The Confusion with Cramps

Author: Brooke Carmen, PT, DPT: Doctor of Physical Therapy and Blog Contributor.  Loves fun informational gems.  Fitness addict and wannabe foodie. Emphasizes patient-specific treatment style and promotes goal-oriented care. Learn more about Brooke on here.

Charlie horse!  We’ve all experienced them at one point or another, but why?  What are cramps?  Why do they happen?  Do supplements or electrolytes help?  What should you do if you get a cramp?

What are cramps?

Muscle cramps are involuntary contractions of muscles and are often described as sudden, intense onsets of pain.  Although they can be extremely painful and at points debilitating, they are usually harmless and self-manageable.

Why do they happen?

The jury is still out. Here are some popular theories (click on the link to read), but none of them have been proven beyond a doubt:

  • Dehydration

  • Over-stretching a muscle

  • Over-exercising a muscle

  • Being deficient in a certain vitamin or mineral

  • Lack of blood flow to a muscle

  • Hot weather

  • Using a muscle when it’s already in its “shortest” position (i.e. neuromuscular inhibition)

  • Don’t forget about medications!

    • Medications, such as Lasix (furosemide), Microzide (hydrochlorothiazide), other diuretics, Aricept (donezil, which is used to treat Alzheimer), and Prostigmine (neostigmine, which is used for myasthenia gravis) can result in cramping as a side effect.  [1]   Talk to your doctor if you believe one of these may be causing your cramps.  Do not change medication intake without talking to your doctor.

Version 1: Bridging for glute max and hamstring activation

Version 1: Bridging for glute max and hamstring activation

Version 2: Bridging for increased hamstring activation

Version 2: Bridging for increased hamstring activation

Do supplements like Creatine or does increasing electrolyte intake help prevent cramps?

One study I came across  looked at D1A college football players that elected to take creatine participating between 1998-2000 football seasons.  The rate of injury and cramping did not correlate with creatine intake. [2]  Another study looked at long distance runners and serum electrolyte and water intake.  It found that neither were associated with exercise associated muscle cramping (EAMC). [3]  However, a study that looked at 210 Ironman triathletes found that an overall faster race past (suggesting that the participate exercises at a high intensity) and previous history of cramping within the last 10 races were two independent factors for exercise associated muscle cramping. [4]  In summary, the evidence for supplements or increased electrolytes is lacking.

Well, what do you do if you get a cramp?

Since we don’t have a strong case for the exact cause of cramps, you want to cover all of the theological bases for prevention.  That means drink plenty of water, incorporate a well balanced diet, and stretch your muscles so they can accept different tensile loads.  When you get an acute (quick onset) cramp, stretch that specific muscle.  Try self-massaging it as well which can be performed with a foam roller, tennis ball, or just your hands.  If you have long lasting cramps, sometimes a hot pack or a warm shower or bath can help.

Lastly, your physical therapist can help reduce muscle cramping by figuring out the most-likely source of your cramping.  We assess muscle flexibility, strength, joint mobility, and joint range of motion to determine if you are more predisposed to cramping.  You may need an organized, specific program to reduce your cramping.  We don’t enjoy cramping either, so talk to us!


[1] "Muscle Cramps, Charley Horse, and Muscle Spasms: Causes and Treatments." WebMD. WebMD, n.d. Web. 10 Dec. 2015.

[2]"Creatine Supplementation during College Football Training Does Not Increase the incidence of Cramping or Injury. N.p., n.d. Web. 14 Dec. 2015.

[3] Schwellnus, M. P., J. Nicol, R. Laubscher, and T. D. Noakes. "Serum Electrolyte Concentrations and Hydration Status Are Not Associated with Exercise Associated Muscle Cramping (EAMC) in Distance Runners." British Journal of Sports Medicine, n.d. Web. 14 Dec. 2015.

[4] Schwellnus, Martin P., Nichola Drew, and Malcolm Collins. "Increased Running Speed and Previous Cramps Rather than Dehydration or Serum Sodium Changes Predict Exercise-associated Muscle Cramping: A Prospective Cohort Study in 210 Ironman Triathletes." British Journal of Sports Medicine, n.d. Web. 14 Dec. 2015.