First off, I would like to apologize for the amount of time between blogs. In addition to finishing my fellowship, moving to Portland and starting practice, my wife also gave birth to our first child, Alison Ann (of course, the most precious beautiful girl in the world). The partners at the Orthopedic and Fracture Clinic have been kind enough to give me some time to spend with our new little girl, so while she naps, I figured I could get some writing in.

Since moving to Portland, I have been fortunate enough to get involved with the local athletic scene right away. I have been helping the Aloha High School Athletic Department as one of the team physicians and competed in the City of Portland Triathlon. One common thing with both endeavors was muscle cramping. For me, I had some twinges of hamstring cramps during the run portion of the triathlon that I was able to control, but it did slow me slightly. As for the boys on the Aloha High School football team, second half cramping has been crippling issue for many of the team’s key skill position players. For triathletes, football players, and anyone working hard for prolonged periods, cramping, or not cramping, can be critical to success or failure in a race or game.

A recent review article in the Journal of the American Academy of Orthopedic Surgeons (JAAOS) examined the recent medical literature regarding the causes, and possible solutions for, muscle cramping. There are several reasons for cramping. Blood borne conditions like sickle cell anemia and disorders of electrolyte metabolism can predispose to cramping, however, the most often cited cause of cramping is muscle fatigue. This is somewhat disheartening, since most of those who suffer from cramps are endurance athletes or football players whose games last three hours and require explosive efforts. Following the recommendation that the athlete back off intensity or stop when they become fatigued to avoid cramps is contrary to the efforts of all competitive athletes.

So the question is, how do we avoid this while still competing at our highest possible level? While electrolyte balance has been implicated as an important part of avoiding cramps, the exact levels of different electrolytes such as sodium and potassium that may lead to cramping have not been elucidated. What we do know, is that dehydration is a factor, and that drinks that contain electrolytes and the right balance of calories in the form of sugars and small amounts of proteins or amino acids are absorbed faster and more completely than plain water. Above all else is that rehydration must occur before dehydration. The thought used to be that you must drink before you get thirsty, but now we know that the thirst mechanism is so powerful that the athlete will be thirsty almost before there is any recognizable fluid loss. So as far as drinking is concerned, the best way to avoid cramping is to rehydrate with drinks that contain electrolytes early in competition (like during the first half of a football game or in the early miles of a marathon), but don’t force it, because a full stomach can delay absorption.

Other things that we can do, according to the AAOS article, take place in our preparation for competition. Training sessions that simulate racing intensity are key, since exposing the body to efforts to which it is not accustomed can lead to early fatigue and increased risk of cramping. In addition to helping with recovery from intense workouts, stretching and massage have been shown to aid in avoiding cramps.

So, as we come down to the final preparation stage for the marathon, make sure and practice your hydration strategy during these last few long runs and don’t forget to stretch and even get a massage or two before the big day (don’t try the massage for the first time during the last week before the race though, as you may get sore the first time).

Good luck, and happy training.