Is there a new Treatment for Muscle Cramps?

by Mitch Hauschildt, MA, ATC, CSCS

Recently I was sent an article from the Wall Street Journal about a new treatment for muscle cramps.  As a collegiate athletic trainer who deals with athletes who cramp on a pretty consistent basis as well as a person who personally deals with some spasticity related to MS, the article caught my attention.

I have personally questioned many of the treatments for muscle cramping in the past because oftentimes I don’t feel that they have told the complete story of what is causing the cramping and what is the best means to treat or prevent them.  And, the recommendations seem to have changed a few times over the past 10-15 years.

While playing football in college, I was told that the cause of muscle cramps was pretty much exclusively related to hydration levels.  While this seemed to make sense at the time during hot and humid summer practices, it didn’t explain why some athletes would experience cramps at night, long after practice was over and their fluids had been replenished.

The night time cramps were explained by an electrolyte imbalance from sweating, needing more potassium.  So, in addition to fluids, we pushed bananas.  That seemed to help some, but still didn’t take care of the issue for a number of people.  The next explanation at emerged was a calcium imbalance and after that was a sodium deficiency.

Then we moved into the pickle juice era, where everyone suddenly believed that pickle juice was the cure all for all things related to muscle cramps.  Teams were buying huge jars of pickles as fast as stores could stock them and other people saw an opportunity and began selling just the juice or some product that resembled the juice’s chemical makeup.  Pickle juice seemed to help a lot of people, but why?  The explanation has been that the high sodium content in pickle juice is taking care of the sodium deficiency that we just spoke about.

But, if cramping is so closely related to hydration and electrolyte imbalances, why do some people experience cramping while competing indoors where dehydration isn’t a big concern?  Why do some very high level athletes experience cramping, even when in great shape?  My historical answer to those questions is that there is a muscle fatigue component to cramping.  Meaning, the more fatigued an athlete becomes, the more predisposed they become to cramping.

Treatment options for those in the midst of a cramp typically include massage and stretching.  In theory, those work to disrupt the actin-myosin cross bridge that causes the contraction.  But, as we learn more and more about the the role of the mechanoreceptors in our fascia and their neurological input to the central nervous system, one can argue that stretching and massage has far more to do with stimulating the brain than anything else.

I bring all of this up to point out there are a lot of theories and treatment options for muscle cramps, which in the world of medicine usually means that there isn’t one, optimal solution.

In the article that I mentioned at the top of the post, they discuss a product that has been developed by a pair of neuroscientists that has been proven in a few small research studies to reduce the rate of muscle cramps.  Their research suggests that the main driver for muscle cramping is the nervous system.  The drink that they are recommending has a “pungent” taste that affects specific receptors in the brain that contribute to the excitability of the nervous system.  They theorize that by impacting the TRPV1 and TRPA1 receptors, they can decrease the overall excitability of the nervous system, thus reducing muscle cramps.  One interesting thing to note with this theory is that pickle juice has some similarities to their orally administered product.  So, maybe pickle juice is affective, but for different reasons than we have been lead to believe.

This raises some other questions.  If cramps ultimately occur because of a hyper stimulated nervous system, than we should be able to affect it in other ways.  I often aggressively scrape (IASTM) the bottom of the foot and/or the Masseter to make quick improvements in flexibility by diminishing the sensitivity of the CNS.  Kinesiology taping has also been shown to have a significant affect on the nervous system by stimulating the mechanoreceptors through the skin.  We also know that static stretching or PNF stretching can reduce the excitability of the nervous system overall.

In theory then, either prior to an activity which may predispose someone to cramping or during a cramping episode, if we perform some sort of activity to reduce the excitability of the nervous system, cramping should be reduced.

Are these treatments preferable to a “pungent” tasting drink?  I don’t know, because things like static stretching has also been shown to be counter productive to performance in speed and power sports when performed prior to competition.  So maybe they aren’t that desirable.  Then again, the risk of a slightly decreased performance due to a reduction in nervous system sensitivity may be preferable to the risk of muscle cramps which usually shut down an athlete all together.

But, if cramps are neurologically driven, why do IV fluids almost always eliminate cramping immediately?  Is that because we’re rehydrating them quickly and restoring their electrolyte balance? Or, is it because we disrupt nervous system with an influx of fluid that changes the feedback loop to the brain.  I’m not sure we know.

Where does all of this leave us?

Quite honestly, I’m not sure.  The more I learn about muscle cramps, the more I believe that they are caused by a number of factors.  Because we know that the brain controls everything, I think that we would be fooling ourselves if we said that the nervous system doesn’t play a primary role in muscle cramping.  Because of that, I think that it is definitely plausible that by affecting specific receptors in the body, that we can affect such actions by the body.  I also think that it is likely that cramps can be diminished by stimulating the nervous system via the skin.  I also believe that there is at least a certain hydration and electrolyte component that triggers the nervous system response.

Is this new drink that magic bullet for cramping?  I don’t know.  I think we will know more over the next few years, but until then, I will continue to hydrate, condition, and feed my athletes well and manage their soft tissue and nervous system as well as I can.  I’m also a bigger believer in pickle juice and similar products than I have been previously based on some of this research.

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