When painful muscle cramps occur during sport: how to treat them?

Athletes often treat cramps themselves, but the effectiveness of untargeted therapy is questionable. What helps with painful attacks and what doesn't?

Treating muscle spasm individually, and avoiding triggers

Generalised recommendations for muscle cramp are often ineffective

People with acute muscle cramps rarely consult a doctor. However, if the painful contractions occur more frequently, those affected often ask their doctor what they can do or whether there is something more serious behind it, such as STIFF syndrome or type 2 diabetes-associated muscle pain.

As a rule, athletes can be reassured, as it is rare that a serious illness is behind the pain. Much more important is the question of the correct treatment in the acute situation. The generalised recommendation to drink more water or take magnesium tablets helps very few people. This is because, contrary to the previously held opinion that cramps are triggered by electrolyte imbalances, it is now assumed that an altered neuromuscular function is behind them.

Stretching, rest and hydration are good for cramps

Stretching and rest are the most effective measures during a muscle cramp. The affected person can stretch the muscle themselves or have it stretched by someone else. Cold applications or massages can also help. It is also important to allow the body to rest and take days off from training.

The recommendation to rehydrate cannot be completely dismissed. However, studies have shown that stretching is more effective than fluid intake. Whether water or electrolyte-containing sports drinks are consumed during an acute muscle cramp depends on the preferences of the person affected.

Cucumber brine as an antispasmodic for the muscles

In addition to tried and tested methods such as stretching and rest, studies have shown that transient receptor potential agonists (TRP agonists) such as vinegar, cinnamon, ginger and capsaicin reduce cramp activity - if they are dosed strong enough. For example, data from a blinded study showed that drinking about 100ml of pickled cucumber brine relieved cramps 45% faster than no intervention and 37% faster than drinking water alone. The most likely reason for this is that the vinegar triggers an oropharyngeal reflex that interrupts the development of cramps. The extent to which capsaicin-containing drinks help is still controversial.

What doesn't help: bananas and quinine

Contrary to the common belief that bananas help to relieve muscle cramps, there is no clinical evidence for this. In one study, the potassium contained in the fruit failed to increase the serum potassium levels of test subjects who had eaten two bananas.

The administration of quinine also did not lead to a significant improvement in symptoms. However, the drug is associated with side effects, which leads to an unfavourable risk-benefit ratio.

First identify risk factors for muscle cramps

To treat chronic sports-related muscle cramps, doctors should identify risk factors and triggers. These include, for example, taking new medication, a changed training routine, overloading certain muscle groups or too little sleep. According to the medical history, these triggers should then be avoided or eliminated.

Prevention: Does electrolyte replacement protect against muscle cramps?

The question of prevention often arises for those affected. The effectiveness of the frequently propagated magnesium supplementation is usually overestimated. Whether and, if so, how electrolyte supplementation is helpful has not yet been conclusively clarified.

Studies have shown that targeted strength training can reduce the frequency of cramps. The training plan should be drawn up by experts. The importance of rest days should also not be underestimated.

Muscle cramp: simple remedies often help in acute cases

Acute sports-related muscle cramps can often be interrupted quickly and with simple remedies. When diagnosing and treating chronic spasms, it is important to establish an individualised approach.

  1. Miller KC, McDermott BP, Yeargin SW, Fiol A, Schwellnus MP. An Evidence-Based Review of the Pathophysiology, Treatment, and Prevention of Exercise-Associated Muscle Cramps. J Athl Train. 2022 Jan 1;57(1):5-15. doi: 10.4085/1062-6050-0696.20. PMID: 34185846; PMCID: PMC8775277.