A Cramp…A Spasm…Are They Really the Same Thing?
A muscle spasm is an involuntary contraction of a muscle; a muscle cramp is just one example of a muscle spasm, one that is sudden, grabbing, and painful.When associated with exercise, a muscle cramp can be a result of fatigue and energy depletion as well as the combination of the loss of fluids, chemicals, and salts—especially sodium, potassium, magnesium, and calcium.
Muscle spasms come in different forms. They can be painless as in the uncoordinated "twitching" spasms of muscle fasciculations, where only some fibers within a muscle repeatedly contract and relax over a minute or so (for example, after exercising for the first time following a long layoff); or they can be longer-lasting, often painful tetanic* contractions that look like one constant, uncontrollable spasm to the observer - even though electrically it may not be - which locks a joint into one position and prevents movement.
So muscle cramps are really just one type of muscle spasm, although we tend to use the terms interchangeably in casual conversation.
*Tetany is a term that can also be used to describe the sustained contractions in the other types of spasms, for example, muscle cramps.
Muscle Spasms On A Regional Level
One of the more common findings is that teams not accustomed to playing at an increased intensity in the heat tend to field players who develop muscle spasms or Exercise Associated Muscle Cramps (EAMC). One example is a national team that makes it to the highest regional tournament level for the first time.The teams and players may not realize the need to alter things like hydration and nutrition for preparation and recovery. Fatigue on the body's nerves and muscles may have an effect too, indicating a need to increase training intensity gradually in the weeks preceding a tournament or a need to pay more attention to recovery between matches.
Drinking For Play
Whether a player drinks water or sports drinks depends on how a player responds to the heat and how long he or she is training.Players who lose a lot of electrolytes (those essential salts and minerals important for regulating the movement of fluid in the body and crucial to many of the body's functions) in their sweat, however, should consider sports drinks to replace the electrolytes that they've lost. Since muscles require electrolytes as well as oxygen, water, and glucose, it's important to address these elements before, during, and after play (please note: the FIFA anti-doping regulations prohibit artificially enhancing oxygen uptake, transport, and delivery).*
* FIFA Anti-Doping Regulations: http://www.fifa.com/mm/document/footballdevelopment/medical/01/17/17/09/anti-doping_inhalt_10_en.pdf
Feed your muscles
To prepare your body for exercise, it is important to eat a variety of foods: fresh fruits and vegetables for the necessary vitamins and minerals, carbohydrates (i.e. pasta, rice) to help maintain energy levels throughout play, fiber to help slow digestion and maximize nutrient absorption (in meals several hours before play), and proteins for healthy muscles and a healthy metabolism.
Try to keep in mind: approximately 50%-60% of energy during 1 to 4 hours of continuous exercise (at 70% of maximal oxygen capacity) is derived from carbohydrates.  It is also commonly recommended that athletes undertaking strenuous daily training or competitions eat a moderate-sized meal about 3 hours before exercise for optimal restoration of liver and muscle glycogen*. [2, 3]
*Glycogen is a key source of energy storage in the body and is broken down into glucose, the primary energy source in the body, as needed and as long as stores are readily available. Fat tissue is the main source of long-term energy storage in the body.
If players or teams have breaks of less than 8 hours (of rest time) between training and matches, taking in carbohydrates (especially those with a high glycemic index*) and proteins should start as soon as possible after the first session.When recovery time available is longer (say 24 hours), players can spread out nutrient intake over time.However, some carbohydrate intake within the first 2 hours after play is beneficial as the speed at which the body converts glucose into glycogen is faster during this timeframe.ª While high glycemic carbohydrates are a necessary part of initial recovery meals to replenish energy stores quickly, some experts believe that combining high and low glycemic foods with low-fat proteins may promote the potential for a better recovery. ͯ* The Glycemic Index is a measure of how quickly carbohydrates are broken down into glucose and released into your bloodstream. High glycemic index carbohydrates break down faster than those with a low glycemic index.
ª Some experts recommend eating a meal or using a recovery drink within 30-45 minutes after a match or training to maximize this recovery potential.
ͯ Keep foods low in fat right after a match as fats slow digestion and the speed at which carbohydrates break down into glucose and replace glycogen stores. After play, these molecules are depleted and need to be restored in the body for proper recovery to take place.
Proteins are important to help with muscle recovery after a match—in other words, to assist with muscle growth, repair, and adaptation to exercise. Proteins also provide the building blocks for many of the body's hormones and enzymes that regulate metabolism and recovery potential. If recovery is not sufficient, muscle spasms or other injuries are more likely to result.
And Don't Forget To Stretch…
When it comes to muscle spasms, stretching can:
● increase blood flow and the availability of oxygen and other elements to the muscles
● improve the resting tightness of muscles that are otherwise more likely to spasm
● remove irritants from the muscles that might encourage them to spasm
So Why Did "I" Get A Muscle Cramp?
Exercise Associated Muscle Cramps tend to show up during or after strenuous exercise. They also show up more often in players with certain predispositions
◊ those players with a history of muscle cramps ◊ those exercising at a higher intensity level or duration than normal ◊ those not used to playing in hot, humid weather
◊ those players with a history of muscle cramps
◊ those exercising at a higher intensity level or duration than normal
◊ those not used to playing in hot, humid weather
Still other players may be at risk for other reasons:
► as a side-effect of anti-contraceptive use
► as a side effect of medications that control blood pressure and cholesterol
► from drinking alcohol the night before a match (alcohol limits water absorption by the body and increases water release, hence dehydration).
Sometimes muscle cramps are related to players who are improperly hydrated for other reasons, like dehydration after flying into a venue the day before a match or suffering from stomach or intestinal problems that may limit water drinking tolerance.
Less obvious changes in the body too may increase risks, such as:
► low potassium, calcium, and magnesium levels
► low oxygen levels (i.e. players unaccustomed to high altitudes)
► low blood glucose levels
At the same time, there are medical conditions thatplay a role in generating muscle spasms, conditions like: restless legs syndrome, nerve compression (in your back), decreased thyroid hormone production, diabetes (or other metabolic disorders), peripheral neuropathy (related to nerve damage or irritation), peripheral vascular disease (inadequate blood supply), multiple sclerosis (or other neurologic disorders), and kidney disease. Even pregnancy may have an effect. Then there is the muscular diaphragm, the muscle that is extremely important for breathing; it can experience spasms in the form of what we commonly refer to as "hiccups".
They just keep happening
If recurring muscle spasms do become an issue, players should look to the team medical staff for more information. Additional tests like getting an appropriate family medical history, taking blood samples to assess metabolic levels (like serum electrolytes, iron, blood urea nitrogen, creatinine, and thyroid function tests), special tests such as x-rays or MRIs that reveal pictures of implicated bones and nerves, nerve conduction studies to assess nerve function, sleep studies to help identify nighttime complaints, and, in difficult cases, genetic testing—may diagnose less obvious medical conditions and direct players to more appropriate treatments.
What to do if it happens on the pitch
Anyone who has suffered a muscle spasm while playing knows that the first thing you want to do, whether by choice or not, is to take the weight off of the muscle that is in spasm, which in football often means taking weight off of the entire limb. Those who have suffered a spasm while trying to sleep at night also know that gradually stretching the muscle can be very helpful too. Sometimes, however, the muscle is in such a severe spasm that it can fight the attempts to stretch it or the pain can be so severe that the idea of stretching it is painful in and of itself. That's why trainers and doctors may first use quick icing or cold spray to decrease the pain and/or massage to relax the muscle and increase circulation before stretching, while stretching, or even after stretching.
The goal is "to convince" the muscle to relax and, ideally, to try to improve the conditions that may have led to the spasm. On the pitch, this usually means rehydration (sports drinks may best help replace some of the lost electrolytes during a match). After the match, prevention of further episodes can be encouraged by getting proper rest and by replacing nutrients (through the foods you eat and fluids you drink). In the days following the spasm, focusing on the affected muscles in your training may help too, starting with stretching, strengthening, and balance exercises, and progressing to plyometrics and endurance training, to improve muscle responses and conditioning.
1. Coyle E, Jeukendrup A, Wagenmakers A, Saris W. Fatty acid oxidation is directly regulated by carbohydrate metabolism during exercise. Am J Physiol. 1997; 273: E268-75.
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