By Cor inne Casey

REDUCING EXERCISE-ASSOCIATED MUSCLE

CRAMPS

What is it Cause

Exercise-associated Muscle Cramps (EAMCs)

single, multijoint muscles (eg, triceps surae, quadriceps, hamstrings) when contracting in a shortened state

Electrolyte Depletion Theory Dehydration Abnormal serum electrolyte

concentrations Altered neuromuscular

control hypothesis Muscle spindle & golgi tendon

proprioceptors

Exercise-Associated Muscle Cramps

Cooper E. R. et al.2006

The Role of Hydration and Effects of Dehydration

Signs of Dehydration

Fatigue Difficulty Concentrating Irritability Lightheadedness Decreased AlertnessCrampingNauseaWeakness

ACSM Recommendations

Body weight (in pounds)/2= daily fluid needs (in oz.)

16 ounces, 1 hour before competition

5-12 ounces of fluid every 15-20 minutes

> 1 hour

sports drinks containing 7% carbohydrates

For every pound lost per hour16-24 ounces of fluid

Percent Dehydration Effect on Physiological Function

Percent Weight Loss

Effects on the Body

1 to 2 Increase in core body temperature

3 Significant increase in body temperature with aerobic exercise

5 • Significant increase in body temperature with a definite decrease in aerobic ability and muscular endurance • Possible 20 to 30% decrease in strength and and anaerobic power• Susceptible to heat exhaustion

6 Muscle spasms and cramping

10 or more • Excessively high core body temperature • Susceptibility to heat stroke •Heat injury and circulatory collapse with aerobic performanceAlabama A&M & Auburn Universities,

2003

Electrolytes: Recommended Intake and Function

http://www.kbnutrition.com

Pro Cons

Approximately 25% of certified athletic trainers advocate

drinking 30 mL to 60 mL of pickle juice relieves an EAMC within 30

to 35 seconds after ingestion

PickleJuiceSport

1-2 ounces recommended 2 times to 20 times the

dosage Decreased gastric emptying

high salt and low fluid content contribute to dehydration-

induced hypertonicity prolonging dehydration increasing the risk of

hyperthermia and poor performance

The Pickle Juice Debate

Miller K. C., Knight K. L., Williams R. B., 2008

Composition of Fluids

Miller K. D., Mack G., Knight K. L, 2009

Plasma Levels

Miller K. D., Mack G., Knight K. L, 2009

Electrolyte Concentration Post-Ingestion

Miller K. D., Mack G., Knight K. L, 2009

Pickle Juice and Deionized Water Composition

Miller KC, Mack GW, Knight KL, 2010

Gastric Volume of Pickle Juice and Water

Miller KC, Mack GW, Knight KL, 2010

Plasma Sodium Concentration

Miller KC, Mack GW, Knight KL, 2010

Cramp Duration DI Water vs. Pickle Juice

Miller K. C., Mack G. W., Knight K. L., et al., 2010

Increased Running Speed and Previous Cramping

Schwellnus MP, Drew N, Collins M. , 2010

Anatomy Increased Excitatory Input

Altered Neuromuscular Control Theory

Schwellnus, M.P., J. Nicol, R. Laubscher, and T.D. Noakes., 2004

http://www.sweatscience.com.

Practical Implications

There is no one cure for EAMCs Find a method that works for you

Pickle juice needs to be further investigated to determine optimal quantities and timing. Should not be used for the first time during competition

Fluid, electrolyte and energy supplementation is desirable to support circulatory, metabolic and thermoregulatory functions.

Sports drinks should not be used in exercise less than 60-90 minutes

Stretching and strengthening of musculature is possibly important for avoiding EAMCs.

Future Research

Only 18 studies on pickle juice and carbohydrate solutions All but three are anecdotal

Mechanism of pickle juice’s role in EAMC alleviation Optimal treatment parameters

More case studies rather than anecdotal findings

Research into the oropharyngeal region Increased focus on the environmental factors

influence on dehydration

References

Cooper E. R., Ferrara M. S., Broglio S. P. Exertional heat illness and environmental conditions during a single football season in the Southeast. J Athl Train. 2006;41(3):332–336.

Jung, A.P., P.A. Bishop, A. Al-Nawwas, and R.B. Dale. Influence of hydration and electrolyte supplementation on incidence and time to onset of exercise-associated muscle cramps. J. Athl. Training. 40:71-75, 2005.

Levin, S. Investigating the cause of muscle cramps. Phys. Sportsmed. 21:111-113, 1993. Maughan, R.J., J.B. Leiper, and S.M. Shirreffs. Restoration of fluid balance after exercise-induced dehydration:

effects of food and fluid intake. Eur. J. Appl. Physiol. Occup. Physiol. 73:317-325, 1996. Maughan, R.J., S.J. Merson, N.P. Broad, and S.M. Shirreffs. Fluid and electrolyte intake and loss in elite soccer

players during training. Int. J. Sport Nutr. Exerc. Metab. 14:333-346, 2004. Maughan R. J., Leiper J. B. Limitations to fluid replacement during exercise. Can J Appl Physiol.

1999;24(2):173–187. Miller K. C., Knight K. L., Williams R. B. Athletic trainers' perceptions of pickle juice's effects on exercise

associated muscle cramps. Athl Ther Today. 2008;13(5):31–34. Miller K. D., Mack G., Knight K. L. Electrolyte and plasma changes after ingestion of pickle juice, water, and a

common carbohydrate-electrolyte solution. J Athl Train. 2009;44(5):454–461. Miller K. C., Mack G. W., Knight K. L., et al. Reflex inhibition of electrically-induced muscle cramps in

hypohydrated humans. Med Sci Sports Exerc. 2010;42(5):953–961. Roeleveld, K., B.G. van Engelen, and D.F. Stegeman. Possible mechanisms of muscle cramp from temporal and

spatial surface EMG characteristics. J. Appl. Physiol. 88:1698-1706, 2000. Schwellnus, M.P., J. Nicol, R. Laubscher, and T.D. Noakes. Serum electrolyte concentrations and hydration

status are not associated with exercise associated muscle cramping (EAMC) in distance runners. Br. J. Sports Med. 38:488-492, 2004.

Schwellnus MP, Drew N, Collins M. Increased running speed and previous cramping rather than dehydration or serum sodium changes predict exercise-associated muscle cramping: a prospective cohort study in 210 Ironman triathletes. Br J Sports Med 2011;45:650-656

Pre-Ingestion Urine Levels

Miller K. D., Mack G., Knight K. L, 2009

Pre-ingestion Plasma Levels

Miller K. D., Mack G., Knight K. L, 2009

When to Use When not to

Within 1 hour of exercise

During a work out lasting >60-90 minutes high intensity intervals

>30-60 min Immediately after

workouts kick starts rehydration

and refueling

Everyday drink For the first time

during a race To replace meals

and snacks on non-race days

During low intensity/short duration workouts

Do’s and Don’ts of Sports Drinks