Arghh! Muscle cramp is killing me!

Arghh! Muscle cramp is killing me!

 April 27, 2022   Return

Sports Medicine Physician


For the third article in our series on sports injuries, a sports medicine physician explains about muscle cramps caused by exercise and ways of overcoming them.

Muscle cramp is a strong and painful contraction, often interpreted as sudden and severe spasms or tightening of a muscle that last anywhere from a few seconds to a few minutes.

Exercise-associated muscle cramps (EAMC) happen during physical activities. Let’s take a look at the WHYs, HOWs (how does it happen and how to prevent it) and WHATs (what to do when it is happening to me) of EAMC.

Why does EAMC happen?

Traditionally, it was thought and it is still popular opinion that muscle cramps during physical activities occur due to dehydration as a result of not drinking enough water, and also exercising in environments that are too warm and humid causing profuse sweating. Excessive sweating leads to deficiency of electrolytes such as sodium, potassium and magnesium. Other causes of muscle cramps include inadequate amount of stretching and muscle fatigue.

People have been believing the theory of electrolyte deficiency being the leading cause of EAMC. So, electrolyte replacement supplements and drinks have taken off significantly in the endurance sporting scene.

However, personal opinions from individual users on whether or not electrolyte replacement supplements and drinks work vary greatly. Some users swear by them, but some claim they are an absolute waste of money. Data from published researches also vary – most findings point to little or no effects of electrolyte replacement on reduction in muscle cramping.

In fact, in recent years many studies have debunked the theory of electrolyte deficiency being the leading cause of EAMC and showed that there is no correlation among EAMC, sodium intake and low blood sodium levels. Sodium is the most common electrolyte to be supplemented.

Also, if you read the sports drinks labels properly, you will notice that the amount of electrolytes present in most popular brands of sports drinks are miniscule and negligible, with the main component of the drink actually being carbohydrate in the form of SUGAR.

When it comes to dehydration, that theory may not hold that much weight as excessive and improper rehydration during prolonged endurance events possibly lead to hyponatraemia, which means low sodium in blood. It happens when people drink too much water too fast resulting in a dilution effect. The term exercise-associated hyponatraemia was first coined in the 1980s and has detrimental effects to the body which ultimately if not treated early, can lead to death. Now the guideline recommends to “drink according to thirst”.

How about the theory of inadequate stretching causing cramps?

Often mid endurance events, when someone suddenly seizes up with a very bad muscle cramp of the leg, the first thing that comes to mind is to stretch that muscle. And anyone who has experienced it will know that stretching the spastic muscle is extremely painful and at that point in time feels like a pointless procedure. But physiologically, the advice to stretch holds a lot of weight.

Keeping the anatomy and physiology lesson short and simple, there are two components in our muscles called muscle spindles and Golgi tendon organs (GTO).

Muscle spindles lie within the fleshy bulk of our muscles and they function to detect the lengthening or stretching of the muscle. When it detects the muscle being stretched, it will send a signal to the brain to prevent further stretching of the muscle. This prevents the muscle from being overstretched hence, preventing muscle tear and damage.

The GTO on the other hand lies at the border where the muscle meets the tendon – all muscles join to become tendons before attaching to a bone – and functions as such: when the muscle contracts forcefully or spastically, such as in a muscle cramp, the muscle tugs at the GTO and the GTO dutifully sends a signal to the brain to tell the spastic muscle to relax.

Therefore, when EAMC occurs, stretching of the affected muscle causes the GTO to send signals to the brain to cause the cramp to stop, for that muscle to relax and release, while the muscle spindle prevents you from overstretching and further hurting yourself. Thus, stretching DOES indeed help to reduce the occurrence of EAMC – or any muscle cramps for that matter – and halts the EAMC when it is already happening.

In recent years, many researchers started hypothesizing that the cause of EAMC is from the central nervous system. Central nervous system is a combination of the brain, the nerve fibres and endings, and the muscles that the nerve supplies. In fact, the altered neuromuscular control theory is taking more weight in the efforts of narrowing down the causes of EAMC and factors such as muscle fatigue, inadequate muscle conditioning and training and muscle damage/injury all fall into this theory.

From my experience of treating patients on the race course and also in retrospective history taking of patients who suffer from EAMC, they all tend to have a few things in common:

1) Inadequate conditioning/strengthening of the muscles – poorly conditioned muscles tend to be weaker, fatigue easily and quickly, and unable to take the rigours of sporting activities. The stronger and more conditioned the muscle is, the more resistant it is to cramps.

2) Inadequate training specificity – not to be confused with inadequate strength, as some of these athletes have good musculature due to regular exercise. However, SPECIFIC training for a particular sport or activity is important as different sports require the use of different muscle groups and different energy systems, to name a few. If you plan to participate in a road running race, training to run more is important.

3) Overtraining/muscle damage or injury – inadequate rest and recovery from overzealous training will lead to overtraining, which may lead to a certain degree of muscle or tendon damage or injury. Injured muscles do fatigue easily and may not withstand activities being participated in.


What can be done to reduce the incidences of EAMC?

Proper and adequate training is important. If you signed up for a half marathon, then train to run the distance and put in adequate time and mileage. Showing up at the start of a half marathon – or whatever distance – without any training may result in a very painful limp towards the tail end of the race due to bad cramps.

Stretching is important and highly recommended as an integral part of one’s training regime. If you feel a cramp is about to happen mid activities, it is advisable to take some time to stretch before continuing.

Rest is equally as important as the training itself. The more intense and often you train, the more rest and recovery is necessary. Injured and damaged muscles become tired easily and cramp more often.

Despite the lack of evidence supporting electrolyte supplementation and replacement drinks, if they work for you from past experiences, you should continue to take it.

On the note of altered neuromuscular control theory, there has been recommendation of consuming pickle juice instead of electrolyte drinks to prevent and even cure EAMC. The exact mechanism of how that works is still unclear and current research studies available out there did not come to any conclusive answer as to why it works. It has been hypothesized that the vinegar content in pickle juice triggers some muscular reflexes when the juice comes into contact with the back of the throat. This same reflex shuts down the misfiring of neurons in muscles thus causing cessation of EAMC. As it can be a cheaper alternative, no harm in giving that a try. On that same note, the idea of any liquid drink with vinegar in it can be used in place of pickle juice; for example, apple cider vinegar, kombucha, kimchi juice, etc.

Note: I take diluted apple cider vinegar before and during my long runs. HT

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Moving House? Don’t Break Your Back Over It

Moving House? Don’t Break Your Back Over It

 April 27, 2022   Return


Speaking from recent first-hand experience: moving houses is NOT FUN. Whether it’s due to a new college, a new job, or a change in family circumstances, the process of packing up and moving an entire household’s worth of possessions to a different building can be incredibly stressful for everyone involved—and potentially hazardous to one’s health. Read up HealthToday basics on how to stay both sane and safe while dealing with a big move.

  1. Pack smart.

Heavy objects go in smaller boxes, lighter objects in bigger boxes. Do not under any circumstances fill a human-sized box with books just because you want them all in the same place. Unless you or your moving help are secretly a superhero, someone’s joints will end up in a bad condition, and that someone’s chiropractor will be very pleased.

For reference, the Malaysian Department of Occupational Safety and Health (DOSH) recommends a maximum lifting- and-lowering weight of 25 kg for average adult men (16 kg for women). 

Spread the weight out among large boxes by putting heavier, sturdier items (books, papers) at the bottom of the box, then filling the remainder with lighter items (bedding, clothes). If the heavy stuff is fragile (dishes, glassware), the lighter materials can be arranged to pad them as well.

When packing, try to put the box on a chair or table so that you don’t have to keep bending down to put items inside.

  1. Lift with your legs, not with your back.

Bending your back over and over to pick up heavy boxes is a sure- fire shortcut to causing a back injury that could last anywhere from a few hours to a lifetime. To prevent that, make sure you lift (and lower!) objects using a squatting movement that spreads out the weight through your hips and legs.

Remember the DOSH maximum weight recommendations? That assumes you’re holding it as close to your core as possible. A box of dishes may seem manageable when you’re carrying it next to your belly, but if it’s going on the top of a stack or an overhead shelf, try to reduce its weight even further.

And as always, don’t try to carry everything on your own; adrenaline may help you in the short term to pick up that heavy end table by yourself, but you’ll feel the ache days later.

“Put heavier, sturdier items at the bottom of large boxes, then fill it with lighter items.”

  1. Have some protective gear on hand (and face and feet).

Consider a face mask to keep your sinuses clear. Even if you’re not usually sensitive to everyday levels of dust, the layers of ancient dust that tend to be stirred up from forgotten corners of the house in a move can cause uncomfortable sensations in your lungs and trigger allergies you didn’t know you had.

“It’s important to keep walking paths through rooms as clear as possible.”

If you’re doing a lot of the lifting yourself, a pair of good work gloves (durable, stretchable, sweat-resistant and well-padded) will help you in both getting a good grip on heavy objects as well as protecting your hands from injuries.

Comfortable shoes are also invaluable since you’ll likely be spending a lot of time on your feet. Think about anti-slip soles, ankle protection and good arch support; your favourite old sports shoes will probably do.

  1. Keep the floor clear of stepping hazards.

Moving is a messy process by nature, but it’s important to keep walking paths through rooms as clear as possible, especially if renovations are still in progress. Sweep the floor at the end of each day to clear potential splinters or other sharp debris that might end up in someone’s foot later.

Don’t leave scissors or blades  lying around on the floor, even when in the middle of packing or unpacking. Another hazard to look out for are electrical cables, loose pieces of plastic or other packaging that could trip people up while carrying items.

  1. Don’t forget to rest.

It can be tempting to survive  the moving period with 4 hours’ sleep a night and enough coffee to replace half of your blood circulation, but it’s best to try avoiding this. Lack of sleep impairs your concentration, memory, and dexterity, which can lead to accidents (tripping, dropping objects), bad decisions (stacking fragile objects precariously) as well as added stressful moments (struggling to deal with five different contractors calling you at once).

You might technically have “more time” if you sleep less, but your body will process things slower, so it might not really be worth it.

If you can’t get your full 8 hours’ sleep during the night, try to find the opportunity for a nap on a chair or in a car during the day; even a short 15-minute stint can help improve your mood and your ability to process problems. If you’re unable to fall asleep, it’s still not time wasted; just the act of reclining with your eyes closed helps relax your body, and puts you in a slightly better state than otherwise.

  1. Don’t forget to eat and drink water, too.

In the chaos of moving, sometimes it’s easy to forget you’re hungry or thirsty until you actually sit down for a moment and feel your stomach growl, or start to feel faint while standing. Ideally, you shouldn’t be straining yourself to that point; make a point of trying to eat and drink at around your usual meal times.

Maybe you’ve packed all your kitchen stuff already, or you just don’t have time to cook or to make a drive out and eat. Getting takeout delivered is fine, but be sure to keep some level of fruit, vegetables, lean meat and grains in your diet. Easy grab-and-go foods to stock up on like biscuits, granola bars, hard- boiled eggs, yogurt and blended juices can help keep you going.

Keep water bottles handy. As tempting as it is to grab sports drinks or soft drinks for the energy rush, your body needs to stay hydrated, especially with the amount of water you’ll be losing as you sweat while moving around all day in the heat. HT

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Exercise Myths Debunked

Exercise Myths Debunked

 April 25, 2022   Return


Wai Hoong

Fitness Director & Co-Founder of W Fitness


Want to lose weight or get fit but don’t know what to believe? Take the advice of a professional fitness coach, Wai Hoong.

Myth #1: I must train every day!

Truth: If you work out every day of the week at high intensity, it is just a matter of time before you hurt or injure yourself. It is recommended to cycle your training, keeping your workouts varied. Try out new activities at different levels of intensity. Much like how athletes have their on-off seasons, we should find a suitable balance for ourselves.

Myth #2: Women will get bulky from lifting weights.

Truth: Men and women are physically built very differently. Women have less muscle tissue, higher progesterone levels, and lower testosterone levels as compared to men. Hence, lifting weights will not bulk up a woman. However, it will benefit them in many ways. Lifting weights helps improve bone density and reduces a person’s risk of developing osteoporosis; it encourages fat loss (the lean muscle you will develop though lifting weights burns more calories than fat even at rest). Lifting weights also helps you gain strength (which can be useful for daily activities such as carrying a baby, groceries, doing manual work, etc); it improves athletic performances for athletes and decreases chances of injuries (in the knee or in the back).

Myth #3: I can eat whatever I want since I work out every day

Truth: Perhaps this may be true if you are younger, have good genes or already have a diet that’s wholesome and filled with food of high nutritional value. Otherwise, you can’t exercise your way out of a bad diet. Be mindful of the food you consume. A cheat meal occasionally is fine. But if you (for example) have a cake every night or indulge in unhealthy processed food every day, your diet wouldn’t provide you with the necessary nutrition for repair and recovery after workouts. Healthy wholesome meals aren’t just restricted to steamed chicken and vegetables every day—there are plenty of fun, interesting and healthy recipes available online to follow. Learn how to cook better using nfresh ingredients, substitute unhealthy sauces or seasonings with herbs and use healthier cooking methods. HT



June 25, 2020   Return


Kevin Kruse, business speaker and co-author of We: How to Increase Performance and Profits through Full Engagement has a few ideas on how to work under a bad boss.

  • Are you the only one with issues with the boss?
  • Do you find that all the bosses you’ve worked with are terrible?
  • If you answer yes to any of the above— or to both questions—it may be worth considering that perhaps you, not your boss, are the one with the issues here. It may be time to adjust your expectations more realistically when it comes to your boss. If you think your boss is the problem,read on!

Talk it out!
Your job as well as your boss’s are a shared accountability—it is within your right to ask for a meeting with them to discuss your performance. Bring up how well you are performing in certain areas of your job and how you believe things can be improved. Use some diplomacy and even cunning to persuade your boss that the implementation of your ideas would be beneficial for the both of you.

Think positive.
If your boss is uncooperative or too difficult to talk to, examine the positive aspects of your job. Are you learning new and marketable skills? Is the salary worth the trouble? If the good outweighs the bad boss problem, it may be worth hanging on for a little longer.

How long will the boss be around anyway?
UIf you are working in a large company that changes bosses every few years, it may be worth hanging on until a hopefully better boss steps in.

If all else fails, it’s time to look for a new job.
At the end of the day, your mental and physical health is more important! HT