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Macmillan C, Sewry N, Schwellnus M, Boulter J, Dyer M, Jordaan E. Sex, training variables, history of chronic disease, and chronic injury are risk factors associated with a history of exercise-associated muscle cramping in 10,973 ultramarathon race entrants: a safer XXXVIII study. J Sports Med Phys Fitness 2024; 64:961-969. [PMID: 38842373 DOI: 10.23736/s0022-4707.24.15842-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND The prevalence of a history of exercise-associated muscle cramping (hEAMC) among ultramarathon runners is high. While the Comrades is one of the most popular mass community-based participation ultramarathons (90 km) globally, research on the epidemiology, clinical characteristics, and risk factors of entrants' lifetime hEAMC are scarce. This research aimed to describe the epidemiology, clinical characteristics, and risk factors of hEAMC among Comrades Marathon entrants. METHODS This was a retrospective, cross-sectional study in which 10973 race entrants of the 2022 Comrades Marathon participated. Entrants completed a prerace medical screening questionnaire that included questions related to the lifetime prevalence (%; 95% CI), severity, treatment and risk factors (demographics, training/racing variables, chronic disease/allergies, injury) for EAMC. RESULTS One thousand five hundred eighty-two entrants reported hEAMC in their lifetime (14.4%; 95% CI: 13.77-15.09). There was a significantly (P<0.01) higher prevalence of male (16.10%; 95% CI:15.34-16.90) than female (8.31%; 95% CI: 7.27-9.50) entrants with hEAMC (PR=1.94; 95% CI:1.68-2.23). The prevalence of hEAMC was highest in entrants with a: 1) 1 disease increase in composite disease score (PR=1.31; 95% CI:1.25-1.39); 2) history of collapse (PR=1.87; 95% CI 1.47-2.38); 3) past chronic musculoskeletal (MSK) injury (PR=1.71; 95% CI 1.50-1.94); and 4) MSK injury in the previous 12 months (PR=2.38;95% CI: 2.05-2.77). Training-related risk factors included an increase of 10 km weekly running distance (PR=0.97; 95% CI:0.95-0.99) and a training pace increase of 1min/ km (slower) (PR=1.07; 95% CI:1.03-1.12). CONCLUSIONS Future research should investigate the causal relationship between risk factors identified and hEAMC in ultramarathon runners. Findings from this study could assist in effective anticipation and adequate planning for treating EAMC encounters during community-based mass participation events.
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Affiliation(s)
- Candice Macmillan
- Sport, Exercise Medicine, and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa -
| | - Nicola Sewry
- Sport, Exercise Medicine, and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- International Olympic Committee (IOC) Research Center, Pretoria, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine, and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- International Olympic Committee (IOC) Research Center, Pretoria, South Africa
| | | | - Marlise Dyer
- Sport, Exercise Medicine, and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Esme Jordaan
- Unit of Biostatistics Research, South African Medical Research Council, Cape Town, South Africa
- Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa
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Evers-Smith JW, Miller KC. Does Prophylactic Stretching Reduce the Occurrence of Exercise-Associated Muscle Cramping? A Critically Appraised Topic. J Sport Rehabil 2024; 33:49-52. [PMID: 37758261 DOI: 10.1123/jsr.2022-0374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 10/03/2023]
Abstract
CLINICAL SCENARIO Exercise-associated muscle cramps (EAMC) are sudden, painful, and involuntary contractions of skeletal muscles during or after physical activity. The best treatment for EAMC is gentle static stretching until abatement. Stretching is theorized to relieve EAMC by normalizing alpha motor neuron control, specifically by increasing Golgi tendon organ activity, and physically separating contractile proteins. However, it is unclear if stretching or flexibility training prevents EAMC via the same mechanisms. Despite this, many clinicians believe prophylactic stretching prevents EAMC occurrence. CLINICAL QUESTION Do athletes who experience EAMC during athletic activities perform less prophylactic stretching or flexibility training than athletes who do not develop EAMC during competitions? SUMMARY OF KEY FINDINGS In 3 cohort studies and 1 case-control study, greater preevent muscle flexibility, stretching, or flexibility training (ie, duration, frequency) was not predictive of who developed EAMC during competition. In one study, athletes who developed EAMC actually stretched more often and 9 times longer (9.8 [23.8] min/wk) than noncrampers (1.1 [2.5] min/wk). CLINICAL BOTTOM LINE There is minimal evidence that the frequency or duration of prophylactic stretching or flexibility training predicts which athletes developed EAMC during competition. To more effectively prevent EAMC, clinicians should identify athletes' unique intrinsic and extrinsic risk factors and target those risk factors with interventions. STRENGTH OF RECOMMENDATION Minimal evidence from 3 prospective cohort studies and 1 case-control study (mostly level 3 studies) that suggests prophylactic stretching or flexibility training can predict which athletes develop EAMC during athletic competitions.
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Affiliation(s)
- John W Evers-Smith
- College of Science and Engineering, Central Michigan University, Mount Pleasant, MI, USA
| | - Kevin C Miller
- Department of Health and Human Performance, Texas State University, San Marcos, TX, USA
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de Jager I, Schwellnus M, Sewry N, Viljoen C, Korkie E, Swanevelder S, Jordaan E. Males, Older Age, Increased Training, Chronic Diseases, Allergies, and History of Injury Are Independent Risk Factors Associated With a History of Exercise-Associated Muscle Cramping in Distance Runners in 76 654 Race Entrants - SAFER XXIX. Clin J Sport Med 2023; 33:521-526. [PMID: 36548112 DOI: 10.1097/jsm.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine independent risk factors associated with a history of exercise-associated muscle cramps (hEAMCs) in distance runner race entrants in a community-based mass participation event. DESIGN Cross-sectional study. SETTING 2012 to 2015, Two Oceans marathon races (21.1 and 56 km), South Africa. PARTICIPANTS Seventy six thousand six hundred fifty-four consenting race entrants. ASSESSMENT OF RISK FACTORS Entrants completed an online prerace medical screening questionnaire as part of the entry process. In a multiple model, sex, age, training variables, history of chronic disease, allergies, and running injuries were included as potential factors associated with hEAMC in 21.1 and 56 km entrants. MAIN OUTCOME MEASURES Prevalence (%) and prevalence ratios (PRs, 95% confidence intervals) are reported. RESULTS Men ( P < 0.0001) and older age (>40 years, P < 0.0001) were significantly associated with hEAMC. Therefore, the model was adjusted for sex and age group and run separately for 21.1- and 56-km entrants. Specific independent risk factors associated with hEAMC in 21.1- and 56-km entrants were: a history of chronic diseases (21.1 km: PR = 1.9; 56 km: PR = 1.6; P < 0.0001), running injury in the last 12 months (21.1 km: PR = 1.7; 56 km: PR = 1.4; P < 0.0001), history of allergies (21.1 km: PR = 1.4; 56 km: PR = 1.2; P < 0.0001), and various training variables (PR = 1.0-1.1). CONCLUSION In 21.1- and 56-km race entrants, independent risk factors associated with hEAMC were men, older age, longer race distances, training variables, chronic diseases, history of allergies, and history of a running injury in the past 12 months.
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Affiliation(s)
- Izaan de Jager
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI) and Department of Physiology, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa
- International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
- Emeritus Professor, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa
- International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
| | - Carel Viljoen
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Sports Campus, Pretoria, South Africa
| | - Elzette Korkie
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Sports Campus, Pretoria, South Africa
| | - Sonja Swanevelder
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa; and
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa; and
- Department of Statistics and Population Studies, University of the Western Cape, Bellville, South Africa
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Prevalence, Clinical Characteristics, and Self-Reported Treatment of Exercise-Associated Muscle Cramping Differ Between 21.1- and 56-Km Running Race Entrants-SAFER XXII. Clin J Sport Med 2022; 32:415-421. [PMID: 34759185 DOI: 10.1097/jsm.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether the lifetime prevalence and clinical characteristics of exercise-associated muscle cramping (EAMC) differ between runners entering a 21.1- versus 56-km road race. DESIGN Cross-sectional study. SETTING The 2012 to 2015 Two Oceans Marathon races (21.1 and 56 km), South Africa. PARTICIPANTS Participants were consenting race entrants (21.1 km = 44 458; 56 km = 26 962) who completed an online prerace medical screening questionnaire. INDEPENDENT VARIABLE A history of EAMC. MAIN OUTCOME MEASURES The main outcome variables were lifetime prevalence (%) and clinical characteristics (muscle groups affected, timing of occurrence, severity, frequency of serious EAMC, and self-reported treatment) of a history of EAMC. Differences between 56- and 21.1-km race entrants were explored (relative risk [RR]). RESULTS The lifetime prevalence of EAMC was 12.8%, which was higher in 56- (20.0%; 95% CI 19.5-20.6) versus 21.1-km race entrants (8.5%; 8.2-8.8) ( P = 0.0001). In all entrants, the fourth quarter was the most common onset (46.4%), calf muscles were the most commonly affected (53.1%), and most EAMCs were of mild-to-moderate severity (95%). In 56- versus 21.1-km entrants, hamstring (RR = 1.7; 1.5-1.9) and quadriceps muscle groups (RR = 1.5; 1.3-1.7) were more frequently affected ( P = 0.0001), the onset of EAMC during racing was less common in the first quarter (RR = 0.3; 0.2-0.4) ( P = 0.0001), and serious EAMC was more frequent (RR = 1.6; 1.4-1.9) ( P = 0.0001). CONCLUSIONS In 56- versus 21.1-km runners, a history of EAMC is 2 times more frequent and muscle groups affected, onset in a race, and severity of EAMC differed. The lifetime prevalence was lower than previously reported in other events. Risk factors associated with EAMC may differ between entrants for different race distances.
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Miller KC, McDermott BP, Yeargin SW, Fiol A, Schwellnus MP. An Evidence-Based Review of the Pathophysiology, Treatment, and Prevention of Exercise-Associated Muscle Cramps. J Athl Train 2022; 57:5-15. [PMID: 34185846 PMCID: PMC8775277 DOI: 10.4085/1062-6050-0696.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Exercise-associated muscle cramps (EAMCs) are common and frustrating for athletes and the physically active. We critically appraised the EAMC literature to provide evidence-based treatment and prevention recommendations. Although the pathophysiology of EAMCs appears controversial, recent evidence suggests that EAMCs are due to a confluence of unique intrinsic and extrinsic factors rather than a singular cause. The treatment of acute EAMCs continues to include self-applied or clinician-guided gentle static stretching until symptoms abate. Once the painful EAMCs are alleviated, the clinician can continue treatment on the sidelines by focusing on patient-specific risk factors that may have contributed to the onset of EAMCs. For EAMC prevention, clinicians should obtain a thorough medical history and then identify any unique risk factors. Individualizing EAMC prevention strategies will likely be more effective than generalized advice (eg, drink more fluids).
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Affiliation(s)
- Kevin C. Miller
- School of Rehabilitation and Medical Sciences, Central Michigan University, Mount Pleasant
| | - Brendon P. McDermott
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville
| | - Susan W. Yeargin
- Exercise Science Department, University of South Carolina, Columbia
| | - Aidan Fiol
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville
| | - Martin P. Schwellnus
- Institute for Sport, Exercise Medicine and Lifestyle Research, University of Pretoria, South Africa
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Hawke F, McKay MJ, Baldwin JN, Chiu S, Sadler S, Oldmeadow C, Chuter V, Burns J. Correlates of night-time and exercise-associated lower limb cramps in healthy adults. Muscle Nerve 2021; 64:301-308. [PMID: 34185321 DOI: 10.1002/mus.27359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 06/15/2021] [Accepted: 06/19/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION/AIMS We explored correlates of night-time and exercise-associated lower limb cramps in participants of the 1000 Norms Project. METHODS A volunteer community sample of healthy people aged ≥18 y underwent assessment of motor function and physical performance, and were questioned about muscle cramps in the previous 3 mo. RESULTS Of 491 (221 female) participants age 18-101 y (mean: 59.12; SD: 18.03), about 1 in 3 experienced night-time lower limb cramps, and about 1 in 4 experienced exercise-associated lower limb cramps. For night-cramps, a one unit increase in Beighton score (greater whole-body flexibility) was associated with a 31% reduced odds of cramps (odds ratio [OR] = 0.69, 95% confidence interval [CI]:0.45, 0.99) and passing all three lesser-toe strength tests was associated with 50% reduced odds of cramps (OR = 0.50, 95% CI: 0.32, 0.78). For exercise-associated cramps, participants in the fourth (lowest arch) quartile of Foot Posture Index were 2.1 times (95% CI: 1.11, 3.95) more likely to experience cramps than participants in the first (highest arch) quartile. Odds of experiencing both types of cramps versus no cramps were lower with passing all three lesser-toe strength tests (OR = 0.40, 95% CI: 0.19, 0.85) and better performance in the six-minute walk test (OR = 0.997, 95% CI: 0.996, 0.998). DISCUSSION People who experienced both exercise-associated and night-time cramps were less functional. The association between night-time cramps with less whole-body flexibility and reduced lesser-toe flexor strength should be explored to determine causation. Planovalgus (low-arched) foot type was independently associated with exercise-associated cramps. The effectiveness of foot orthoses for secondary prevention of exercise-associated cramps in people with low-arched feet should be explored.
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Affiliation(s)
- Fiona Hawke
- School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Marnee J McKay
- Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer N Baldwin
- School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales, Australia.,Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Simon Chiu
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Sean Sadler
- School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Vivienne Chuter
- School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Joshua Burns
- Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,The University of Sydney & The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Abstract
PURPOSE OF REVIEW Better define the proposed etiologies, risk factors, and treatment plans for exercise-associated muscle cramps in the tennis player. RECENT FINDINGS While no one theory has been able to fully explain the etiology behind exercise-associated muscle cramping, further classification of acute localized cramping and systemic or recurrent cramping may help guide future treatment and prevention strategies. Neuromuscular fatigue more than electrolyte deficit or dehydration is believed to play a large role in development of exercise-associated muscle cramps. Despite inconclusive evidence at this time, electrolyte deficit may play more of a role in the development of recurrent or systemic muscle cramping in the tennis athlete. More research is needed to better define its conclusive etiology.
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Affiliation(s)
| | | | - Neeru Jayanthi
- Emory Sports Medicine Center, Johns Creek, GA USA
- Department of Orthopedics and Rehabilitation, Department of Family Medicine, Emory School of Medicine, Atlanta, GA USA
- Emory Johns Creek Hospital, 6325 Hospital Pkwy, Suite 302, Johns Creek, GA 30097 USA
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Martínez-Navarro I, Montoya-Vieco A, Collado E, Hernando B, Panizo N, Hernando C. Muscle Cramping in the Marathon: Dehydration and Electrolyte Depletion vs. Muscle Damage. J Strength Cond Res 2020; 36:1629-1635. [PMID: 32796418 DOI: 10.1519/jsc.0000000000003713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Martínez-Navarro, I, Montoya-Vieco, A, Collado, E, Hernando, B, Panizo, N, and Hernando, C. Muscle Cramping in the marathon: Dehydration and electrolyte depletion vs. muscle damage. J Strength Cond Res XX(X): 000-000, 2020-Our aim was to compare dehydration variables, serum electrolytes, and muscle damage serum markers between runners who suffered exercise-associated muscle cramps (EAMC) and runners who did not suffer EAMC in a road marathon. We were also interested in analyzing race pacing and training background. Nighty-eight marathoners took part in the study. Subjects were subjected to a cardiopulmonary exercise test. Before and after the race, blood and urine samples were collected and body mass (BM) was measured. Immediately after the race EAMC were diagnosed. Eighty-eight runners finished the marathon, and 20 of them developed EAMC (24%) during or immediately after the race. Body mass change, post-race urine specific gravity, and serum sodium and potassium concentrations were not different between crampers and noncrampers. Conversely, runners who suffered EAMC exhibited significantly greater post-race creatine kinase (464.17 ± 220.47 vs. 383.04 ± 253.41 UI/L, p = 0.034) and lactate dehydrogenase (LDH) (362.27 ± 72.10 vs. 307.87 ± 52.42 UI/L, p = 0.002). Twenty-four hours post-race also values of both biomarkers were higher among crampers (CK: 2,438.59 ± 2,625.24 vs. 1,166.66 ± 910.71 UI/L, p = 0.014; LDH: 277.05 ± 89.74 vs. 227.07 ± 37.15 UI/L, p = 0.021). The difference in the percentage of runners who included strength conditioning in their race training approached statistical significance (EAMC: 25%, non-EAMC: 47.6%; p = 0.074). Eventually, relative speed between crampers and noncrampers only differed from the 25th km onward (p < 0.05). Therefore, runners who suffered EAMC did not exhibit a greater degree of dehydration and electrolyte depletion after the marathon but displayed significantly higher concentrations of muscle damage biomarkers.
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Affiliation(s)
- Ignacio Martínez-Navarro
- Physical Education and Sports Department, University of Valencia, Valencia, Spain.,Sports Health Unit, Vithas Hospital October 9, Valencia, Spain
| | - Antonio Montoya-Vieco
- Physical Education and Sports Department, University of Valencia, Valencia, Spain.,Sports Health Unit, Vithas Hospital October 9, Valencia, Spain
| | - Eladio Collado
- Faculty of Health Sciences, Jaume I University, Castellon, Spain
| | | | - Nayara Panizo
- Department of Medicine, Jaume I University, Castellon, Spain.,Universitary Clinical Hospital of Valencia
| | - Carlos Hernando
- Sport Service, Jaume I University, Castellon, Spain.,Department of Education and Specific Didactics, Jaume I University, Castellon, Spain
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Novel Factors Associated With Analgesic and Anti-inflammatory Medication Use in Distance Runners: Pre-race Screening Among 76 654 Race Entrants-SAFER Study VI. Clin J Sport Med 2018; 28:427-434. [PMID: 29944515 DOI: 10.1097/jsm.0000000000000619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Analgesic/anti-inflammatory medication (AAIM) increases the risk of medical complications during endurance races. We determined how many runners use AAIM before or during races, AAIM types, and factors associated with AAIM use. DESIGN Cross-sectional study. SETTING 21.1-km and 56-km races. PARTICIPANTS Seventy-six thousand six hundred fifty-four race entrants. METHODS Participants completed pre-race medical screening questions on AAIM use, running injury or exercise-associated muscle cramping (EAMC) history, and general medical history. MAIN OUTCOME MEASURES Analgesic/anti-inflammatory medication use, types of AAIM (% runners; 95% confidence interval), and factors associated with AAIM use (sex, age, race distance, history of running injury or EAMC, and history of chronic diseases) [prevalence ratio (PR)]. RESULTS Overall, 12.2% (12.0-12.5) runners used AAIM 1 week before and/or during races (56 km = 18.6%; 18.0-19.1, 21.1 km = 8.3%; 8.1-8.6) (P < 0.0001). During races, nonsteroidal anti-inflammatory drugs (NSAIDs) (5.3%; 5.1-5.5) and paracetamol (2.6%; 2.4-2.7) were used mostly. Independent factors (adjusted PR for sex, age, and race distance; P < 0.0001) associated with AAIM use were running injury (2.7; 2.6-2.9), EAMC (2.0; 1.9-2.1), cardiovascular disease (CVD) symptoms (2.1; 1.8-2.4), known CVD (1.7; 1.5-1.9), CVD risk factors (1.6; 1.5-1.6), allergies (1.6; 1.5-1.7), cancer (1.3; 1.1-1.5), and respiratory (1.7; 1.6-1.8), gastrointestinal (2.0; 1.9-2.2), nervous system (1.9; 1.7-2.1), kidney/bladder (1.8; 1.6-2.0), endocrine (1.5; 1.4-1.7), and hematological/immune (1.5; 1.2-1.8) diseases. CONCLUSIONS 12.2% runners use AAIM before and/or during races, mostly NSAIDs. Factors (independent of sex, age, and race distance) associated with AAIM use were history of injuries, EAMC, and numerous chronic diseases. We suggest a pre-race screening and educational program to reduce AAIM use in endurance athletes to promote safer races.
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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; 28:289-298. [PMID: 28901963 DOI: 10.1097/jsm.0000000000000456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Exercise-associated muscle cramping (EAMC) is a significant medical complication in distance runners, yet factors associated with EAMC are poorly documented. OBJECTIVE To document risk factors associated with EAMC in runners. DESIGN Cross-sectional study. SETTING Two ocean races (21.1 km, and 56 km). PARTICIPANTS Fifteen thousand seven hundred seventy-eight race entrants. METHODS Participants completed a prerace medical history screening tool including: training, cardiovascular disease (CVD), risk factors for, and symptoms of CVD, history of diseases affecting major organ systems, cancer, allergies, medication use, and running injury. Runners were grouped as having a history of EAMC (hEAMC group = 2997) and a control group (Control = 12 781). RESULTS Independent factors associated with a higher prevalence ratio (PR) of hEAMC were any risk factor for CVD (PR = 1.16; P = 0.0002), symptoms of CVD (PR = 2.38; P < 0.0001), respiratory disease (PR = 1.33; P < 0.0001), gastrointestinal disease (PR = 1.86; P < 0.0001), nervous system or psychiatric disease (PR = 1.51; P < 0.0001), kidney or bladder disease, (PR = 1.60; P < 0.0001), haematological or immune disease (PR = 1.54; P = 0.0048), cancer (PR = 1.34; P = 0.0031), allergies (PR = 1.37; P < 0.0001), regular medication use (PR = 1.80; P < 0.0001), statin use (PR = 1.26; P = 0.0127), medication use during racing (PR = 1.88; P < 0.0001), running injury (PR = 1.66; P < 0.0001), muscle injury (PR = 1.82; P < 0.0001), tendon injury (PR = 1.62; P < 0.0001), and runners in the experienced category (PR = 1.22; P < 0.0001). CONCLUSION Novel risk factors associated with EAMC in distance runners were underlying chronic disease, medication use, a history of running injuries, and experienced runners. These factors must be identified as possible associations, and therefore be considered in the diagnosis and treatment of EAMC.
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Abstract
Introduction: Exercise-associated muscle cramp (EAMC) is one of the most common conditions that occur during or immediately after the exercise, with questionable etiology. Aim: Aim of article was to present doubts about the cause of EAMC, whether it is primarily a neurological condition or it is water and salt imbalance. Results: Strongest evidence supports the neuromuscular aetiology with the focus on the muscle fatigue. Muscle overload and fatigue affects the balance between the excitatory drive from muscle spindles and the inhibitory drive from the Golgi tendon organs (GTO). This results in a localized muscle cramp. Since the dehydration and electrolyte depletion are systemic abnormalities, it is not clear how these changes would result in local symptoms such as cramping of the working muscle groups. Conclusion: “Triad” of causes might be behind the etiology of EAMC, although the “altered neuromuscular control” theory with the “dehydration” theory is the most cogent descriptive model that explains the origin of EAMC. Treatment and prevention strategies for EAMC include: electrical cramp induction, kinesio taping and compression garments, massage therapy, electrolyte supplementation and hydration, corrective exercise, stretching, quinine, pickle juice, hyperventilation strategies.
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Affiliation(s)
- Dzenan Jahic
- Orthopaedics and Traumatology Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina.,Faculty of Sport and Physical Education, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Edin Begic
- Department of Pharmacology, Faculty of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
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Miller KC, Harsen JD, Long BC. Prophylactic stretching does not reduce cramp susceptibility. Muscle Nerve 2017; 57:473-477. [PMID: 28796278 DOI: 10.1002/mus.25762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 07/22/2017] [Accepted: 08/05/2017] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Some clinicians advocate stretching to prevent muscle cramps. It is unknown whether static or proprioceptive neuromuscular facilitation (PNF) stretching increases cramp threshold frequency (TFc ), a quantitative measure of cramp susceptibility. METHODS Fifteen individuals completed this randomized, counterbalanced, cross-over study. We measured passive hallux range of motion (ROM) and then performed 3 minutes of either static stretching, PNF stretching (hold-relax-with agonist contraction), or no stretching. ROM was reassessed and TFc was measured. RESULTS PNF stretching increased hallux extension (pre-PNF 81 ± 11°, post-PNF 90 ± 10°; P < 0.05) but not hallux flexion (pre-PNF 40 ± 7°, post-PNF 40 ± 7°; P > 0.05). Static stretching increased hallux extension (pre-static 80 ± 11°, post-static 88 ± 9°; P < 0.05) but not hallux flexion (pre-static 38 ± 9°, post-static 39 ± 8°; P > 0.05). No ROM changes occurred with no stretching (P > 0.05). TFc was unaffected by stretching (no stretching 18 ± 7 Hz, PNF 16 ± 4 Hz, static 16 ± 5 Hz; P = 0.37). DISCUSSION Static and PNF stretching increased hallux extension, but neither increased TFc . Acute stretching may not prevent muscle cramping. Muscle Nerve 57: 473-477, 2018.
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Affiliation(s)
- Kevin C Miller
- School of Rehabilitation and Medical Sciences, Central Michigan University, 1208 Health Professions Building, Mount Pleasant, Michigan, 48859, USA
| | - James D Harsen
- School of Rehabilitation and Medical Sciences, Central Michigan University, 1208 Health Professions Building, Mount Pleasant, Michigan, 48859, USA
| | - Blaine C Long
- School of Rehabilitation and Medical Sciences, Central Michigan University, 1208 Health Professions Building, Mount Pleasant, Michigan, 48859, USA
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Miller KC, Long BC, Edwards JE. Muscle cramp susceptibility increases following a volitionally induced muscle cramp. Muscle Nerve 2017; 56:E95-E99. [PMID: 28063158 DOI: 10.1002/mus.25562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Muscle cramping may increase peripheral nervous system excitability. It is unknown if, and how long, cramp susceptibility is affected by previous cramping. We tested whether volitionally induced muscle cramps (VIMCs) lowered cramp threshold frequency (TFc ) and how long TFc was affected post-VIMC. METHODS Fifteen cramp-prone participants volitionally induced a flexor hallucis brevis (FHB) cramp on 4 separate days. FHB TFc was measured before VIMC (i.e., baseline) and 5, 30, and 60 min post-VIMC. VIMC electromyography (EMG) amplitude, VIMC duration, and perceived VIMC intensity were measured to ensure consistency of VIMC between days. RESULTS VIMC EMG amplitude, duration, and perceived intensity were similar between days (P > 0.05). VIMC lowered TFc ; baseline TFc (18 ± 6 Hz) was higher than 5-min (14 ± 6 Hz), 30-min (14 ± 5 Hz), and 60-min TFc (14 ± 5 Hz; P < 0.05). DISCUSSION Acute VIMCs increase cramp susceptibility. Clinicians should apply treatments for at least 60 min postcramp to decrease the probability of cramp recurrence. Muscle Nerve 56: E95-E99, 2017.
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Affiliation(s)
- Kevin C Miller
- Central Michigan University, School of Rehabilitation and Medical Sciences, 1208 Health Professions Building, Mount Pleasant, Michigan, USA
| | - Blaine C Long
- Central Michigan University, School of Rehabilitation and Medical Sciences, 1208 Health Professions Building, Mount Pleasant, Michigan, USA
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Turris SA, Lund A, Bowles RR, Camporese M, Green T. Patient Presentations and Medical Logistics at Full and Half Ironman Distance Triathlons. Curr Sports Med Rep 2017; 16:137-143. [DOI: 10.1249/jsr.0000000000000367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Nelson NL, Churilla JR. A narrative review of exercise-associated muscle cramps: Factors that contribute to neuromuscular fatigue and management implications. Muscle Nerve 2016; 54:177-85. [DOI: 10.1002/mus.25176] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Nicole L. Nelson
- Clinical and Applied Movement Sciences, Brooks College of Health, University of North Florida; 1 UNF Drive Jacksonville Florida 32224-2673 USA
| | - James R. Churilla
- Clinical and Applied Movement Sciences, Brooks College of Health, University of North Florida; 1 UNF Drive Jacksonville Florida 32224-2673 USA
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Casa DJ, DeMartini JK, Bergeron MF, Csillan D, Eichner ER, Lopez RM, Ferrara MS, Miller KC, O'Connor F, Sawka MN, Yeargin SW. National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses. J Athl Train 2016; 50:986-1000. [PMID: 26381473 DOI: 10.4085/1062-6050-50.9.07] [Citation(s) in RCA: 331] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To present best-practice recommendations for the prevention, recognition, and treatment of exertional heat illnesses (EHIs) and to describe the relevant physiology of thermoregulation. BACKGROUND Certified athletic trainers recognize and treat athletes with EHIs, often in high-risk environments. Although the proper recognition and successful treatment strategies are well documented, EHIs continue to plague athletes, and exertional heat stroke remains one of the leading causes of sudden death during sport. The recommendations presented in this document provide athletic trainers and allied health providers with an integrated scientific and clinically applicable approach to the prevention, recognition, treatment of, and return-to-activity guidelines for EHIs. These recommendations are given so that proper recognition and treatment can be accomplished in order to maximize the safety and performance of athletes. RECOMMENDATIONS Athletic trainers and other allied health care professionals should use these recommendations to establish onsite emergency action plans for their venues and athletes. The primary goal of athlete safety is addressed through the appropriate prevention strategies, proper recognition tactics, and effective treatment plans for EHIs. Athletic trainers and other allied health care professionals must be properly educated and prepared to respond in an expedient manner to alleviate symptoms and minimize the morbidity and mortality associated with these illnesses.
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Affiliation(s)
| | | | | | | | - E Randy Eichner
- University of Oklahoma Health Sciences Center, Oklahoma City
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Casa DJ, DeMartini JK, Bergeron MF, Csillan D, Eichner ER, Lopez RM, Ferrara MS, Miller KC, O'Connor F, Sawka MN, Yeargin SW. National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses. J Athl Train 2015. [PMID: 26381473 DOI: 10.4085/1062-6050-50-9-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To present best-practice recommendations for the prevention, recognition, and treatment of exertional heat illnesses (EHIs) and to describe the relevant physiology of thermoregulation. BACKGROUND Certified athletic trainers recognize and treat athletes with EHIs, often in high-risk environments. Although the proper recognition and successful treatment strategies are well documented, EHIs continue to plague athletes, and exertional heat stroke remains one of the leading causes of sudden death during sport. The recommendations presented in this document provide athletic trainers and allied health providers with an integrated scientific and clinically applicable approach to the prevention, recognition, treatment of, and return-to-activity guidelines for EHIs. These recommendations are given so that proper recognition and treatment can be accomplished in order to maximize the safety and performance of athletes. RECOMMENDATIONS Athletic trainers and other allied health care professionals should use these recommendations to establish onsite emergency action plans for their venues and athletes. The primary goal of athlete safety is addressed through the appropriate prevention strategies, proper recognition tactics, and effective treatment plans for EHIs. Athletic trainers and other allied health care professionals must be properly educated and prepared to respond in an expedient manner to alleviate symptoms and minimize the morbidity and mortality associated with these illnesses.
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Affiliation(s)
| | | | | | | | - E Randy Eichner
- University of Oklahoma Health Sciences Center, Oklahoma City
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Miller KC. Electrolyte and plasma responses after pickle juice, mustard, and deionized water ingestion in dehydrated humans. J Athl Train 2015; 49:360-7. [PMID: 24955622 DOI: 10.4085/1062-6050-49.2.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Some athletes ingest pickle juice (PJ) or mustard to treat exercise-associated muscle cramps (EAMCs). Clinicians warn against this because they are concerned it will exacerbate exercise-induced hypertonicity or cause hyperkalemia. Few researchers have examined plasma responses after PJ or mustard ingestion in dehydrated, exercised individuals. OBJECTIVE To determine if ingesting PJ, mustard, or deionized water (DIW) while hypohydrated affects plasma sodium (Na(+)) concentration ([Na(+)]p), plasma potassium (K(+)) concentration ([K(+)]p), plasma osmolality (OSMp), or percentage changes in plasma volume or Na(+) content. DESIGN Crossover study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 9 physically active, nonacclimated individuals (age = 25 ± 2 years, height = 175.5 ± 9.0 cm, mass = 78.6 ± 13.8 kg). INTERVENTION(S) Participants exercised vigorously for 2 hours (temperature = 37°C ± 1°C, relative humidity = 24% ± 4%). After a 30-minute rest, a baseline blood sample was collected, and they ingested 1 mL/kg body mass of PJ or DIW. For the mustard trial, participants ingested a mass of mustard containing a similar amount of Na(+) as for the PJ trial. Postingestion blood samples were collected at 5, 15, 30, and 60 minutes. MAIN OUTCOME MEASURE(S) The dependent variables were [Na(+)]p, [K(+)]p, OSMp, and percentage change in plasma Na(+) content and plasma volume. RESULTS Participants became 2.9% ± 0.6% hypohydrated and lost 96.8 ± 27.1 mmol (conventional unit = 96.8 ± 27.1 mEq) of Na(+), 8.4 ± 2 mmol (conventional unit = 8.4 ± 2 mEq) of K(+), and 2.03 ± 0.44 L of fluid due to exercise-induced sweating. They ingested approximately 79 mL of PJ or DIW or 135.24 ± 22.8 g of mustard. Despite ingesting approximately 1.5 g of Na(+) in the PJ and mustard trials, no changes occurred within 60 minutes postingestion for [Na(+)]p, [K(+)]p, OSMp, or percentage changes in plasma volume or Na(+) content (P > .05). CONCLUSIONS Ingesting a small bolus of PJ or large mass of mustard after dehydration did not exacerbate exercise-induced hypertonicity or cause hyperkalemia. Consuming small volumes of PJ or mustard did not fully replenish electrolytes and fluid losses. Additional research on plasma responses pre-ingestion and postingestion to these treatments in individuals experiencing acute EAMCs is needed.
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Affiliation(s)
- Kevin C Miller
- School of Rehabilitation and Medical Science, Central Michigan University, Mount Pleasant
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van Breda K, Collins M, Stein DJ, Rauch L. The COMT val(158)met polymorphism in ultra-endurance athletes. Physiol Behav 2015; 151:279-83. [PMID: 26253211 DOI: 10.1016/j.physbeh.2015.07.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/27/2015] [Accepted: 07/30/2015] [Indexed: 12/24/2022]
Abstract
UNLABELLED Chronic levels of physical activity have been associated with increased dopamine (D2) receptors resulting in increased sensitivity to dopamine release. The catechol-O-methyltransferase enzyme, responsible for dopamine degradation, contains a functional polymorphism, which plays an important role in dopamine regulation within the prefrontal cortex. This polymorphism has previously been shown to affect human cognition and personality. However, the effect of this polymorphism has not been shown in ultra-endurance athletes. AIM To examine the association of the COMT val(158)met variant with personality traits (harm avoidance, novelty seeking, reward dependence, resilience) and psychological distress (K10) of habitual physically active Ironman athletes compared to recreationally active controls. METHODS 51 ultra-endurance Ironman athletes and 56 recreationally active controls were genotyped for the catechol-O-methyltransferase val(158)met polymorphism. Of the 107 participants, 55 ultra-endurance athletes and 32 recreationally active controls completed online personality questionnaires (harm avoidance, novelty seeking, reward dependence, resilience) and a psychological distress questionnaire (K10). RESULTS The personality trait, harm avoidance (p=0.001) and psychological distress (p=0.003) were significantly lower in Ironman athlete participants. Novelty seeking was significantly higher (p=0.02) in Ironman athlete participants with a significantly higher (p=0.04) score in Met(158) homozygous allele carriers. CONCLUSION Chronic levels of physical activity, as seen in ultra-endurance athletes, show increased novelty seeking scores in Met(158) homozygous allele carriers.
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Affiliation(s)
- Keelyn van Breda
- Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, South Africa.
| | - Malcolm Collins
- Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, University of Cape Town, South Africa
| | - Laurie Rauch
- Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, South Africa
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Hoffman MD, Stuempfle KJ. Muscle Cramping During a 161-km Ultramarathon: Comparison of Characteristics of Those With and Without Cramping. SPORTS MEDICINE-OPEN 2015; 1:24. [PMID: 26284165 PMCID: PMC4532703 DOI: 10.1186/s40798-015-0019-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/08/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND This work sought to identify characteristics differing between those with and without muscle cramping during a 161-km ultramarathon. METHODS In this observational study, race participants underwent body weight measurements before, during, and after the race; completed a post-race questionnaire about muscle cramping and "near" cramping (controllable, not reaching full-blown cramping), drinking strategies, and use of sodium supplementation during four race segments; and underwent a post-race blood draw for determination of serum sodium and blood creatine kinase (CK) concentrations. RESULTS The post-race questionnaire was completed by 280 (74.5 %) of the 376 starters. A post-race blood sample was provided by 181 (61.1 %) of the 296 finishers, and 157 (53.0 %) of finishers completed the post-race survey and also provided a post-race blood sample. Among those who completed the survey, the prevalence of cramping and near cramping was 14.3 and 26.8 %, respectively, with greatest involvement being in the calf (54 %), quadriceps (44 %), and hamstring (33 %) muscles. Those with cramping or near cramping were more likely to have a prior history of muscle cramping during an ultramarathon (p < 0.0001) and had higher blood CK concentrations (p = 0.001) than those without cramping. Weight change during the race, use of sodium supplements, intake rate of sodium in supplements, and post-race serum sodium concentration did not differ between those with and without cramping. CONCLUSIONS Muscle cramping is most common in those with a prior history of cramping and greater muscle damage during an ultramarathon, suggesting an association with relative muscular demand. Impaired fluid and sodium balance did not appear to be an etiology of muscle cramping during an ultramarathon.
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Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, 10535 Hospital Way, Sacramento, CA USA
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Schwabe K, Schwellnus MP, Derman W, Swanevelder S, Jordaan E. Less experience and running pace are potential risk factors for medical complications during a 56 km road running race: a prospective study in 26 354 race starters—SAFER study II. Br J Sports Med 2014; 48:905-11. [DOI: 10.1136/bjsports-2014-093471] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Miller KC, Burne JA. Golgi tendon organ reflex inhibition following manually applied acute static stretching. J Sports Sci 2014; 32:1491-7. [PMID: 24716521 DOI: 10.1080/02640414.2014.899708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Golgi tendon organ disinhibition may contribute to exercise-associated muscle cramp (henceforth referred to as "cramps") genesis. Static stretching pre-exercise is prescribed to prevent cramps based on the assumption golgi tendon organ inhibition remains elevated post-stretching. We determined whether stretching increased gastrocnemius golgi tendon organ inhibition and, if so, the time course of this inhibition post-stretching. Twelve participants' dominant limb medial gastrocnemius inhibition was measured before, and at 1, 5, 10, 15 and 30 min after investigators applied three, 1-min duration stretches. Participants maintained voluntary contraction intensities of 5% of their maximum while the Achilles tendon was stimulated transcutaneously 50 times. Five-hundred millisecond epochs of raw electromyographic activity were band-pass filtered, full-wave rectified and averaged. An algorithm identified inhibitory points and calculated the area, maximum and duration of inhibition. Area of inhibition (F1,14 = 1.5, P = 0.25), maximum inhibition (F1,14 = 0.2, P = 0.72) and duration of inhibition (F1,14 = 1.5, P = 0.24) were unaffected by static stretching over the 30-min post-stretching period. If pre-stretching does prevent fatigue-induced cramping, the mechanism is unlikely to involve the autoinhibition produced by the golgi tendon organ reflex. Further empirical research is needed to validate the proposed link between static stretching and cramping and then to investigate alternative mechanisms.
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Affiliation(s)
- Kevin C Miller
- a School of Rehabilitation and Medical Sciences , Central Michigan University , Mt Pleasant , MI , USA
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Abstract
OBJECTIVE The authors hypothesized that variants within genes, such as COL5A1, COL3A1, COL6A1, and COL12A1, that code for connective tissue components of the musculoskeletal system may modulate susceptibility to exercise-associated muscle cramping (EAMC). Specifically, the aim of this study was to investigate if the COL5A1 rs12722 (C/T), COL3A1 rs1800255 (G/A), COL6A1 rs35796750 (T/C), and COL12A1 rs970547 (A/G) polymorphisms are associated with a history of EAMC. DESIGN Retrospective genetic case-control association study. SETTING Participants were recruited at triathlon and ultra-marathon events and were asked to report physical activity, medical history, and cramping history. PARTICIPANTS One hundred sixteen participants with self-reported history of EAMC within the past 12 months before an ultra-endurance event were included as cases in this study (EAMC group). One hundred fifty participants with no self-reported history of previous (lifelong) EAMC were included as controls (NON group). INTERVENTIONS All participants were genotyped for the selected variants. MAIN OUTCOME MEASURES Differences in genotype frequency distributions, for COL5A1 rs12722, COL3A1 rs1800255, COL6A1 rs35796750, and COL12A1 rs970547, among the cases and controls. RESULTS The COL5A1 CC genotype was significantly overrepresented (P = 0.031) among the NON group (21.8%) when compared with the EAMC group (11.1%). No significant genotype differences were found for the COL3A1 (P = 0.828), COL6A1 (P = 0.300), or COL12A1 (P = 0.120) genotypes between the EAMC and NON groups. CONCLUSIONS This study identified, for the first time, the COL5A1 gene as a potential marker for a history of EAMC.
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Abstract
CONTEXT Time allowing, euhydration can be achieved in the vast majority of individuals by drinking and eating normal beverages and meals. Important to the competitive athlete is prevention and treatment of dehydration and exercise-associated muscle cramps, as they are linked to a decline in athletic performance. Intravenous (IV) prehydration and rehydration has been proposed as an ergogenic aid to achieve euhydration more effectively and efficiently. EVIDENCE ACQUISITION PubMed database was searched in November 2011 for all English-language articles related to IV utilization in sport using the keywords intravenous, fluid requirements, rehydration, hydration, athlete, sport, exercise, volume expansion, and performance. RESULTS Limited evidence exists for prehydration with IV fluids. Although anecdotal evidence does exist, at this time there are no high-level studies confirming that IV prehydration prevents dehydration or the onset of exercise-associated muscle cramps. Currently, there are no published studies describing IV fluid use during the course of an event, at intermission, or after the event as an ergogenic aid. CONCLUSION The use of IV fluid may be beneficial for a subset of fluid-sensitive athletes; this should be reserved for high-level athletes with strong histories of symptoms in well-monitored settings. Volume expanders may also be beneficial for some athletes. IV fluids and plasma binders are not allowed in World Anti-Doping Agency-governed competitions. Routine IV therapy cannot be recommended as best practice for the majority of athletes.
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