try to have something on my stomach to avoid upset); Skratch Labs hydration mix. Haven’t heard of using mustard. Good to know just in case.

    Reply
  17. Eric on

    CTS:
    The formatting on these replies is really bad. The replies are formatted in a red box, which is nice to be able to see the replies, however the important details in those replies (the repliers name, time, email links, etc) are then also formatted in red and thus blend into the background. You can hover over the area where they should be and they show up in blue, but that is the only way to see them. Please look into fixing this.

    Reply
  18. John Bergquist on

    I’ll chime in on the temperature issue. While Oregon doesn’t get as hot as California or Arizona, I’ve found that using the aforementioned SpruzzaMist device has helped me during summer riding when the temperature gets way up there. I even used it last year at the XTERRA Portland triathlon and it made a HUGE difference in my performance over the previous year (2014 was hotter than 2013, too).

    FWIW, I’m not associated with the company at all, just a consumer who strongly believes in the product and the company’s vision. :)

    Reply
  19. Lee F on

    I’m 62 and have suffered with leg cramps for decades. I once cramped so bad sitting on the couch watching TV with my wife (after a 50 or 60 mile ride earlier in the day) that she thought I was having a heart attack and started to dial 911. I’ve had them 60 miles into a century ride where they start in one hamstring, advance to also cramp the hip and front side of the same leg, progress through my pelvis and then down into the other leg … all at once!

    Fortunately, about a year ago I started buying sports drinks loaded with sodium, magnesium and potassium. I have no idea why this works for me, but I am thankful that it does. I’ve now gone as far as a hilly metric century with no problems. Next on my agenda is a full century. I’m optimistic.

    Reply
    • ben on

      Add Tums to this mixture of yours the calcium in it is what bonds the potassium and magnesium to your cells and that’s what keeps you from peeing or sweating those out.

      Reply
  20. Jan on

    Cramps are awful…relief…Toic water with quinine. I also add a tablespoon lime juice. Tonic water comes in diet if you don’t want the sugar. I sip on it all day..No more cramps. Yeh.

    Reply
    • Ray Scott on

      Pro baseball players used to take quinine tablets as some artificial turf would get very hot thus causing cramping. I tried to get some but they are not available anymore. I do love my G & T Happy hours so I think I will start using the tonic water with quinine, just no gin.

      Reply
  21. Geoffrey A on

    An internet search revealed to me that these foods help us increase our magnesium intake:

    - Spinach, and other leaf greens

    - Beans, like black beans

    - Dark chocolate

    - Milk products help absorption of Mg, like yogurts and of course milk

    - Fish

    As for me, I am going to increase my daily intake of Mg-rich foods. I might also add a sport drink that specifically contains Mg, for DURING the tough rides.

    Reply
  22. Geoffrey A on

    Measure like with a scale how much water you are ACTUALLY drinking per hour. Don’t assume, and the results may surprise you. It’s easy to do with an ordinary electronic kitchen scale because 1 gram of water is exactly 1 ml of water. Weigh your cup or bottle before and after your ride, the difference being what you actually drank.

    Riding on the indoor trainer yesterday I decided to really see (instead of estimate) how much water I actually drink. Well to my surprise I was on the low end. This despite my feeling that I drank frequently and plenty.

    I am going to DOUBLE the amount of water I drink routinely during rides. This will move me into the MODERATE category of water intake.

    There is a GREAT diagram of the effect of different levels of water intake on heart rate, in the textbook EXERCISE PHYSIOLOGY by Powers, et al. You can actually see a large improvement (reduction) in heart rate after the 60 minute mark when more water is consumed.

    The experimenters used a bunch of EXPERIENCED WELL TRAINED running racers do their races for 30K distance, at four different water intake levels: None, Small, Moderate, High water intake.

    The differences in heart rate were negligible for the first 60 minutes. AFTER 60 minutes the racers heart rates were STRONGLY impacted by their water drinking schedules. There is around about 5-10 beats per minute difference just from water schedule at around 90 minutes, and the difference grows even larger with more time during the race.

    It was an eye opener for me. Really, do measure your water per hour, see what you get.

    I drank only 515 ml per 90 minutes yesterday, which was in the SMALL level of water intake per 60 minutes. I have some improvements to make!!!!

    Reply
  23. Tony on

    20 years ago a frequently recommended treatment was quinine sulfate, which was available OTC in 5mg capsules as a malaria treatment. It worked for me at the time. It has since been withdrawn and is available if at all only by prescription. Does anyone know why?

    Reply
  24. Diane on

    I, too, am a Spruzza user. Last year, one of our local bike shops had a Spruzza demo ride. That day changed my riding habits. I was going to say, “What a great accessory!”, but it is so much more than that. It is a hot weather training/racing tool.

    Spruzza has given me many more training hours. Five in the evening and 100+ degrees? No problem. There’s an immediate cooling effect from the spritz of water, AND the continued cooling as the water evaporates from my face, ears, neck and chest. I can go longer and harder with less perceived effort.

    Spruzza is not a substitute for stretching, strengthening, cross-training, or good nutrition/hydration. It can, however, give you that something extra that your competitors don’t have.

    It’s also great for casual summer rides. And it respects California’s horrible drought conditions by using way less water than dumping that bottle over your head.

    Ride on!

    Reply

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