Volume 7, Issue 2 (8-2021)                   J Sport Biomech 2021, 7(2): 78-93 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Fattahi A, Dehnavi M, Hamzeh L. Exercise-associated Muscle Cramps in Runners: A Review. J Sport Biomech 2021; 7 (2) :78-93
URL: http://biomechanics.iauh.ac.ir/article-1-253-en.html
1- Department of Sports Biomechanics, Faculty of Physical Education and Sports Science, Central Tehran Branch, Islamic Azad University, Tehran, Iran.
Full-Text [PDF 5155 kb]   (1097 Downloads)     |   Abstract (HTML)  (2183 Views)
Full-Text:   (1474 Views)
1. Introduction
revalence of Exercise-associated muscle cramp (EAMC) has been reported in different studies and groups of athletes [12, 3, 45]. One of these groups is runners [6, 7]. Due to the fact that a lot of muscles are used during running and the amount of energy consumed in these runners is high, and considering that no review study was not found that addressed the causes of EAMC in runners, this review study aims to investigate EAMC in runners to determine the cause and general nature of EAMC in this sport to provide more complete and better information for interventions and future studies on EAMC in runners. As a result, it can help prevent, treat and reduce its occurrence.
2. Methods
A search was conducted for studies on EAMC in runners published in Persian or English from 1997 to 2021 in MEDLINE/PubMed, EMBASE/SCOPUS, LILACS, CINAHL, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, PEDro, Google Scholar, MAGIRAN, IRANDOC, IranMedex, MedLib, and SID using the MeSH keywords: Muscle cramp or muscle fatigue or chronic disease, running, ultra-marathon or half-marathon or marathon or ultrarunning or athletes or athletic performance, exercise or endurance exercise, water-electrolyte imbalance, electrolytes or dehydration or sports nutrition or hydration. After finding articles, first their title and abstracts and then their contents were read. If they met the inclusion criteria, they would be used in the review. Inclusion criteria were: Being published in Persian or English, studies on EAMC in runners, and availability of fulltexts. 
3. Results
The search in online databases yielded 326 articles. By reviewing their reference sections, 5 more articles were yielded. After removing duplicates, 241 were identified for review. After reviewing their titles and abstracts, 202 were deleted and 39 remained for reading their fulltexts. Finally, 15 eligible articles were selected and their results were reported (Table 1).

4. Discussion and Conclusion

The purpose of this study was to investigate EAMC in runners. Studies have reported a variety of information on EAMC in runners. Studies showed that the causes of EAMC are: dehydration and electrolyte deficiency, cold, prolonged training or competition, increased body temperature during training or competition, history of muscle injuries and cramps in the past, increased intensity of training in a short time, and dietary restrictions. Therefore, in order to reduce the occurrence EAMC in runners, it is necessary to consider these factors and study them in detail.

Ethical Considerations
Compliance with ethical guidelines

There were no ethical considerations to be considered in this research.

This research did not receive any grant from funding agencies in the public, commercial, or profit-non sectors.

Authors' contributions
All authors equally contributed to preparing this article.

Conflicts of interest
The authors declared no conflict of interest.

  1. Murray D, Miller KC, Edwards JE. Does a reduction in serum sodium concentration or serum potassium concentration increase the prevalence of exercise-associated muscle cramps? J Sport Rehabil. 2016; 25(3):301-4. [DOI:10.1123/jsr.2014-0293] [PMID]
  2. Miller KC. The evolution of exercise-associated muscle cramp research. ACSMs Health Fit J. 2018; 22(4):6-8. [DOI:10.1249/FIT.0000000000000395]
  3. Katzberg HD, Khan AH, So YT. Assessment: Symptomatic treatment for muscle cramps (an evidence-based review): Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology. 2010; 74(8):691-6. [DOI:10.1212/WNL.0b013e3181d0ccca] [PMID]
  4. Schwellnus MP. Skeletal muscle cramps during exercise. Phys Sportsmed. 1999; 27(12):109-15. [DOI:10.3810/psm.1999.11.1116] [PMID]
  5. Dickhuth HH, Röcker K, Niess A, Horstmann T, Mayer F, Striegel H. Execise-induced, persistent and generalized muscle cramps. A case report. J Sports Med Phys Fitness. 2002; 42(1):92-4. [PMID]
  6. Simchak AC, Pascuzzi RM. Muscle cramps. Semin Neurol. 1991; 11(3):281-7. [DOI:10.1055/s-2008-1041233] [PMID]
  7. Armstrong S, Cross T. Exercise-associated muscle cramps. Med Today. 2013; 14(11):62-5. https://medicinetoday.com.au/2013/november/regular-series/exercise-associated-muscle-cramps
  8. Maquirriain J, Merello M. The athlete with muscular cramps: Clinical approach. J Am Acad Orthop Surg. 2007; 15(7):425-31. [DOI:10.5435/00124635-200707000-00007] [PMID]
  9. Miller KC. Myths and misconceptions about exercise-associated muscle cramping. ACSMs Health Fit J. 2016; 20(2):37-9. [DOI:10.1249/FIT.0000000000000187]
  10. Sulzer NU. Exercise associated muscle cramping: Investigating a novel hypothesis. Cape Town: University of Cape Town; 2003. https://books.google.com/books?id=NYtfNwAACAAJ&dq
  11. Qiu J, Kang J. Exercise associated muscle cramps - A current perspective. Arch Sports Med. 2017; 1(1):3-14. [DOI:10.36959/987/223]
  12. Miller KC, Mack GW, Knight KL, Hopkins JT, Draper DO, Fields PJ, et al. Three percent hypohydration does not affect threshold frequency of electrically induced cramps. Med Sci Sports Exerc. 2010; 42(11):2056-63. [DOI:10.1249/MSS.0b013e3181dd5e3a] [PMID]
  13. Hallissey HM. The use of bananas in preventing exercise associated muscle cramps [MSc. thesis]. Fargo, ND: North Dakota State University; 2014. https://library.ndsu.edu/ir/handle/10365/27535
  14. Bergeron MF. Muscle cramps during exercise-Is it fatigue or electrolyte deficit? Curr Sports Med Rep. 2008; 7(4):S50-5. [DOI:10.1249/JSR.0b013e31817f476a]
  15. Eichner ER. The role of sodium in ‘heat cramping’. Sports Med. 2007; 37(4-5):368-70. [DOI:10.2165/00007256-200737040-00024] [PMID]
  16. Miller KC, Stone MS, Huxel KC, Edwards JE. Exercise-associated muscle cramps: Causes, treatment, and prevention. Sports Health. 2010; 2(4):279-83. [DOI:10.1177/1941738109357299] [PMID] [PMCID]
  17. Schwellnus MP. Cause of Exercise Associated Muscle Cramps (EAMC)-altered neuromuscular control, dehydration or electrolyte depletion? Br J Sports Med. 2009; 43(6):401-8. [DOI:10.1136/bjsm.2008.050401] [PMID]
  18. Bentley S. Exercise-induced muscle cramp. Proposed mechanisms and management. Sports Med. 1996; 21(6):409-20. [DOI:10.2165/00007256-199621060-00003] [PMID]
  19. Jayaraman RC, Reid RW, Foley JM, Prior BM, Dudley GA, Weingand KW, et al. MRI evaluation of topical heat and static stretching as therapeutic modalities for the treatment of eccentric exercise-induced muscle damage. Eur J Appl Physiol. 2004; 93(1-2):30-8. [DOI:10.1007/s00421-004-1153-y] [PMID]
  20. Eichner ER. Heat cramps in sports. Curr Sports Med Rep. 2008; 7(4):178-9. [DOI:10.1249/JSR.0b013e31817ebfcd] [PMID]
  21. Schallig W, Levels K, Daanen HAM. Heat and exercise associated muscle cramps: The influence of heat on the occurrence of exercise associated muscle cramps: A review. Sport Geneesk. 2017; 50(1):30-9. https://research.vu.nl/en/publications/heat-and-exercise-associated-muscle-cramps
  22. Jones BH, Rock PB, Smith LS, Teves MA, Casey JK, Eddings K, et al. Medical complaints after a marathon run in cool weather. Phys Sportsmed. 1985; 13(10):103-10. [DOI:10.1080/00913847.1985.11708904] [PMID]
  23. Behringer M, Link TW, Montag JCK, McCourt ML, Mester J. Are electrically induced muscle cramps able to increase the cramp threshold frequency, when induced once a week? Orthop Rev. 2015; 7(3):6028. [DOI:10.4081/or.2015.6028] [PMID] [PMCID]
  24. Miller KC, Knight KL, Wilding SR, Stone MB. Duration of electrically induced muscle cramp increased by increasing stimulation frequency. J Sport Rehabil. 2012; 21(2):182-5. [DOI:10.1123/jsr.21.2.182] [PMID]
  25. Miller KC, Knight KL. Initial electrical stimulation frequency and cramp threshold frequency and force. J Athl Train. 2012; 47(6):643-7. [DOI:10.4085/1062-6050-47.5.12] [PMID] [PMCID]
  26. Minetto MA, Holobar A, Botter A, Ravenni R, Farina D. Mechanisms of cramp contractions: Peripheral or central generation? J Physiol. 2011; 589(23):5759-73. [DOI:10.1113/jphysiol.2011.212332] [PMID] [PMCID]
  27. Minetto MA, Holobar A, Botter A, Farina D. Discharge properties of motor units of the abductor hallucis muscle during cramp contractions. J Neurophysiol. 2009; 102(3):1890-901. [DOI:10.1152/jn.00309.2009] [PMID]
  28. Khan SI, Burne JA. Reflex inhibition of normal cramp following electrical stimulation of the muscle tendon. J Neurophysiol. 2007; 98(3):1102-7. [DOI:10.1152/jn.00371.2007] [PMID]
  29. Miller KC, Burne JA. Golgi tendon organ reflex inhibition following manually applied acute static stretching. J Sports Sci. 2014; 32(15):1491-7. [DOI:10.1080/02640414.2014.899708] [PMID]
  30. Giuriato G, Pedrinolla A, Schena F, Venturelli M. Muscle cramps: A comparison of the two-leading hypothesis. J Electromyogr Kinesiol. 2018; 41:89-95. [DOI:10.1016/j.jelekin.2018.05.006] [PMID]
  31. Nelson NL, Churilla JR. A narrative review of exercise-associated muscle cramps: Factors that contribute to neuromuscular fatigue and management implications. Muscle Nerve. 2016; 54(2):177-85. [DOI:10.1002/mus.25176] [PMID]
  32. Miller KC. Exercise-associated muscle cramps. In: Adams W, Jardine J, editors. Exertional Heat Illness. Cham: Springer; 2020. pp. 117-136. [DOI:10.1007/978-3-030-27805-2_6]
  33. Troyer W, Render A, Jayanthi N. Exercise-associated muscle cramps in the tennis player. Curr Rev Musculoskelet Med. 2020; 13(5):612-21. [DOI:10.1007/s12178-020-09662-8] [PMID] [PMCID]
  34. Wise P, Lafferty L, Phillips SF. A case of persistent muscle cramps in an American football player with cystic fibrosis. Cureus. 2020; 12(6):e8621. [DOI:10.7759/cureus.8621] [PMID] [PMCID]
  35. Changstrom B, Brill J, Hecht S. Severe exercise-associated hyponatremia in a collegiate American football player. Curr Sports Med Rep. 2017; 16(5):343-5. [DOI:10.1249/JSR.0000000000000399] [PMID]
  36. Summers KM, Snodgrass SJ, Callister R. Predictors of calf cramping in rugby league. J Strength Cond Res. 2014; 28(3):774-83. [DOI:10.1519/JSC.0b013e31829f360c] [PMID]
  37. ZwemZa. Cramps in swimming…. What is the cause? [Internet]. 2014 [Updated 2014 November 15]. Available from: https://www.zwemza.com/?p=17753
  38. Turnipseed WD. Popliteal entrapment in runners. Clin Sports Med. 2012; 31(2):321-8. [DOI:10.1016/j.csm.2011.09.010] [PMID]
  39. Hanson J, Dole A. Potential nutrition contributions to exercise-associated muscle cramping in four recreational half-marathoners: A case series. Int J Strength Cond. 2021; 1(1):1-9. [DOI:10.47206/ijsc.v1i1.43]
  40. Fredericson M, Kim BJ, Date ES. Disabling foot cramping in a runner secondary to paramyotonia congenita: A case report. Foot Ankle Int. 2004; 25(7):510-2. [DOI:10.1177/107110070402500712] [PMID]
  41. Caselli MA, Longobardi SJ. Lower extremity injuries at the New York City marathon. J Am Podiatr Med Assoc. 1997; 87(1):34-7. [DOI:10.7547/87507315-87-1-34] [PMID]
  42. Ferreira FG, Pereira LG, Xavier WDR, Guttierres APM, Santana ÂMC, Costa NMB, et al. Hydration practices of runners during training vs competition. Arch Med Deporte. 2016; 33(1):11-7. https://archivosdemedicinadeldeporte.com/articulos/upload/or01_ferreira.pdf
  43. Hawes R, McMorran J, Vallis C. Exertional heat illness in half marathon runners: Experiences of the Great North Run. Emerg Med J. 2010; 27(11):866-7. [DOI:10.1136/emj.2010.090928] [PMID]
  44. Martínez-Navarro I, Montoya-Vieco A, Collado-Boira E, Hernando B, Panizo N, Hernando C. Muscle cramping in the marathon: Dehydration and electrolyte depletion vs. muscle damage. J Strength Cond Res. 2020; August. [DOI:10.1519/JSC.0000000000003713] [PMID]
  45. Hoffman MD, Stuempfle KJ. Muscle cramping during a 161-km ultramarathon: Comparison of characteristics of those with and without cramping. Sports Med Open. 2015; 1:24. [DOI:10.1186/s40798-015-0019-7] [PMID] [PMCID]
  46. Schwellnus MP, Drew N, Collins M. Increased running speed and previous cramps 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(8):650-6. [DOI:10.1136/bjsm.2010.078535] [PMID]
  47. Schwabe K, Schwellnus M, Derman W, Swanevelder S, Jordaan E. Medical complications and deaths in 21 and 56 km road race runners: A 4-year prospective study in 65 865 runners-SAFER study I. Br J Sports Med. 2014; 48(11):912-8. [DOI:10.1136/bjsports-2014-093470] [PMID]
  48. Parnell JA, Wagner-Jones K, Madden RF, Erdman KA. Dietary restrictions in endurance runners to mitigate exercise-induced gastrointestinal symptoms. J Int Soc Sports Nutr. 2020; 17:32. [DOI:10.1186/s12970-020-00361-w] [PMID] [PMCID]
  49. Schwellnus MP, Swanevelder S, Jordaan E, Derman W, Van Rensburg DCJ. Underlying chronic disease, medication use, history of running injuries and being a more experienced runner are independent factors associated with exercise-associated muscle cramping: A cross-sectional study in 15778 distance runners. Clin J Sport Med. 2018; 28(3):289-98. [DOI:10.1097/JSM.0000000000000456] [PMID]
  50. Schwellnus MP, Allie S, Derman W, Collins M. Increased running speed and pre-race muscle damage as risk factors for exercise-associated muscle cramps in a 56 km ultra-marathon: A prospective cohort study. Br J Sports Med. 2011; 45(14):1132-6. [DOI:10.1136/bjsm.2010.082677] [PMID]
  51. Hoogervorst D, van der Burg N, Versteegen JJ, Lambrechtse KJ, Redegeld MI, Cornelissen LA, et al. Gastrointestinal complaints and correlations with self-reported macronutrient intake in independent groups of (ultra) marathon runners competing at different distances. Sports. 2019; 7(6):140. [DOI:10.3390/sports7060140] [PMID] [PMCID]
  52. Schwellnus MP, Nicol J, Laubscher R, Noakes TD. Serum electrolyte concentrations and hydration status are not associated with Exercise Associated Muscle Cramping (EAMC) in distance runners. Br J Sports Med. 2004; 38(4):488-92. [DOI:10.1136/bjsm.2003.007021] [PMID] [PMCID]
  53. Wardenaar FC, Dijkhuizen R, Ceelen IJM, Jonk E, de Vries JHM, Witkamp RF, et al. Nutrient intake by ultramarathon runners: Can they meet recommendations? Int J Sport Nutr Exerc Metab. 2015; 25(4):375-86. [DOI:10.1123/ijsnem.2014-0199] [PMID]
  54. Miller KC, Knight KL. Electrical stimulation cramp threshold frequency correlates well with the occurrence of skeletal muscle cramps. Muscle Nerve. 2009; 39(3):364-8. [DOI:10.1002/mus.21170] [PMID]
  55. Sulzer NU, Schwellnus MP, Noakes TD. Serum electrolytes in Ironman triathletes with exercise-associated muscle cramping. Med Sci Sports Exerc. 2005; 37(7):1081-5. [DOI:10.1249/01.mss.0000169723.79558.cf] [PMID]
  56. Stone MB, Edwards JE, Stemmans CL, Ingersoll CD, Palmieri RM, Krause BA. Certified athletic trainers’ perceptions of exercise-associated muscle cramps. J Sport Rehabil. 2003; 12(4):333-42. [DOI:10.1123/jsr.12.4.333]
  57. McCubbin AJ, Cox GR, Costa RJS. Sodium intake beliefs, information sources, and intended practices of endurance athletes before and during exercise. Int J Sport Nutr Exerc Metab. 2019; 29(4):371-81. [DOI:10.1123/ijsnem.2018-0270] [PMID]
  58. Braulick KW, Miller KC, Albrecht JM, Tucker JM, Deal JE. Significant and serious dehydration does not affect skeletal muscle cramp threshold frequency. Br J Sports Med. 2013; 47(11):710-4. [DOI:10.1136/bjsports-2012-091501] [PMID]
  59. Jung AP, Bishop PA, Al-Nawwas A, Dale RB. Influence of hydration and electrolyte supplementation on incidence and time to onset of exercise-associated muscle cramps. J Athl Train. 2005; 40(2):71-5. [PMID] [PMCID]
  60. Shang G, Collins M, Schwellnus MP. Factors associated with a self-reported history of exercise-associated muscle cramps in Ironman triathletes: A case-control study. Clin J Sport Med. 2011; 21(3):204-10. [DOI:10.1097/JSM.0b013e31820bcbfd] [PMID]
  61. O’Connell KO, Posthumus M, Schwellnus MP, Collins M. Collagen genes and exercise-associated muscle cramping. Clin J Sport Med. 2013; 23(1):64-9. [DOI:10.1097/JSM.0b013e3182686aa7] [PMID]
  62. MacSearraigh ET, Kallmeyer JC, Schiff HB. Acute renal failure in marathon runners. Nephron. 1979; 24(5):236-40. [DOI:10.1159/000181723] [PMID]
  63. Minetto MA, Holobar A, Botter A, Farina D. Origin and development of muscle cramps. Exerc Sport Sci Rev. 2013; 41(1):3-10. [DOI:10.1097/JES.0b013e3182724817] [PMID]
  64. Parisi L, Pierelli F, Amabile G, Valente G, Calandriello E, Fattapposta F, et al. Muscular cramps: Proposals for a new classification. Acta Neurol Scand. 2003; 107(3):176-86. [DOI:10.1034/j.1600-0404.2003.01289.x] [PMID]
  65. Miller TM, Layzer RB. Muscle cramps. Muscle Nerve. 2005; 32(4):431-42. [DOI:10.1002/mus.20341] [PMID]
  66. Mehta SS, Fallon MB. Muscle cramps in liver disease. Clin Gastroenterol Hepatol. 2013; 11(11):1385-91. [DOI:10.1016/j.cgh.2013.03.017] [PMID]
  67. Viljoen CT, van Rensburg DCJ, Verhagen E, van Mechelen W, Tomás R, Schoeman M, et al. Epidemiology of injury and illness among trail runners: A systematic review. Sports Med. 2021; 51(5):917-43. [DOI:10.1007/s40279-020-01418-1] [PMID]
  68. Peters HP, van Schelven FW, Verstappen PA, de Boer RW, Bol E, Erich WB, et al. Gastrointestinal problems as a function of carbohydrate supplements and mode of exercise. Med Sci Sports Exerc. 1993; 25(11):1211-24. [DOI:10.1249/00005768-199311000-00003] [PMID]
  69. Ter Steege RWF, Van Der Palen J, Kolkman JJ. Prevalence of gastrointestinal complaints in runners competing in a long-distance run: An internet-based observational study in 1281 subjects. Scand J Gastroenterol. 2008; 43(12):1477-82. [DOI:10.1080/00365520802321170] [PMID]
  70. Stuempfle KJ, Hoffman MD, Weschler LB, Rogers IR, Hew-Butler T. Race diet of finishers and non-finishers in a 100 mile (161 km) mountain footrace. J Am Coll Nutr. 2011; 30(6):529-35. [DOI:10.1080/07315724.2011.10719999] [PMID]
  71. de Oliveira EP, Burini RC, Jeukendrup A. Gastrointestinal complaints during exercise: Prevalence, etiology, and nutritional recommendations. Sports Med. 2014; 44(Suppl 1):79-85. [DOI:10.1007/s40279-014-0153-2] [PMID] [PMCID]
  72. Jeukendrup AE. Training the gut for athletes. Sports Med. 2017; 47(Suppl 1):101-10. [DOI:10.1007/s40279-017-0690-6] [PMID] [PMCID]
  73. Rehrer NJ, van Kemenade M, Meester W, Brouns F, Saris WHM. Gastrointestinal complaints in relation to dietary intake in triathletes. Int J Sport Nutr Exerc Metab. 1992; 2(1):48-59. [DOI:10.1123/ijsn.2.1.48] [PMID]
  74. Abe K. A patient developed painful muscle cramps due to overeating mangos. Case Rep Neurol Med. 2012; 2012:742125. [DOI:10.1155/2012/742125] [PMID] [PMCID]
  75. Ørtenblad N, Westerblad H, Nielsen J. Muscle glycogen stores and fatigue. J Physiol. 2013; 591(18):4405-13. [DOI:10.1113/jphysiol.2013.251629] [PMID] [PMCID]
  76. Jeukendrup A. A step towards personalized sports nutrition: Carbohydrate intake during exercise. Sports Med. 2014; 44(Suppl 1):25-33. [DOI:10.1007/s40279-014-0148-z] [PMID] [PMCID]
  77. Thomas DT, Erdman KA, Burke LM. Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance. J Acad Nutr Diet. 2016; 116(3):501-28. [DOI:10.1016/j.jand.2015.12.006] [PMID]
  78. Burke LM, Jeukendrup AE, Jones AM, Mooses M. Contemporary nutrition strategies to optimize performance in distance runners and race walkers. Int J Sport Nutr Exerc Metab. 2019; 29(2):117-29. [DOI:10.1123/ijsnem.2019-0004] [PMID]
  79. Wardenaar FC, Hoogervorst D, Versteegen JJ, van der Burg N, Lambrechtse KJ, Bongers CCWG. Real-time observations of food and fluid timing during a 120 km ultramarathon. Front Nutr. 2018; 5:32. [DOI:10.3389/fnut.2018.00032] [PMID] [PMCID]
  80. Moran ST, Dziedzic CE, Cox GR. Feeding strategies of a female athlete during an ultraendurance running event. Int J Sport Nutr Exerc Metab. 2011; 21(4):347-51. [DOI:10.1123/ijsnem.21.4.347] [PMID]
  81. Martinez S, Aguilo A, Rodas L, Lozano L, Moreno C, Tauler P. Energy, macronutrient and water intake during a mountain ultramarathon event: The influence of distance. J Sports Sci. 2018; 36(3):333-9. [DOI:10.1080/02640414.2017.1306092] [PMID]
  82. Kruseman M, Bucher S, Bovard M, Kayser B, Bovier PA. Nutrient intake and performance during a mountain marathon: An observational study. Eur J Appl Physiol. 2005; 94(1-2):151-7. [DOI:10.1007/s00421-004-1234-y] [PMID]
Type of Study: Research | Subject: General
Received: 2021/05/31 | Accepted: 2021/06/26 | Published: 2021/09/1

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Journal of Sport Biomechanics

Designed & Developed by : Yektaweb