Cramps In the Elite Tennis Player In the Heat: An ... · heat and development of EAMC. 4. EAMC...
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Cramps In the Elite Tennis Player In the Heat: An Algorithm for
SuccessWesley Troyer, DO
Emory Sports Medicine Fellow@WesTroyerDO
18-year-old ranked junior tournament player cramps in the calves and hamstrings in his 5 match of a national tournament in July.
How do you approach the situation? Now? After the Match? For the future?
Exercise Associated Muscle Cramps (EAMC)
• Defined as painful, spasmodic, and involuntary contractions of the skeletal muscle occurring during or immediately after physical exercise or sports event 1
• Typically occur in exercising musculature but can be generalized in some athletes
• Can last for minutes to hours in length• Ranges from a mild inconvenience to debilitating
Exercise Associate Muscle Cramps (EAMC)-It’s Complicated!
Muscle Fatigue?
Electrolyte Loss?
Dehydration?
Localized vs. Systemic?
Figure 1: “Exercise Associated Muscle Cramping Risk Factors and Proposed Mechanism” from manuscript submitted for publication, Troyer et al “Exercise Associated Muscle Cramps in the Tennis Player”
Muscle Fatigue Drives Cramping
Figures from the following paper: Qiu J, Kang J. Exercise Associated Muscle Cramps -A Current Perspective. Scientific Page of Sports Medicine. 2017:3-14.
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Heat Cramps?
No single association between heat and development of EAMC4
EAMC likely to occur from a combination of factors.
Muscle cramps can occur in cool conditions1,2
Contributing Factors in Tennis
HIGH SWEAT RATES IN ATHLETES
TOURNAMENTS WITH MULTIPLE MATCHES A DAY
LONGER MATCHES ENVIRONMENT
How do we address cramping during match play?
Figure 2: “Proposed Flowchart for Treatment of Acute EAMC”from manuscript submitted for publication, Troyer et al. “Exercise
Associated Muscle Cramps in the Tennis Player”
What about when it becomes a recurrent issue?
Evaluation by Physician and Basic Labs (CMP/ Electrolytes)
Cramp Journal
Rule out other causes of cramping
If recurrent despite work-up, consider EMG/ Muscle Biopsy or reevaluation of diagnosis.
Strategies and Prevention
Carbohydrate intake of 6-10 g.kg -1 d-1 and protein intake of 1.6g·kg-1·d-1 for those training 4-6 days a week. 6
Drink at least one Liter of water or electrolyte beverage one-hour prior or maintaining proper hydration.
Train at increased levels of intensity and duration.Warm up prior to competition.
Acclimatize to current environment conditions.Wear light-colored, breathable clothing.
BeforeMatch
https://unsplash.com/photos/sI-p_NLBNr0
Strategies and Prevention
Recommend 30-60g.hr -1 of carbohydrate during match-play that lasts longer than 2 hours, as has been linked to improved performance 6
Drink 200ml (<27°C) – 400ml (>27°C) of water or sports beverage at change over to maintain hydration.7,8
Consider 0.5 tsp of NaCl to 16oz sports drink if early signs of systemic cramping. 7,9
Stretch or massage affected musculature if early signs of EAMC during breaks and in between points. 10-12
Sit in the shade or use an ice towel to cool affected musculature.
DuringMatch
https://www.dailymail.co.uk/sport/tennis/article-1284023/Andre-Agassi-Anna-Kournikova-voted-sexiest-tennis-players-time.html
Strategies and Prevention
Carbohydrate intake of 1.5 g.kg -1 after matches when glycogen synthesis is highest tofacilitate repletion 6
Start rehydrating immediately post match with goals of 125-150% of estimated losses within 4-6 hours
Cool down and stretching program post match
Change out of wet, damp clothes and get into cool environment.
AfterMatch
https://www.pinterest.com/pin/4292562127965276/?autologin=true
Take Away Points!• Stay prepared by packing appropriate clothing, maintaining suggested nutrition, and proper
hydration prior to match play, especially in conditions that can hasten muscle fatigue.
• Be able to recognize the signs and symptoms of EAMC and treat appropriately depending on the athlete’s situation.
• If an athlete develops recurrent, systemic muscle cramping that is refractory to the above interventions, consider further work up for possible other causes.
• If any concerns for hemodynamic instability, AMS, or concerns for heat stroke Change treatment plan and Treat immediately/transport.
References1. Schwellnus MP, Drew N, Collins M. Muscle cramping in athletes--risk factors, clinical assessment, and management. Clin Sports Med. 2008;27(1):183-94, ix-x.
2. Qiu J, Kang J. Exercise Associated Muscle Cramps -A Current Perspective. Scientific Page of Sports Medicine. 2017:3-14.
3. Schwellnus MP, Derman EW, Noakes TD. Aetiology of skeletal muscle ‘cramps’ during exercise: a novel hypothesis. J Sports than usual exercise intensity were the only indepen- Sci 1997; 15: 277-85
4. Maughan, R. J. (1986) Exercise-induced muscle cramp: a prospective biochemical study in marathon runners. J Sports Sci, 4, 31-4.
5. Jones B, Rock P, Smith L, et al. Medical complaints after a marathon run in cool weather. Phys Sportsmed. 1985;13:103-110.
6. Ranchordas MK, Rogersion D, Ruddock A, Killer SC, Winter EM. Nutrition for tennis: practical recommendations. J Sports Sci Med. 2013;12(2):211-24.
7. Bergeron MF. Heat cramps during tennis: a case report. Int J Sport Nutr. 1996;6(1):62-8.
8. Kovacs MS. Hydration and temperature in tennis - a practical review. J Sports Sci Med. 2006;5(1):1-9.
9. Bergeron MF. Heat cramps: fluid and electrolyte challenges during tennis in the heat. J Sci Med Sport. 2003;6(1):19-27.
10. Bertolasi L, De Grandis D, Bongiovanni LG, Zanette GP, Gasperini M. The influence of muscular lengthening on cramps. Ann. Neurol.; 1993. p. 176–80.
11. Eaton JM. Is this really a muscle cramp? Postgrad Med. 1989;86(3):227-32.
12. Helin P. Physiotherapy and electromyography in muscle cramp. Br J Sports Med. 1985;19(4):230-1.