Exercise associated muscle cramping is muscle cramping that occurs in working muscles either during or up to six hours after exercise.  Although the verdict is still out of what exactly causes a muscle to suddenly cramp it is widely though that muscle cramps are usually caused by fatigue of the muscle, water loss, and electrolyte imbalances, exercising in extreme temperatures, or by inadequate stretching, conditioning, and/or warm-up. Cramps generally occur without warning and are involuntary spasming of the skeletal muscles that can range from mild to severe intensity. 

Signs and Symptoms: 

• Sudden, sharp, and severe pain, usually when the athlete is in action, but can also occur during a rest interval or even several hours after prolonged, strenuous activity.
• Hard "knotting" (involuntary contraction) of a muscle.
• Loss of function.
• The most common site is the calf

On-Site Management:

Passive stretching of the muscle for 20 -30 seconds should bring symptomatic relief to the athlete.  Gentle massage can also be effective at relaxing the cramping muscle.

Referral:

Whenever a cramping muscle does not respond to stretching, massage, and/or fluid replacement, assume that there may be tissue damage to the muscle. Medical referral to a physiotherapist or sport medicine professional may be required to get a proper diagnosis. Referral to a registered dietitian should also be considered.

Rehabilitation:

Gentle Stretching. Gently stretch involved muscles gradually but avoid increasing pain.

Hydration. An adequate intake of fluids may prevent, or help to alleviate the cramping. Cramps can be one of the first signs of heat illness.

Gentle Massage. Light massage around the periphery (outside), not directly on the cramping muscle, will often help (prior to massaging the area). Take care to ensure that there is no specific history of direct contact or over-stretching (which would indicate a more serious injury).

Return to Activity:

 When pain subsides and the athlete is able to stretch the muscle without pain, then the athlete may be ready to exercise. Although it is not usually a major injury, err on the side of caution, as returning to play too early can lead to further injury or damage to the fatigued muscle.

Prevention

• Sport- specific strength and conditioning program
• Proper warm-up and cool-down
• Proper hydration and electrolyte balance

Brukner, P. and Khan, K. Brukner and Khan's Clinical Sports Medicine Brukner, P. and Khan, K. (2007) Brukner and Khan's Clinical Sports Medicine. 4th ed. North Ryde: McGraw-Hill.

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