Cramps during exercise – By Simon Case (Senior Physiotherapist)

I would confidently say that most people at some point have experienced a CRAMP. If you haven’t  lets provide a description of cramps defined by Schwellnus et al, (2008).

“…a painful, spasmodic, and involuntary contraction of skeletal muscle that occurs during or immediately after exercise”

Cramps hurt!! They can cause significant pain and inhibit further exercise or activity sometimes for prolonged periods.


Traditionally people believe dehydration to be one of the main contributing factors in muscle cramps and that has not been disproven to date. However if this were the only reason then managing cramps would be easy right? Drink plenty of fluids.

WaterEspecially in the middle east where the temperatures are typically high, the likelihood of increased fluid loss due to temperature needs to be considered.

Electrolytes are the ‘buzzword’ for the go to muscle cramp eliminator. However as Miller et al, (2010) suggests most sports drinks don’t contain enough and equally they are not absorbed immediately after ingestion, with even hypertonic drinks requiring around 13 minutes to be absorbed in to the circulatory system. Also there is disparity between how much fluid is required as different athletes sweat differently and have different rates of fluid loss. As everyone is individual. 

Miller et al (2010) does state however

“An athlete who ingests a litre of water or hypotonic sports drink at least 1 hour before competition can be confident that the majority of the fluid, electrolytes, and nutrients have been absorbed and are available in the body.” So is that it?

Neuromuscular System

Moving on to the neuromuscular system, which has also been investigated and it has shown that overload and fatigue can cause an imbalance which in turn causes the muscle to contact when it is already in a shortened position, so CRAMP TIME. How do we manage or prevent this?

Plyometrics or jump training, have been shown to improve neuromuscular control whilst endurance training has been shown to be beneficial in delaying neuromuscular fatigue. As usual more evidence is needed, however this is a good start.

PlyometricsUnfortunately the only thing researchers can agree upon is that the ‘true’ cause of exercise associated muscle cramps remains unknown. Which makes it difficult to develop clear treatment and prevention strategies, with what we do know we can at least aim to limit the likelihood of the onset of cramps.

In first instance all can agree that when a cramp occurs, gentle passive stretching to the affected area will help relieve symptoms almost immediately.

Main points for prevention, stay hydrated, incorporate plyometrics and endurance training in to your regime.


Schwellnus, M.P., Drew, N., Collins, M., 2008. Muscle cramping in athletes–risk factors, clinical assessment, and management. Clinical Journal of Sports Medicine [Online]. 27(1) pp183-94. Available from: [Accessed on 12 November 2019]

Miller, K.C., Stone, M.S.,Huxel, K.C., Edwards, J.E., 2010. Exercise-Associated Muscle Cramps

Causes, Treatment, and Prevention. Sports Health [Online]. 2(4) pp 279-283. Available from: [Accessed on 12 November 2019]


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