Table 2.

Treatment and Prevention Recommendations for EAMCs With Strength of Recommendation Taxonomy Grading¹⁰

Recommendation	Grade
Treatment
1. Athletes or clinicians should apply gentle static stretching to the EAMC until it abates.1,5,22,26,35	A
2. Food items containing acetic acid (ie, vinegar) or transient receptor potential activators (eg, capsaicin) may help relieve acute EAMCs. If used, these should be administered infrequently and in small volumes (<100 mL). Moreover, they should only be attempted in patients without related food allergies.41,42,44,45	B
3. Once EAMCs have abated and the athlete has been removed from exercise, clinicians may attempt or encourage the following:
(a) Rest in a position of comfort in which treatments can be applied.6	C
(b) Continued gentle stretching, as necessary.6	C
(c) Oral ingestion of fluids containing carbohydrates and electrolytes ad libitum.6	C
(d) Intravenous fluid administration and emergency transport if the athlete cannot tolerate fluids orally or has severe gastrointestinal distress (eg, vomiting, diarrhea).6,39	C
(e) Interventions that reduce muscle pain or soreness in the cramping muscles (eg, cryotherapy, massage, electrical stimulation).6	C
4. The EAMC treatments should continue in the hours after an initial episode to reduce risk of recurrence.29	C
5. No medications should be administered for EAMCs without a physician's consent or in a physician's absence.35	C
6. Quinine or products containing quinine (eg, tonic water) should not be administered for EAMC treatment.47	A
Prevention
1. Thoroughly evaluate athletes for underlying general medical conditions, allergies, or medication usage that may contribute to EAMC occurrence.35	C
2. Thoroughly question athletes with an EAMC history to identify their unique extrinsic and intrinsic risk factors and then target those risk factors with appropriate interventions.4	C
3. Incorporate neuromuscular reeducation, plyometrics, or strength training into training sessions when neuromuscular fatigue has been identified as a factor in an athlete's EAMC.3,18,31	B
4. Train at intensities and in environments (eg, temperature, altitude) similar to those in competition.3,22,30,31	B
5. Include suitable rest periods after training and competition to allow recovery and minimize the residual effects of muscle damage.6,31	C
6. Educate athletes about the various causes of EAMCs and safe hydration and drinking behaviors before beginning an EAMC prevention strategy.38	C
7. Encourage athletes to consume a nutritious, well-balanced diet that accounts for their unique carbohydrate, electrolyte, and fluid needs before training and competitions.38	C
8. Advise athletes to consume carbohydrates or a carbohydrate-electrolyte drink during exercise to help stave off fatigue and promote greater absorption and retention of ingested fluids.6,38	C
9. Identify athletes' fluid and electrolyte needs based on sweat rates and composition to avoid underhydration or overhydration or insufficient or excessive electrolyte supplementation if fluid and electrolyte monitoring is included in an EAMC prevention strategy.38	C
10. Intravenous fluids should not be administered before events for the sole purpose of preventing EAMCs.6	C

Abbreviation: EAMC, exercise-associated muscle cramp.