I went to see a Neurologist, Cardiologist, MD Endovascular and Vascular Surgery, Sports Medicine Physician and Endocrinologist and I did the following tests....


How many more docs do you need?

When I started running from scratch my quads were hell. Blood supply, flow in and out of a muscle is king for proper function. So if you were to compromise blood flow, then you have issues - just like oil flow to the crank of an engine.

After a few years of training here for me 1. Daily salt intake over recommended ( more than 1500mg) is a bad thing. A nasty vaso-constrictor. It should be the NaCL lie imo. I had evidence of high sodium issues/damage with my circulatory system 10-15 years ago. And I don't have high BP.
2. Mineral balance so up the potassium and magnesium that does make sense. Anything to promote blood flow. Do you supplement with fish oil?
3. Muscle trauma. Traumatized muscle tissue impedes healthy blood flow. Can they do IMS to quads? I sure needed it. Not so much now. I'll ask tomorrow @ PT, going for another round on my back.

When I went gluten free I noticed an immediate improvement in vascular function. But this was actually the result of reduced daily sodium intake - I shoot for less than 1000mg a day. Simple to try, only takes a few days and you'll notice a difference.

---

Training Tweets: https://twitter.com/Jagersport_com
FM Sports: http://fluidmotionsports.com

I'm 46 years old, white male, 5"7, 152 lbs and fit year round.
Every year I'll compete in 2 long distance races (spring /autumn) and to prepare I'll will do 2 blocks of 12-16 weeks of hard sessions 10-12h per week.
My CPK on Wednesday (2 days after my cramping in Boston) was 8,768. I got my blood tested again yesterday and it was 490.

I personally think now that the CPK spike of 8,768 was the result of my cramping, and not that my cramping is a result of the high CPK.

So what then what triggered the cramping. From the test, research and input from postings on this forum, the reason for the cramping might be linked to:
For sure:
- sitting for prolonged periods
- travel before the race (flight)
- probably some dehydration


Maybe:
- some mineral deficiencies?
- something too much (glycogen) in my blood?


One last thing that remains a mystery is how can it happen so immediately, I would understand if I get the cramps a couple of miles in the race.
In Boston I just did a slow warmup jog of 1 minute. Is there something like adrenaline (created by the excitement of a race) that triggers the cramps to happen immediately and so severely?

Increasing your Vitamin E intake might also be a consideration.

You are correct in your assessment that the CPK increase was a result of the cramp (CPK leaks into the blood from damaged muscles).

What most people forget is that cramps are caused by increased neural discharge from the spinal motor neurons, and not the muscle per se. Therefore electrolytes, glycogen, etc are unlikely to be a factor (especially with your very early cramping).

Certainly muscle fatigue in prolonged exercise can contribute to an increased likelihood of cramping (which is then again still mediated by neural mechanisms), but in your case of the immediate severe cramp early on in a race/run is not related to fatigue, rather likely related to other things that increase the nerve discharge to the muscle.

General fatigue, lack of sleep, too much caffeine, the excitement/adrenaline for a race, or the sudden change to downhill running (which requires a different muscle contraction pattern and places suddenly different loads on the muscles/tendons) maybe after an inadequate warmup can change the spinal reflexes and motor neuron firing patterns to induce the cramp.

So you may be able to prevent them from happening by:
keeping your pre-race routine for the weeks/days prior to a race as much the same as your routine during training (diet, sleep, alcohol/caffeine intake), give yourself a few days to recover (sleep!) after flying in for a race, adequately warming up (warm up is useful for the nervous system as well as the muscles themselves), and using some relaxation prior to the race and starting slowly (resist the urge to hammer away when the gun goes off).

---

Two wheels good. Four wheels bad.

Thank you DrTriKat for the excellent points.

We have narrowed it down to a combination of the following:
+ fatigue (including stress)
+ setting too long (getting my already tight hips and upper part of the quads even tighter and putting the lower part of the quads on stretch)
+ downhill running (which requires a different muscle contraction pattern and places suddenly different loads on the muscles/tendons)

The cramp starts with a "tickling" feeling in my left leg Vastus Medialis, if I keep on running, cramps will start and moments later the upper part of the quad (Vastus Medialis, Rectus Femoris, Vastus Intermedius) will be cramping in both legs.
The cramping has always been just in my upper quadriceps, nowhere else.

Rob ... this is very common ... the glute cramping intially on the bike usually coincides with sighting on the swim ... lift head --> kink back --> kift kick --> tighten glutes repeatedly and I believe it shows up early in the bike until the body settles into bike position. I typically use to have that happen in early season races OR long non wetsuit races.

I still see it with athletes today and try to address if possible beforehand

Best,

---

-------------------------
Dave Latourette
http://www.TTENation.com

thanks Dave - good to know - what type of preventative measures do you put in place?

---

____________________________________

Are you ready to do an Ultraman? | How I calculate Ironman race fueling | Strength Training for Athletes |

- Open water swimming fequenty w/ sighting practice if possible (wetsuit / non wetsuit depending on races)
- Properly fitting wetsuit is KEY (mine was worse with poorly fitting suits in mid section / low back (very tight suit in lower back)
- Generally mobility AND / OR specific strengthening helps --> {Superman / Prone Back Extension ... and / or ... 1 Arm Superman (opposing leg & arm) .... if someone were already doing some sort of deadlift, that would cover it too}

---

-------------------------
Dave Latourette
http://www.TTENation.com

makes sense - now that you mention it - I haven't had the issue since changing wetsuits

---

____________________________________

Are you ready to do an Ultraman? | How I calculate Ironman race fueling | Strength Training for Athletes |

Somehow you qualified for Boston, how did you do that? Did you have Severe Muscle cramping then too?

Increased neural discharge could be triggering cramps in most situations, but what about diseases where there is something screwy going on with metabolism of glycogen due to lack of specific enzymes?
https://www.mda.org/...ypes/mcardle-disease . McArdle disease for one produces cramps that are electrically silent.

Granted these metabolic diseases appear to be genetic in origin, but I don't think it's a stretch to imagine that a normally healthy fit person could suffer from cramps at the beginning of exercise brought on by something screwy going on with glycogen metabolism. A deficiency in a particular nutrient that produces the necessary enzymes or hormonal influences brought on by stress or lack of sleep, or an oxygen deficiency in muscles at the beginning of exercise doesn't seem that far-fetched to me.

hi Jaretj,
I have been running marathons and doing IM (mostly 70.3) for 10 years now. I train hard and had some good results (BQ last 5 years, KQ in 2012), and until last October I never had any issues that stopped me from participating the week of the race. I have had some issues (tendonitis, knee pain, stress fracture, ...) that temporary stopped my training.

For IM LC I trained 4 months hard (typical weekend program was Sat: 100m ride with intervals + run 4m off the bike, Sun: 18m run including 6x1m speed), never had any issues with cramps even when pushing it to the limit.

OK, that explains my confusion.

Believe me, it is extremely unlikely that anyone on this forum has McArdle's disease, or any other glycogen storage disease. (FYI I am an MDA clinic director.....)

There may however be folks here that have good athletic ability, that MAY have a genetic problem making them more prone to cramping, and this would more likely be problems with ion channels on the muscle membrane.

---

Two wheels good. Four wheels bad.

Hi vinvin - confirmed, no sign of high CPK. Right in the normal range.

Any way to diagnose and or prevent this?

No idea, but I've definitely suffered from this same issue twice. Both times left me with a recurring smaller cramp for the next week and a half to two weeks that prevented any training.

First time was last year's Peachtree Road Race (10K). I think it was a combination of taking two days off prior to the event, having a carb heavy meal the night prior to the event, and then not having enough electrolytes the day of the race (it was very hot, so I probably drank too much water). The cramps flared on a long downhill stretch.

Second time was earlier this year in Hawaii climbing down Diamond Head. Less movement than normal with a long flight, lots of carbs on the trip (the Hawaiian diet is what, 90% white rice?), and probably again not enough electrolytes. I was totally fine going up to the peak, but very quickly 'blew up' going back down...even at an easy walking pace.

Reading about this "Monday Morning Sickness" seems to correlate VERY closely with my past issues. It's definitely provided me with some food for thought on how to prevent this leading up to future races.

Were you tapering at the time? How long was your taper period?

I was a collegiate swimmer. My freshman year, my coach did a 2 week taper with me. By the time I got to NCAAs, my legs were COMPLETELY shot. I could barely move them in the pool and swam horribly. We determined I needed about a 3 day taper after that! I know its not cramping, but maybe it could be playing a roll?

Interesting to see this thread now, I had my first incidence of this a few years ago, 2015 I think. I scoured the web looking for info and found almost nothing, except a few forum threads where other cyclists were discussing the same phenomenon. The longest-running, most informative thread seems to be this one, but even there no real concrete answers, despite some people making several visits to various specialists.

One thing I'll say is that these are not really cramps, that's just the closest thing I can think of to describe them. Anybody who's gone through this will tell you that these 'cramps' are very different from normal cramping caused by over-exertion or lack of fitness. Interesting that this thread discusses it in the context of running, since all the other discussions I've read were from cyclists (although walking/running downhill can definitely trigger an attack).

In all my searching, I've yet to find any diagnosis in humans that matches the symptoms of this. The only thing that matches, is tying up in horses. There's definitely a diet-related component to it in my experience, the first few times this happened I was coming off a heavy training block, and during a holiday weekend visit with family I was not only off the bike for a few days but was eating lots of junk during that time. It seems to be some combination of a sudden drop in training volume combined with high carb intake. I've also noticed that several of my episodes were preceded by travel (either plane or car). Hydration/electrolytes may or may not come into play, I can't say for sure in my case.

My first few 'minor' episodes were after a weekend off the bike eating/drinking too much as mentioned above. First time back on the bike, the 'cramps' started within a couple of minutes and I had to stop the ride. This lasted for a few days, I would keep trying to get on the trainer and spin easily till the cramps started, stop spinning, repeat. Eventually you hit a point where you can ride through the pain and once I do that, they just stop and I can resume normal training.

I had one episode that was much worse in severity/duration. I was in probably the best shape of my life, and crashed out of a bike race. Frame was damaged and I was pretty banged up, so I was completely inactive for several days (and eating tons of junk out of frustration). One morning I got up, walked around a bit, and then when I sat down BAM the cramps started out of nowhere, except they were much worse this time. I could feel the cramps 'travel', moving between the different muscles in my thighs. Pretty much any time I bent my knee, the cramps would start again, and for several days in a row I would wake up in the morning to severe cramps. This episode lasted a while, probably 8-10 days. Part of that I think is because I hadn't made the connection to diet yet, also because I wasn't getting on the bike or doing anything else active. Eventually I realized that rest just prolongs the episode; to get through it I had to eventually start trying to ride (even though it would be just a few minutes of soft-pedaling at a time to start).

I've gradually learned how to prevent these episodes. The biggest thing is to avoid a sudden drop in training volume/intensity, especially if I've been doing VO2max work. Multiple rest days or even a few short/easy recovery rides in a row can be enough to cause an episode, especially if I'm not being careful about my diet. Fortunately I've learned to recognized warning signs, there's a certain feeling my legs get (I call them tremors), that tell me that I need to ride in the next day or so or I'm going to be in trouble. And if I know I'm going to be off the bike for a while (eg for vacation), I need to gradually reduce my training in the week before. The absolute worst thing would be to try to cram extra training in right before leaving on a trip.

Nutritionally, I make a point of trying to match carb intake to training load, when I reduce training, I need to reduce carb intake to match. I also make more effort to stay hydrated throughout the day and keep my eloctrolytes up (I take magnesium and potassium supplements).

The only real problem is unplanned interruptions in training due to sickness or other reasons, when I can't cut training gradually. It also makes tapering for an A-race tricky because if I back off training too much I'll be in trouble. The best taper I've round is to ride every other day and make sure there are at least a few hard efforts in each ride. But taking a rest day right before an A-race is always scary.

I see this a lot in my practice. Exercise associated muscle cramping is related to altered neuromuscular patterning.

For you personal examples, there are several parts that indicate it is not an electrolyte or water issue.

1. It is not systemic - systemic cramping would be the expected result of full body loss of electrolytes. This has not been shown in research.
2. You were running downhill for a long period - most likely a large increase in total ground reaction forces on every step. Both of your blow ups were related to going down hill which is when there is a large increase in the forces and will expose problems. For hamstring it is typically more related to the swing phase of gait when you are working eccentrically more. The increase in quad recruitment on the downhill portion is to prevent knee collapse from initial control to midstance.
3. You were fatigued. Fatigued states alter the muscular firing pattern.
4. Dehydration has not been related to exercise associated muscle cramping in any well designed studies. Nor has the opposite.

Altered neuromuscular patterning is very common in triathletes due to the interaction between the disciplines. Muscle firing patterns in running and walking are governed in some ways volitionally along with central pattern generators in the spinal cord. The amount of muscle activation used based on the pattern of running you use along with the state of the muscle spindle, golgi tendon organ, fatigue state, environmental conditions, and previous activity. If the muscle spindle is activated it drives up muscle activation while the golgi tendon organ does the opposite. This balance can be impacted by the activation of antagonist muscles (like the hamstring for the quad) or synergistic muscles (like posterior tibialis in force absorption during loading response of running gait) along with incomplete activation of the inhibitor (the golgi tendon organ) through stretch of the tendon.
So your issue is one related to getting off the bike which has driven up quad activation, ridiculous fatigue level, over activation of the quads, most likely poor recruitment of synergists, and your gait pattern overall.
Finally, even an easy walking pace is a large load on the body which we just don't realize that.

Preventing these issues is fairly simple, but I would start with a clear understanding of your gait pattern and muscle strength.