Help, My Calf is Cramping!

I know football season has started when I hear the yell for help as an athlete endures the pain and tightness associated with a muscle cramp. Exertional cramps most often occur in muscles that are repeatedly contracted in sprinting or running activities such as the gastrocnemius and soleus (calf) or hamstring muscles. Cramps are very common during the warmer months when an athlete is sweating more and still training the muscles to handle the demand of the sport. Ultimately preventing a muscle cramp is my primary objective, but there are a few strategies that I find effective if an athlete is suffering from a cramp.

In many athletes, muscle cramps are thought to be related to an electrolyte imbalance that is created from excess sweating during exercise. If the body is losing too muscle salt in the sweat, then the muscles will not have the correct ratio of electrolytes to regulate muscle contraction. The best way to prevent a muscle cramp is for the athlete to eat a well balance diet and follow good hydration habits. Athletes should understand that hydration is a cumulative process throughout the week and cannot be achieved in a single day.

Athletes should hydrate with 20 oz of water 2 to 3 hours before physical activity, then 10 oz 10 to 15 minutes before physical activity. During physical activity, hydrate with 30 to 40 oz every hour. After activity, hydrate with 20 oz for every pound of body weight lost. Athletes can self-monitor for dehydration by checking their thirst levels and urine output/color. A typical rule of thumb is that if athletes are thirsty, they are already dehydrated. Another indication of dehydration is if an athlete is not regularly urinating, or the color of the urine is a darker color. For example, if urine is pale yellow like lemonade, you are hydrated. If urine is a darker yellow like apple juice, you are dehydrated.

If prone to cramps, there are several supplement drinks available that are high in electrolyte concentration. Popular electrolyte supplementation drinks in my athletic training clinic are Pedialyte, Liquid IV, BANA water, and LMNT. These drinks are much higher in electrolyte concentration than hydration drinks found on the sidelines such as Gatorade, Powerade, and Body Armor. Electrolyte supplementation drinks should be consumed well in advance of competition for the best benefit and to decrease stomach upset. Thus, an athlete with a Friday night game should be diligent about drinking water daily and consider electrolyte supplementation starting Wednesday, if not sooner, depending on practice intensity.

If an athlete does experience a muscle cramp, there are a few treatment options that seem to ease the spasm and pain. The first instruction I give the athlete is to contract the antagonist (opposite) muscle to the one that is cramping. For example, if an athlete’s calf is cramping, I will say, “pull your toes to your nose as hard as you can.” The contraction of the anterior tibialis (shin) muscle should cause a reflexive relaxation to the cramping calf. You will often see athletes walking off the field with only weight on their heels and their toes lifted off the ground to keep the calf from cramping again. In addition to giving water and encouraging deep breathing, I will also offer the athlete a “shot” of pickle juice. Pickle juice is known to be very high in electrolytes, but the electrolytes can’t possibly get into the muscle that quickly. According to research, the acidity of the pickle juice may cause a nerve in the mouth or throat to trigger a reflex relaxation to the muscle. The other treatment that is quite effective is stretching of the muscle while using a rolling stick or a massage gun. The faster the cramp is relieved, the quicker the athlete can safely return to competition. After competition, it is important that the athlete ice the involved muscle for 15 to 20 minutes.

Exertional muscle cramps are quite painful and can severely limit performance. There are treatment options, but the best strategy is to try to prevent a cramp by a healthy diet and proper hydration. An athlete who suffers repeated muscle cramps, despite following prevention strategies, should be evaluated by a sports medicine physician to rule out underlying medical issues.