Muscle Cramps Explained by Science | Muscle Cramp Treatment Options

Buying options
Muscle cramps explained

Muscle Cramps Explained by Science | Muscle Cramp Treatment Options

In a 12-year summary report of marathon medical issues, cramping accounted for 6.1% of medical encounters, with 1.2 cases per 1.000 participants. However, exercise-associated muscle cramps are a problem in other vigorous sports too.

It has long been thought that cramps are resulting from dehydration and electrolyte imbalance. The theory behind it is that the extracellular fluid compartment becomes increasingly contracted due to sweating, leading to a loss of interstitial volume. In addition, excessive sweating can lead to concomitant sodium, calcium, magnesium, chloride, and potassium deficits. Both of these effects are reasoned to lead to mechanical deformation of nerve endings and an increase in surrounding ionic and neurotransmitters concentrations, which leads to hyperexcitable motor nerve terminals and spontaneous discharge.

However, all studies supporting this theory have not shown any cause and effect relations, none of the participants in the supporting studies had cramps despite having either serum or sweat electrolyte losses and why is it that cramps only occur within working muscles then and that stretching can relieve cramps immediately?

Schwellnus et al. (2009) popularized the idea that cramps occur due to an altered reflex control mechanism in response to neuromuscular fatigue. Specifically, muscle overload and fatigue engender an imbalance of the excitatory drive from muscle spindles and the inhibitory drive to the alpha motor neuron, which ultimately produces a localized cramp. This hypothesis has experimental support, as skeletal muscle fatigue has been shown to reduce inhibitory input to alpha motor neurons from the Golgi Tendon Apparatus and to increase excitatory input from the muscle spindles in animal models. It has also been shown that when skeletal muscle contracts in a shortened position, there is depressed signaling from the GTOs, which explains why stretching is the best-known and most effective treatment for acute EAMC.

So what are the risk factors for altered neuromuscular control?

It seems that athletes have different individual cramp threshold frequencies, which is the minimal electrical stimulation required to evoke a cramp.

Not surprisingly, having a history of exercise-associated cramps seems to be the highest risk factor for future cramps. Although research is equivocal, it seems that a family history of cramping, as well as a specific collagen gene, might be contributing factors. Furthermore, men seem to be more prone to exercise-induced cramps than women, which might be due to a higher ratio of fast-twitch fibers in muscles of locomotion. At last, Schwabe et al. Have proven that higher exercise intensity and duration lead to a higher risk of cramping, and Shang et al. Found that cramp-prone athletes were more likely to have a history of tendon or ligament injury when compared to non-cramping athletes.

So how can we treat and prevent cramps?

Due to the limitations of the electrolyte and hydration theory, salt tablets and magnesium supplementation  – although commonly used – lack evidence. The use of quinine has been shown to reduce the incidence of nocturnal and idiopathic cramps but is no longer allowed in the United States as it can lead to a decreased blood platelet level.

Nelson et al. (2016) report several promising strategies for exercise-associated muscle cramps, although high-quality trials yet have to prove their efficiency:

  • Re-education of agonistic muscles like the gluteus maximus in cramp-prone hamstrings (Wagnet et al. 2010)
  • Kinesio Taping and Compression Garments are proposed to create convolutions in the skin, which engenders an increase in local blood flow and reduced pressure on mechanoreceptors (Marban et al. 2011)
  • Massage Therapy has been shown to alter neural excitability (Behm et al. 2013)
  • Hyperventilation prevents respiratory acidosis as a contributing factor to muscle cramping (Murphy et al. 2011)
  • Pickle juice of around 1ml/kg body weight which contains high concentrations of salt along with acetic acid, is thought to trigger a reflex that increases inhibitory neurotransmitter activity in cramping muscles (Miller et al. 2010)

At last, it appears that stretching is the most effective treatment in relieving acute fatigue-induced muscular cramping, as it is believed to increase tension in the Golgi tendon organ, resulting in an increased afferent reflex inhibition to the alpha motor neuron.

Feel free to experiment with several of those options…and let us know what helped you!



Physiotutors Free Assessment E-book


Nelson NL, Churilla JR. A narrative review of exercise‐associated muscle cramps: Factors that contribute to neuromuscular fatigue and management implications. Muscle & nerve. 2016 Aug;54(2):177-85.

Schwabe K, Schwellnus MP, Derman W, Swanevelder S, Jordaan E. Less experience and running pace are potential risk factors for medical complications during a 56 km road running race: a prospective study in 26 354 race starters—SAFER study II. British journal of sports medicine. 2014 Jun 1;48(11):905-11.

Schwellnus MP. Cause of exercise associated muscle cramps (EAMC)—altered neuromuscular control, dehydration or electrolyte depletion?. British journal of sports medicine. 2009 Jun 1;43(6):401-8.

Wagner T, Behnia N, Ancheta WK, Shen R, Farrokhi S, Powers CM. Strengthening and neuromuscular reeducation of the gluteus maximus in a triathlete with exercise-associated cramping of the hamstrings. journal of orthopaedic & sports physical therapy. 2010 Feb;40(2):112-9.

Murphy PM, Murphy CA. Hyperventilation as a simple cure for severe exercise-associated muscle cramping. Pain Medicine. 2011 Jun 1;12(6):987-.

Miller KC, Mack GW, Knight KL, Hopkins JT, Draper DO, Fields PJ, Hunter I. Reflex inhibition of electrically induced muscle cramps in hypohydrated humans. Med Sci Sports Exerc. 2010 May 1;42(5):953-61.

Behm DG, Peach A, Maddigan M, Aboodarda SJ, DiSanto MC, Button DC, Maffiuletti NA. Massage and stretching reduce spinal reflex excitability without affecting twitch contractile properties. Journal of Electromyography and Kinesiology. 2013 Oct 1;23(5):1215-21.



  • 600+ Pages e-Book
  • Interactive Content (Direct Video Demonstration, PubMed articles)
  • Statistical Values for all Special Tests from the latest research
  • Clinical Value Recommendation
  • Detailed descriptions & searchable
  • Currently on Version 4.0 – Free lifetime updates
  • And much more!


Assessment app banner
Assessment E-book

What customers have to say about the Assessment E-Book

  • Kangmin Lee Avatar
    Kangmin Lee

    The Assessment E-Book This is amazing book for health professions & students

    Janine Doe Avatar
    Janine Doe

    The Assessment E-Book The book is fantastic. A great acquisition for all professionals because it presents all information in a concise, clear and grouped way.

    As I said earlier I would like to be able to access the material on all my devices.

  • Vince1992 Avatar

    The Assessment E-Book This book helped me in my studying for my exam and in assessing my first patients. Awesome! Also for beginners!

    Simon Pagitz Avatar
    Simon Pagitz

    The Assessment E-Book It’s an amazing Compilation! Congrats to all the work you have put in there. You’ll propably find all the test’s you’ve been looking for with propper explaination and source to doublecheck for you self. definetly a must have for every student, but it will also help an experienced practioner. Im looking forward to the lifelong updates on the topics.
    Great work, guys

  • Angel10 Avatar

    The Assessment E-Book (Spanish Version) Excelente Libro electrónico, me gusta que esta basado en la evidencia clínica y me apoya mucho para mi practica clínica. Es el mejor libro que he visto de evaluación, y me gusta mucho que esta en constante actualización, estaría bien meter más evaluaciones funcionales, que ya comienzan a subir en los videos con la nueva integrante mujer al equipo. Gracias kai y Andreas.

    혁 이 Avatar
    혁 이

    The Assessment E-Book I can’t believe this extremely inconvenience interface of this book. I’m used to reading my physio books with kindle, ipad just swiping the page back and forth, but this book , you need to tap the arrow on the left corner of the book to turn the page..even space bar and enter key don’t work to turn the’s feel like read a book in the computer in 1990s..

  • Jordi Burrut Avatar
    Jordi Burrut

    The Assessment E-Book A must-have for all physiotherapists, osteopaths and manual therapists. The authors conducted an extensive research on assessment tests in manual therapy. I find it very easy to read. The more I read the more I learn. Thank you!

    Roel Rademaker Avatar
    Roel Rademaker

    The Assessment E-Book Very helpful during my study and making clinical decisions. You have made the test descriptions perfect for every region! Compliments! Loving the extra information (screening/guidelines) that comes with the cervical spine and the lumbar spine. Looking forward to see those as well for the other regions.

  • Manel Avatar

    The Assessment E-Book (Spanish Version) Un libro genial!!! Pero le doy 4 estrellas en vez de 5 ya que no me gusta el poder abrirlo solo en dos dispositivos. Tengo 2 ordenadores (uno en el trabajo), un móvil y una tablet, pudiendo abrirlo solo en dos de ellos. Por lo demás, un libro muy recomendable.

    Josh Avatar

    The Assessment E-Book This book is great! It is very structured and detailed. It works extremely well on my Macbook and iPad.

  • Julia Hauser

    The Assessment E-Book These are probably the best 80€ that I have ever invested in a book. Absolutly greatful for your work. It has been such a great effort, that you have put into this book and together with your videos, it really helped me to pass some exams and to later decide which assessment to use for my patients. I can only recommend this book to every single physiotherapist or physio student!!!
    thumps up, guys

    Polo_soa Avatar

    The Assessment E-Book The best way to spend 80euros. Totally worth it. The amount of work you put behind this must have been absolutely huge. Every physical or physiotherapist should own it.
    Congrats guys you’ve done an incredible job.
    I’ve learnd a lot of new things and my approach to therapy in general have totally changed.
    In one word: amazing. Keep going guys ! Best wishes from france.

  • VCocho Avatar

    The Assessment E-Book Congrats ! It’s an amazing work ! A great book you have to work with: on a computer & on my iPad, at home and at work ! Links with articles and videos are fabulous !
    Thank you very much & long life to Physiotutors !

    dominicledinger Avatar

    The Assessment E-Book A must-have for every pt in this field! Excellent content that is absolutely worth the price. As you can use the ebook on two different devices, you can have it on your (work) computer and your phone.

  • Simon Busk Avatar
    Simon Busk

    The Assessment E-Book Got me through my assessment exams with a breeze would not have been as easy and enjoyable without the assessment handbook. It provides relevant data, and insights into statistical values and the lay of the land on the research side of things. A great book and a must for any physiotherapist, student, or practitioner...

    Marios Pan Avatar
    Marios Pan

    The Assessment E-Book Very good book to easily find relevant tests and their clinical value. I would recommend it for everyone in the Musculoskeletal or Sports Medicine field.

  • Facundo Avatar

    The Assessment E-Book -


In this FREE video series by 
Vestibular Rehab Specialist