Exercise-Associated Muscle Cramps in Athletes: Beyond Dehydration and Electrolyte Loss — A Narrative Review

Abstract

Introduction and Purpose

Exercise-associated muscle cramps (EAMC) are painful, involuntary contractions occurring during or shortly after physical activity. Their mechanisms remain uncertain, and dehydration or electrolyte loss alone does not explain many episodes. This review summarizes current evidence on the epidemiology, mechanisms, risk factors, treatment, and prevention of EAMC in athletes.

Materials and Methods

A structured PubMed/MEDLINE search was performed, with the final search completed on 13 September 2026. Priority was given to studies published between 2010 and 2026, with earlier landmark publications included when relevant.

Results

EAMC are common in endurance sports and usually affect heavily recruited muscles late in prolonged exercise. Evidence does not consistently support dehydration or systemic electrolyte depletion as a universal cause. Neuromuscular fatigue and altered neuromuscular control provide a stronger framework, although EAMC are likely multifactorial. Previous EAMC are the most consistent predictor of recurrence. Gentle static stretching remains the best-supported acute treatment; routine pre-exercise stretching or electrolyte supplementation has not shown consistent preventive benefit.

Conclusion

EAMC are best viewed as a multifactorial condition shaped by neuromuscular fatigue, individual susceptibility, and exercise-specific demands. Management and prevention should therefore be individualized.