Putting the squeeze on cramping
By Al Lyman
This report filed November 21, 2001
Question: Three weeks to the day before my first Ironman I crashed on my bike during an Olympic distance triathlon. The results were a first-degree separation of the left shoulder. I don't know if there is any relationship between my shoulder injury and the severe cramping I experienced in my calves during my Ironman race, but I am curious.
My question is, what damage can severe cramping do to the muscles in my legs? They continue to feel unnecessarily tight, and I am wondering if I have done any damage to the tissues that requires further steps than massage and rest. Any suggestions?
Unfortunately, skeletal muscle cramping during races is one of the most common and serious problems encountered by triathletes, especially those competing in their first Ironman-distance race. There is nothing more frustrating than having your best race plans and goals laid to rest because of a debilitating cramp. Whether you have to stop in the middle of an Ironman swim or feel the searing pain of a cramp during the bike or on the run, having to deal with cramps during your most important race of the season will leave even the most optimistic triathlete frustrated.
There are many possible causes for cramping, and until you know what the cause was, it is hard to say what you could or should have done differently to avoid the problem. What we do know is that despite the scientific community having identified many risk factors and formulated theories as to why cramping occurs, there just isn't one explanation that applies to every situation and person who experiences cramping.
That being said, let's briefly examine the most commonly accepted causes for why cramping can occur during extended bouts of exercise. They are, in no particular order:
1) Inadequate electrolyte concentrations and dehydration: Hawaii Ironman veterans may know that hyponatremia, or low blood sodium, is the most common reason that many competitors at that race end up in the medical tent.
2) Low muscle glycogen levels: Without adequate fuel, your muscles can't contract normally.
3) Extreme environmental conditions: Extremely hot and cold conditions make muscles more prone to cramping.
4) High levels of muscle fatigue: Fatigue causes a lack of control of nervous system activity, which greatly increases the risk of cramps. Tension, due to a high state of anxiety or a lack of flexibility, can also be a factor.
However, I suspect that while all of the above factors (working together or in isolation) can and often do lead to abnormal cellular activity and thus an increased risk of cramping, it is my opinion that there is the possibility that tension in your lower legs combined with premature muscle fatigue were the primary causes of your cramping, especially since the cramps began during the swim.
Bouts of cramping in the lower legs during a long open water swim are common, especially among athletes with less experience or those who may lack the conditioning and/or skill to swim for a long distance and remain relaxed. Because of your shoulder injury, a number of possible scenarios could have developed that would have contributed to a higher risk of cramping. For instance, your injury may have prevented you from adequately preparing yourself to be able to swim 2.4 miles with your ankles in a plantar flexed position (toes pointed). It's also possible that a post-injury weakness in your shoulder muscles forced you to kick harder than normal to stabilize your body during the chaos of the swim. Lastly, if the water was colder than you were accustomed to, that would have contributed to greater tension and could have easily brought on a cramping episode.
Since we have delved into the issue of fatigue/tension and their relation to cramping, let's look a bit closer at how these factors can create a scenario where the risk of cramping is high. In the 1990s, some great research was done on the origins of cramping during exercise. The researchers discovered that electromyographic (EMG) data obtained from runners whose muscles were cramping revealed a significant "baseline activity," particularly between spasms of cramps. In layman terms, this means that the muscles were getting constant signals from the nervous system to contract. A reduction in this "baseline activity" (through a series of passive stretching exercises) correlated perfectly with the disappearance of cramps.
Interestingly, this lack of control with the communication of the muscle/nervous system resulted in an up-regulation of muscle spindles and a down-regulation of Golgi-tendon-organs (GTOs). These two important muscle structures work within the muscles to keep them from getting either too tight or too loose. The end result of the researcher's findings was that extreme muscle fatigue, more than any other factor, clearly was the central reason for this lack of control, resulting in the cramping.
To bring this back to my earlier postulation that your cramps were caused by this extreme tension and premature fatigue, realize that when a swimmer is kicking hard or is unusually tense (as in an open water swim while fighting for position) or has to work to point the toes because of limited flexibility, fatigue in the muscle group rises. This fatigue and tension can theoretically lead to down regulation (i.e. tiredness) of the GTOs, resulting in more contraction, and thus cramping. At the same time, up regulation of muscle spindles creates an even higher likelihood that cramping will occur.
Additionally, tension or tightness can be a factor in cramping in the calf because of a lack of adequate flexibility. For example, if a swimmer has a high level of flexibility, less muscle force (contraction) is necessary to plantar flex the ankle, thus there is less tension, which equals less chance of cramping. Note: you should never try to point the toes when swimming and/or kicking, as this only increases the tension and makes effective kicking harder. Instead, with increased flexibility a swimmer can just let his or her ankles flop around, resulting in little tension in the Achilles tendon (especially compared with the potential tension if the ankle is dorsi-flexed, i.e. toes pulled back toward the shin) and an even lower risk of cramping.
With regard to your question about possible residual damage from the cramps, yes it is very possible that you suffered some damage (perhaps some localized rhabdomyolysis, i.e. muscle destruction) from the cramping, but it shouldn't be severe or long term. The repeated contractions and tightness associated with the cramps could damage muscle membranes, but these should heal in 4-6 weeks or so as long as the area is not stressed further (did you allow adequate recovery time including stretching, massage and very easy aerobic training prior to returning to your normal training routine?).
The tightness and cramping can become sort of a vicious cycle. That is, it is possible that you experienced the cramps in that area because the muscles were already somewhat tight. After the cramping episodes and the exertion associated with simply finishing the race, there is muscle trauma in that area and so the muscles remain stiff, which can induce further cramping, and so on.
To ensure adequate recovery and a return to normal range of motion, I would advise that you first see a medical specialist to rule out any possible medical cause for the cramps and then begin a comprehensive program (including massage and stretching) that is designed to enhance functional strength and flexibility for the lower leg area. Good luck!
Al Lyman is a USAT certified coach and an Expert Level coach working for the National Triathlon Academy. He can be reached at the Triathlon Academy.