Exercise-associated muscle cramps (EAMC) are among the most common problems encountered by a clinician looking after football players. This problem typically happens only during extreme exertion and is far more common during games than during training sessions. Some players frequently experience cramps while others do not. As a result, it seems likely that there is a genetic component to cramp (a predisposing gene has also been identified). 1 The fact that many players describe a family history of cramp also supports this hypothesis. Older players also seem to be at an increased risk of cramping. There is very little evidence to support the widely held belief that cramp is caused by either dehydration or electrolyte abnormalities. It appears to be a direct consequence of muscle fatigue. 2
Cramp typically involves muscles which cross two joints (like the calf, hamstrings or quadriceps). There is often a prodromal – “cramp prone state” – when the muscle feels vulnerable which precedes the onset of symptoms. During this time, the player may have a sense of tightness or muscle pain or be apprehensive that cramp is imminent.
No specific investigations are generally required. This is a clinical (rather than radiological or laboratory) diagnosis.
The acute, on-field management of muscle cramps involves stretching the involved muscle with contraction of the antagonist. Once the player has developed cramp, however, it is very likely that they will be substituted.
Given that acute muscle cramping can be difficult to manage, it is important to try to prevent this from happening. The key strategy involves being adequately prepared and conditioned.
Dr Mark Fulcher
Sport and Exercise Physician