Muscle Cramping in Athletes—Risk Factors, Clinical Assessment, and Management

      Exercise associated muscle cramping (EAMC) is defined as a painful, spasmodic, and involuntary contraction of skeletal muscle that occurs during or immediately after exercise. There is a high lifetime prevalence of EAMC in athletes, specifically in endurance athletes. The most important risk factors for EAMC in athletes are a previous history of EAMC, and performing exercise at a higher relative exercise intensity or duration, when compared with normal training and participating in hot and humid environmental conditions. The diagnosis of EAMC is made clinically, and the most effective immediate management of EAMC is rest and passive stretching. The key to the prevention of EAMC is to reduce the risk of developing premature muscle fatigue.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Clinics in Sports Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hiller W.D.
        • O'Toole M.L.
        • Fortess E.E.
        • et al.
        Medical and physiological considerations in triathlons.
        Am J Sports Med. 1987; 15: 164-167
        • Holmich P.
        • Darre E.
        • Jahnsen F.
        • et al.
        The elite marathon runner: problems during and after competition.
        Br J Sports Med. 1988; 22: 19-21
        • Laird R.H.
        Medical care at ultraendurance triathlons.
        Med Sci Sports Exerc. 1989; 21: S222-S225
        • Robertson J.W.
        Medical problems in mass participation runs: recommendations.
        Sports Med. 1988; 6: 261-270
        • Drew N.
        Exercise Associated Muscle Cramps (EAMC) in Triathletes. MPhil (Sports Medicine) dissertation.
        University of Cape Town, Cape Town2006
        • Cooper E.R.
        • Ferrara M.S.
        • Broglio S.P.
        Exertional heat illness and environmental conditions during a single football season in the Southeast.
        J Athl Train. 2006; 41: 332-336
        • Stofan J.R.
        • Zachwieja J.J.
        • Horswill C.A.
        • et al.
        Sweat and sodium losses in NCAA football players: a precursor to heat cramps?.
        Int J Sport Nutr Exerc Metab. 2005; 15: 641-652
        • Ganio M.S.
        • Casa D.J.
        • Armstrong L.E.
        • et al.
        Evidence-based approach to lingering hydration questions.
        Clin Sports Med. 2007; 26: 1-16
        • Tindall R.
        A survey of Exercise Associated Muscle Cramps (EAMC) in rugby players. BSc (Med) (Hons) dissertation.
        University of Cape Town, Cape Town2001
        • Bergeron M.F.
        Heat cramps: fluid and electrolyte challenges during tennis in the heat.
        J Sci Med Sport. 2003; 6: 19-27
        • Bergeron M.F.
        Heat cramps during tennis: a case report.
        Int J Sport Nutr. 1996; 6: 62-68
        • Grundling C.
        Die voorkoms van spierkrampe in fietsryers. MPrax Med dissertation.
        University of the Free State, 1994
        • Parisi L.
        • Pierelli F.
        • Amabile G.
        • et al.
        Muscular cramps: proposals for a new classification.
        Acta Neurol Scand. 2003; 107: 176-186
        • Jung A.P.
        • Bishop P.A.
        • Al Nawwas A.
        • et al.
        Influence of hydration and electrolyte supplementation on incidence and time to onset of exercise-associated muscle cramps.
        J Athl Train. 2005; 40: 71-75
        • Sulzer N.U.
        • Schwellnus M.P.
        • Noakes T.D.
        Serum electrolytes in Ironman triathletes with exercise-associated muscle cramping.
        Med Sci Sports Exerc. 2005; 37: 1081-1085
        • Schwellnus M.P.
        • Nicol J.
        • Laubscher R.
        • et al.
        Serum electrolyte concentrations and hydration status are not associated with exercise associated muscle cramping (EAMC) in distance runners.
        Br J Sports Med. 2004; 38: 488-492
        • Schwellnus M.P.
        • Derman E.W.
        • Noakes T.D.
        Aetiology of skeletal muscle 'cramps' during exercise: a novel hypothesis.
        J Sports Sci. 1997; 15: 277-285
        • Greenhalgh T.
        How to read a paper. The basics of evidence based medicine.
        BMJ Publishing Group, London1997 (p. 45)
        • Schwellnus M.P.
        Muscle cramping in the marathon. Etiology and risk factors.
        Sports Med. 2007; 37: 364-367
        • Talbot H.T.
        Heat cramps.
        Medicine. 1935; 14: 323-376
        • Edsall D.L.
        New disorder from heat: a disorder due to exposure to intense heat.
        JAMA. 1908; 11: 1969-1971
        • Oswald R.J.W.
        Saline drink in industrial fatigue.
        Lancet. 1925; : 1369-1379
        • Maughan R.J.
        Exercise-induced muscle cramp: a prospective biochemical study in marathon runners.
        J Sports Sci. 1986; 4: 31-34
        • Nelson L.D.
        • Hutton R.S.
        Dynamic and static stretch response in muscle spindle receptors in fatigued muscle.
        Med Sci Sports Exerc. 1985; 17: 445-450
        • Hutton R.S.
        • Nelson L.D.
        Stretch sensitivity of golgi tendon organs in fatigued gastrocnemius muscle.
        Med Sci Sports Exerc. 1986; 18: 69-74
        • Manjra S.I.
        Muscle cramps in athletes, BSc (Med) (Hons) Sports Medicine dissertation.
        University of Cape Town, Cape Town1991
        • Manjra S.I.
        • Schwellnus M.P.
        • Noakes T.D.
        Risk factors for exercise associated muscle cramping (EAMC) in marathon runners.
        Med Sci Sports Exerc. 1996; 28: S167
        • Sawka M.N.
        • Burke L.M.
        • Eichner E.R.
        • et al.
        Exercise and fluid replacement. ACSM position stand.
        Med Sci Sports Exerc. 2007; 39: 377-390
        • Armstrong L.E.
        • Casa D.J.
        • Millard-Stafford M.
        • et al.
        Exertional heat illness during training and competition. ACSM position stand.
        Med Sci Sports Exerc. 2007; 39: 556-572
        • Obremskey W.T.
        • Pappas N.
        • Attallah-Wasif E.
        • et al.
        Level of evidence in orthopaedic journals.
        J Bone Joint Surg Am. 2005; 87: 2632-2638
        • Schwellnus M.P.
        Skeletal muscle cramps during exercise.
        Phys Sportsmed. 1999; 27: 109-115
        • Bertolasi L.
        • De Grandis D.
        • Bongiovanni L.G.
        • et al.
        The influence of muscular lengthening on cramps.
        Ann Neurol. 1993; 33: 176-180
        • Eaton J.M.
        Is this really a muscle cramp?.
        Postgrad Med. 1989; 86: 227-232
        • Helin P.
        Physiotherapy and electromyography in muscle cramp.
        Br J Sports Med. 1985; 19: 230-231
        • Norris F.H.
        • Gasteiger E.L.
        • Chatfield P.O.
        An electromyographic study of induced and spontaneous muscle cramps.
        EEG Clin Neurophysiol. 1957; 9: 139-147
        • Sontag S.J.
        • Wanner J.N.
        The cause of leg cramps and knee pains: an hypothesis and effective treatment.
        Med Hypotheses. 1988; 25: 35-41
        • Nicol J.
        Exercise-associated muscle cramps in distance runners: the role of serum electrolytes both during and following an ultra-marathon and IEMG activity in the recovery phase post-cramp. MPhil (Sports Medicine) dissertation.
        University of Cape Town, Cape Town1996
        • Kantorowski P.G.
        • Hiller W.D.
        • Garrett W.E.
        • et al.
        Cramping studies in 2600 endurance athletes.
        Med Sci Sports Exerc. 1990; 22: S104
        • Sulzer N.U.
        Exercise associated muscle cramping: investigating a novel hypothesis. MSc (Med) dissertation.
        University of Cape Town, Cape Town2003
        • Talbott J.H.
        • Michelsen J.
        Heat cramps: a clinical and chemical study.
        J Clin Invest. 1933; 12: 533-549