What happens when muscle cramps become debilitating?

August 4, 2014

The cramping began in Maggie Bartonís toes during a tennis playoff match six summers ago. It swept up her body like a torrent, overtaking her calves and her entire body, leaving in its wake excruciating pain and an inability to move her arms.

"My arms were around a bench, and it took three people to get me off of it," says Barton, 39, of Dallas. "Youíre not in control. Itís really, really painful, and itís scary. You feel like itís going to go to your heart."

Though cramping can happen in any season, itís especially prevalent during summer. Heat, humidity and an imbalance of electrolytes can bring down anyone ó even and especially elite athletes like LeBron James, who was debilitated by cramps during the NBA finals. Thatís because the elite often try to push through cramps; everyday athletes tend to stop once they feel cramps beginning.

Though James got scoffs for leaving the game, those who know about cramping also know he had no choice.

"You can pass judgment on the dramatics," says Scott Galloway, an athletic trainer at an area branch of Texas Health Ben Hogan Sports Medicine. "But what you canít pass judgment on is the level of fatigue and the actual injury."

What causes it?

Full-body cramping is the way the body lets you know, "Hey, I canít handle any more," he says. "If your brain doesnít tell you to stop, your body will. Itís one thing to get a cramp in the bed in your calf. You pull your toes back, and it stretches and goes away. But when an elite athlete starts experiencing cramping, your body is basically shutting down and youíre going into a form of exhaustion."

Physically, continuing isnít an option, says Cindy Trowbridge of the University of Texas at Arlington. During cramping, muscles tighten so much "youíre almost in rigor mortis without the death." Moving your arms and legs, like trying to unfurl someoneís hand in rigor mortis, is all but impossible, she says.

"You canít do anything to straighten them because the muscles are so powerful, and itís painful," says Trowbridge, associate professor of kinesiology and clinical education coordinator for the universityís Athletic Training Education Program. "The pain is causing more cramping."

She describes cramping as the nervous system being "on overdrive. In particular, the motor nerves that cause the muscle to contract are shortened. Itís like putting your foot on the accelerator and revving the carís engine."

Normally, the body would say, "How much contraction do I need?" and shuts off when it needs to shut off, she says.

"But this time, the muscles are contracted and are contracting so hard and so fast, it ends up in a positive feedback loop. Your body turns on more cramping.

"Youíre asking more and more of your body, but it canít shut off," Trowbridge says. "Youíre dehydrated. What that does is not only cause water loss but an electrolyte imbalance."

In other words, you can be hydrated but your electrolytes can be off. Barton says she was diligent about drinking water that first summer she succumbed to cramps. A native of Colorado, she hadnít experienced summers like those in Texas.

"I had been drinking a ton because everybody said to drink, drink, drink," says Barton.

"But nobody mentioned electrolytes. Now I overdo with electrolytes because once youíve cramped, your body tends to cramp earlier."

She also leaves the tennis court the moment she starts cramping.

Brian Hull, tennis professional at Lakes Tennis Academy in Frisco, Tex., has seen plenty of cramping, the most recent a 15-year-old player whose legs couldnít stop spasming and who needed four IVs at the hospital. Tennis matches are usually played at the most grueling time of day, plus temperatures rise 10 degrees on tennis courts.

"Once you start cramping, itís over," says Hull, who was that boyís age when he had his own cramping episode during tennis practice.

Who is prone?

Some people may have a predisposition to cramping, Trowbridge says, but thereís still no telling who will.

"What causes you to get them when someone next to you is losing the same amount of water and electrolytes, but isnít getting them?" she says. "Weíre different. We digest things differently; we sweat certain amounts."

In addition, some people are salty sweaters, whereas others donít sweat as much salt.

"When youíre a sweater," Galloway says, "your body releases sodium. You have depletion of sodium, and your muscles need sodium to work."

Other people may be deficient in calcium, so that mineral could be a trigger for them, he says. Just as vague as the cause is the solution. Some people swear by bananas, some by yellow mustard. Barton says people call her the "pickle juice girl" because she always has a bottle of the salty liquid in her bag.

"If anyone ever tells you they have the cure for cramps, theyíre lying," Trowbridge says. "Maybe for a few athletes they tested, something worked. Iím not saying it didnít."



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