http://www.teamsky.com/article/0,27290,20192_7441709,00.html
Expert guide: How to stop cramp
Top tips from the team
Last updated: 16th March 2012
Many cyclists will be familiar with the crippling pain of cramp, especially at the end of a particularly tough day's riding where the distance or temperature takes you out of your normal comfort zone. However, as Team Sky nutritionist Nigel Mitchell and physiotherapist Bob Grainger explain, you can stop cramp if you are well prepared in terms of conditioning and nutrition.
"Cramps are an interesting phenomenon," says Mitchell. "People get cramps in lots of different sports, even in darts sometimes because they've been standing in a particular position for a long time. What people have to think about if they suffer from cramps is what are the contributing factors. In my experience, most cramps can be put down to an issue with either conditioning or biomechanics."
Mitchell says that most people who suffer from cramp when exercising do so during the early part of a season when their body has not been fully conditioned. "The cramps then come as a result of the competition demands. Good nutrition will help - and it may actually help prevent some of them - but the main cause can be that the body is just not conditioned.
"If cyclists or athletes in any sport think about when they've tended to have cramps, it could well be that they've had more during the early season, and then as they've got fitter and more used to racing the cramps have become less of an issue. Part of that is down to the fact that the body can adapt to the way that it's dealing with electrolytes and fluid."
Some athletes, though, may have a problem with cramping due to underlying biomechanical issues. "This is often the case with people who suffer chronically from cramps. The nutrition side of things may help them by getting their electrolyte intake and their hydration right, but it's often not the cause. Your hydration has got to be quite poor for you to end up getting cramps because you're not adequately hydrated," says Mitchell.
The physiology of cramp
Team Sky physio Grainger confirms this. "With regard to the scientific literature at the moment, the causes of cramp are still not fully understood," he says. "There seem to be some different types of cramp. There's a fatigue-associated cramp, whereas people who are suffering slightly from heat exhaustion seem to get a slightly different kind of cramp," says Grainger
"The mechanics of cramp are that the muscle has effectively become hyper-excitable. The only way your muscles can tense is via electrical input from your brain. It's a centrally driven process with your brain telling your muscles to work. The muscles have little sensors within them called muscle spindles. Their job is to sense the rate and length change of muscles. So if when you're exercising you move too fast and the muscles end up stretching too quickly, these will send messages back to the spinal cord and back to the brain for the brain to be able to regulate how we're moving.
"We also have some little sensors within the tendons, which are called the golgi tendon organs, and their job is to monitor the change of the length of the tendon. So if muscles contract too quickly, these will send messages to the spinal cord and to the brain to get things to calm down - it's a protective function. What seems to happen, and this is certainly the case after prolonged exercise, is that some of these systems misfire a little bit and there's less of the inhibitory control from these two systems, which means that the muscle gets hyper-excited - the membranes around the muscles get hyper-excited - which causes the involuntary mass contraction of the muscle because there's no inhibitory control coming from these protective systems."
Beating cramp
Having outlined what causes cramping, Mitchell and Grainger go on to explain how to deal with it. One key factor, says Mitchell, is ensuring that you maintain a good electrolyte balance and that you're adequately hydrated. "A simple way for those who are prone to cramping to do this is to use products that contain electrolytes. Team Sky's riders use a product called Gatorlyte, which provides the electrolytes needed to guarantee optimum function of your muscles, including sodium, potassium and magnesium," Mitchell explains. "The riders can take it without massively increasing their carbohydrate intake.
"We also get considerable benefit from CNP's products. Their protein drinks after exercise are a very good fluid replacer and their gels also contain the electrolytes required during exercise."
Mitchell adds that sweat testing may be a useful exercise for some riders as it will show the concentration of electrolytes that are lost when sweating. But he stresses that good conditioning is crucial, especially when heat is likely to be a factor. "This is particularly the case for athletes in this country who become conditioned to the moderate temperatures we have," he says. "If you take the London marathon as a example. It takes place in April and people train for it during coldest part of the year. Every now and then we get a freak hot day for the marathon itself and runners end up dropping out left, right and centre because their bodies are not conditioned for the heat. But the body can be conditioned to cope with hot temperatures - you can heat acclimatise."
Team Sky's performance at the recent Vuelta a España, where conditions were blisteringly hot, underlines the benefits of heat acclimatisation. Chris Froome and Bradley Wiggins finished second and third overall respectively, while only one of the team's riders dropped out of the race, and that was due to a crash-related injuries rather than heat-induced fatigue.
"Doing that kind of heat acclimatisation worked extremely well for our riders at the Vuelta," Mitchell confirms. "We made sure that they were able to train in hot temperatures so that their bodies could adapt to it."
Grainger also affirms that conditioning is a vital aspect of dealing with cramps and can have a much greater and long-lasting impact than better-known remedies for cramp reduction. "Because we don't fully understand the causes of cramping, some of the treatments can be questioned. There are certainly some old wives' tales out there, such as increased sodium intake - there's no real theoretical basis behind that and there's certainly no evidence to show that it's effective. Quinine is another one. A lot of people say it works for them but there's not a lot of quality research that suggests that it does have an impact," says Grainger.
Treating cramp
"If you develop an acute cramp there are a couple of things you can do. Stretching the muscle is very useful as that stimulates the golgi tendon organs into giving some inhibitory feedback into the system and consequently help to switch that muscle off again. It can seem a bit brutal to be trying to stretch a muscle out at the time when it's massively tight and tensed up, but that can be of immediate benefit," Grainger explains.
"Also, it can help if you can get the muscle on the opposite side of the joint to work. So if, for example, your hamstring muscles have gone into cramp if you can do some work to tense your quadriceps muscles then it can help because muscles work in agonistic and antagonistic pairs. In other words, when one is working it is sending through messages to the other one to reduce its level of activity. So if you can get the quadriceps working when the hamstrings are in cramp, you will get some inhibitory messages going to the hamstring muscles.
"It can also be useful to stimulate the skin over the area where the cramp is - if you're seeing a physiotherapist they could put some electricity through it - but if you can rub the skin over the cramp or use a cold spray, that can calm down some of the cramping effects. It's felt that if you can excite the skin then the some of the receptors in the skin can send inhibitory messages to the muscle to get them to calm down."
The strength factor
In Grainger's experience, cramping can also be reduced by strength conditioning. "Anecdotally - and there's not a lot of evidence backing this up - but certainly from a clinical experience when we get people in who have had regular problems with calf cramps or hamstring cramps, when we put them through some strength testing, muscle flexibility testing and muscle strength endurance testing we often find that they are not as strong as we'd like them to be. Going through a strengthening programme can often reduce the number and intensity of the cramps, or delay the onset of them.
"There certainly seems to be a bit of a fitness issue relating to cramp - not necessarily cardiovascular fitness, but muscular fitness in specific areas of the body and these deficiencies can be worked on. Certainly it would pay for someone who is getting regular cramps to go and visit a sports physiotherapist who is going to have some experience in testing strength and strength endurance around that area."
Grainger points towards top tennis player Andy Murray as an athlete who has benefited considerably from strength conditioning. "He used to get quite dramatic cramps on the tennis court, but since he's been working very hard on his conditioning it doesn't seem to affect him any more. It used to be the case with football matches going into extra time that there would be players dropping with cramp all over the place, but you don't see that so much nowadays. There's certainly a lot more of an emphasis on players being physically fitter and working on specific areas after being assessed by a physiotherapist."
Grainger points out that there is one other aspect particular to cycling that can cause cramping. "Bike set-up can also be an issue because if it is not set up properly for you that's going to lead to some areas of your body undergoing more stress and strain and some muscles perhaps having to work harder than they would have to if your bike set-up was correct. So, it is well worth get your set-up checked," Grainger concludes.
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