Exercise-Associated Muscle Cramps: Pathophysiology and Evidence-Based Prevention Strategies - a narrative review
Abstract
Background. Exercise-associated muscle cramps (EAMC) are among the most common acute conditions affecting athletes across endurance, team, and individual sports, yet their pathophysiology remains contested. Two principal theories dominate: the historical dehydration-electrolyte depletion hypothesis and the neuromuscular control theory, with emerging evidence implicating fatigue-related spinal disinhibition, persistent inward currents, and impaired termination of contraction.Aim. To critically synthesise current evidence on the pathophysiology, risk factors, and prevention and treatment strategies for EAMC, situating this condition within exercise physiology, electrolyte and magnesium homeostasis, and heat-related illness.Materials and Methods. This narrative review draws on peer-reviewed epidemiological studies, prospective and case-control cohorts, randomised controlled trials, neurophysiological studies, genetic analyses, consensus statements, and mechanistic reviews addressing muscle cramping, electrolyte disorders, magnesium physiology, and heat illness.Results. Cohort studies consistently identify prior cramping history, longer race distance, higher relative exercise intensity, chronic disease, allergy history, and previous injury as independent predictors of EAMC, whereas dehydration and serum electrolyte concentrations show inconsistent associations. Neurophysiological studies demonstrate muscle-specific, rather than generalised, alterations in motoneuron discharge…
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