Cramp

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What is it? Excruciating. That's what. Out running last week and my left calf decided to cramp. I knew I needed to stop...not much choice really...and stretch out the muscles. But why it was happening is another thing, which I'll come to later.

Back to the what. Well, it is an intensely painful sensation caused by a sudden onset of involuntary muscle contractions or severe muscle shortening. What essentially is happening is an acute muscle spasm. This forces the blood out of the muscle: this is bad, it means oxygen and nutrients aren't getting to where they should be. Lack of oxygen and the muscle contraction stimulate pain receptors and hey presto – you're bent over in agony. Cramp is most common in the calves, quadriceps (thighs) and arches of the feet.

So why do muscles cramp? Although the exact cause (or causes) are not known; there are many theories: fatigue, low sodium and/or potassium in the blood, dehydration, low carbohydrates, and overexertion. More recent research could point to there being disturbances in the central and peripheral nervous systems, connected to neural excitability, but this is still a hypothesis and hasn't yet been proved. I'll be on the look out for more on this theory.

What to do about it? In a pre-emptive sense, the main thing you can do is to ensure your body is in a healthy state. You may be physically fit, you may not be, however, if your electrolyte balance isn't optimal then as you dehydrate, the balance of sodium/potassium/carbs in your blood and thereforei n your muscles is going to be off. Generally you should avoid dramatically increasing your mileage, duration or intensity of activity, or undertaking any strenuous activity to which you're unaccustomed. Gradual increases are the way to go. I suspect that my run last week and the ensuing cramp was a combination of overexertion (I had just climbed about 150m in 0.4km after 4km of already uphill running), electrolyte imbalance and some residual tightness in the calf muscles (gastrocnemius and soleus – which merge into the achilles tendon). I'm now having regular massage on my calves to decrease the change of this reoccurring.

When cramp does strike, you need to stop the activity and stretch out the muscles, gentle massage can help too. What you're aiming to do is to relax out the muscles and increase blood flow to the area, thereby improving circulation and delivering fresh oxygen and nutrients to the muscle fibres. There is often pain or stiffness felt in the affected muscles for a few days afterwards. This is because the effects of cramp is the same as a muscle strain. Fibres can be damaged because of the lack of oxygen and the severe muscle contractions. Treatment following any occurrence of cramp should follow the RICE protocol (Rest, Ice, Compression, Elevation), just as though you had suffered a strain, because it possible you have without realising it. We don't tend to think of cramp as the cause of injury, but it can be. Added to that, I've read that incorporating plyometrics and eccentric muscle strengthening can help, as well as regular massage and elimination of trigger points (these can be the source of already taut bands of muscle).