Dear CRW Members,

It is with mixed emotions that we announce the resignation of Eli Post as the editor of WheelPeople, effective June 1, 2024. For the past several years, Eli has been the driving force behind our beloved newsletter, dedicating countless hours to ensure that each issue is informative, engaging, and reflective of our vibrant cycling community.

Eli’s passion for cycling and his commitment to CRW have been evident in every edition of WheelPeople. His editorial vision has helped shape the publication into a cornerstone of our club, providing members with ride updates, cycling tips, and captivating stories from our community. Under his leadership, WheelPeople has not only informed but also inspired us all. 

We want to take this opportunity to thank Eli for his outstanding service. His hard work, creativity, and dedication have left an indelible mark on CRW. Eli has graciously agreed to work with Barbara Jacobs on the June issue and will assist his successor to ensure a smooth transition. Eli will continue to contribute as a writer, sharing his insights and experiences with us in future articles.

One of Eli's upcoming projects is a collaborative article with his son about the geographical distribution of our membership—a testament to his ongoing commitment to CRW. We are excited to see his future contributions and are grateful for his continued involvement.

Eli’s decision to step down comes due to personal health reasons. While we will miss his leadership as editor, we understand and fully support his decision. We are fortunate that Eli will remain a part of our community and continue to share his passion for cycling with us.

Please join us in expressing our heartfelt thanks to Eli for his years of exceptional service and dedication. We wish him all the best in his health and future endeavors. Eli, your contributions have made a significant impact, and we look forward to seeing you on the road and reading your inspiring articles in WheelPeople.

With gratitude,

Randolph Williams
President, Charles River Wheelers

Cape in a Day Too, June 22

Join CRW for this one-way 105 mile ride that starts from the MBTA train station in Braintree and goes south through mostly quiet roads all the way to Cape Cod.

You will enjoy great scenery along the coast and down the Shining Sea Bike Path, grab lunch in Woods Hole and maybe stop for some beach time before catching the Cape Flyer in Hyannis back to Braintree.

Ride Leader(s): Jerry Skurla  jskurla@comcast.net 

The Willie Hume Pneumatic Classic celebrates the 1889 debut of pneumatic tires in bike racing, June 30

On May 18th, 1889 the captain of the Belfast Cruisers Cycling Club was the first person to compete in a bike race on newfangled "sausage tyres" invented in 1887 by Scotland's John Boyd Dunlap (https://en.wikipedia.org/wiki/John_Boyd_Dunlop).

The Pneumatic Classic features 2 late morning rides (25m & 40m) departing from the Dirigible Brewery in Littleton, MA.

After finishing the rides we'll toast Willie and John's accomplishments - and marvel at today's tubeless tires - with Dirigible's craft brews and food. 

Ride Start Location:  

Dirigible Brewery in Littleton, MA.    https://dirigiblebrewing.com/faqs 

Ride Leader(s):

Jerry Skurla  jskurla@comcast.net 

Bikepacking 101, July 6-7

In its 4th season, Bikepacking 101 is a two day, one night introduction to "bikepacking," which means all overnight gear is carried on your trusty bike, NOT your back.  

The trip starts in St. Johnsbury, Vermont. The first day’s 38-mile route is on paved road, dirt roads in New Hampshire and a section of the Cross Vermont rail trail, finishing at Ricker Pond State Campground in Vermont which features a swimming beach and modern bathhouse. 

The second day’s 39-mile ride includes more Cross Vermont rail trail, a unique hardware store & bar in Cabot, Vermont, and a wonderful LONG descent on the Lamoille Valley rail trail back to the start in St. Johnsbury.

Climb to the Clouds, August 11

This legendary CRW ride will test your biking abilities with two challenging routes climbing up Mount Wachusett. There is a century length ride with 6,324 feet of climbing or a metric century with 3,358 feet of climbing. To help you succeed there are rest stops along the way.

Come climb this iconic Massachusetts mountain and bask in the glorious views of New England with CRW this August!

Image courtesy of trailspotting.com

3rd Annual Spring Swap Meet & Rides, May 5th

By Jerry Skurla

Both riders and bargain hunters enjoyed a fine spring day for the 3rd Annual Spring Swap Meet & Rides in Lexington on May 11.  

Almost 50 riders turned out to ride. Kudos to Lindy King, who led the 10 am ride of 38 miles, and Mary & Larry Kernan,  co-leaders of the 25 mile ride that rolled out at 11 am.  Both groups arrived back at Harrington Middle School just as the Swap Meet was opening at 1pm.

By Barbara Jacobs

The Bike Thursday Ride series is a weekly ride that runs between May and October for cyclists that enjoy riding at a slower pace of 10-12.5 mph. The routes are usually in the western suburbs, but could be in other areas. All rides are scenic, usually on low traveled roads. Bike Thursday is a very social ride that includes a picnic lunch at or near the start location. Sometimes there are stores available to purchase food, other times we bring lunch and hang out together. 

The rides are between 20-25 miles and take 2+ hours. At the start we break up into 3 groups of 10-14 riders each. 

Bike Thursday is a "led ride". There is always a ride leader (approved by CRW) and a sweep (chosen from the group of riders) for each group, and "human arrows" are used to help keep the group together.  

People often wonder why there a limit of 36 participants (including leaders) on Bike Thursday rides. Since we break into 3 groups of riders based on average speed (ranging from 10 to 12+ mph overall), we have 3 volunteer leaders each take out a group of 10-14 people. We have found that this is a safe and enjoyable group size for these rides.

Here is the ride grouping for each Bike Thursday ride:

• Group 1: riders between 12-13 mph overall
• Group 2: riders between 11-12 mph overall
• Group 3: riders between 10-11 mph overall

Parking is another reason there is a limit to the number of riders.  Some of the places we park at are public which is great if they have a lot of parking spaces. In other cases we get permission from a store, church, or school to park in their lots. It is best not to overwhelm these parking lots with lots of cars.

If the ride is already full when you attempt to register you can add yourself to the waitlist. If there are cancellations, people on the waitlist will be added to the ride in the order that they signed up.

People often ask where the ride starts. In the weekly ride description the city/town that the ride starts in is listed. Once you register for the ride, you will receive a "confirmation email" from Charles River Wheelers. This email will provide you with the ride start location and the Ride with GPS route link.  

Interested in learning more about Bike Thursday? Email bj.bikethursday@gmail.com

Ride Leaders needed

by John O'Dowd

Please consider leading during the weekends, both Saturday and Sunday's are great times to lead rides and support your club. Please connect with the VP of Rides if you need some assistance. 

Ride Leader Incentives

by Norma Loehr

In 2024 we want to do even more to show our Ride Leaders just how much we appreciate their time and efforts!

While we currently have incentives in place for Ride Leaders who are occasional leaders in the form of kick-off and year-end parties and a yearly gift, this new rewards program is designed to recognize our super-leaders: those who go above-and-beyond for CRW and our members.

There are six awards categories for our super Ride Leaders.

For the following categories, the top three Ride Leaders will receive a $50 gift card plus a free one-year membership to CRW. 

• Most Recurring rides led

• Most Non-recurring rides led

For the following categories, the top three ride Co-leaders will receive a $25 gift card.

• Most Recurring rides co-led

• Most Non-recurring rides co-led

For the following categories, the top Ride Leader will receive a $50 gift card plus a free one-year membership to CRW:

• Most rides by a new Ride Leader (class of 2024)

• Most feedback from members

We will publish and regularly update a leaderboard for the general Ride Leader and Co-leader categories so you can track your progress throughout the season. The new Ride Leader and feedback categories are more complicated to track so there will not be a regularly published leaderboard. All awards will be presented at the annual Ride Leader party in November (you do not need to be present to win). 

For more information on this rewards program, see the following FAQ.

FAQ

Who is eligible for these awards?

All active Ride Leaders are eligible except our board members. You will still see board members on the leaderboard, though!

What rides count towards these awards?

Rides posted publicly on the CRW Ride Calendar and that took place are eligible. Special riding workshops and rides designed for a subset of rider types (e.g. devo, gravel, Women’s/NB) are eligible.

The following are not eligible:

• Rides canceled for any reason

• Rides added to the calendar after the ride has occurred

• Virtual rides

• Non-ride events (e.g., lecture, tutorial, party)

What do I need to do to be sure my ride counts towards these rewards?

1. Create a detailed ride listing. A great ride listing will have the following information, as applicable:

• Route description

• Ride start time and location (or town)

• Affiliated ride program and/or intended audience (e.g., devo, intro to gravel, mellow/recovery)

• Ride type, size, and pace(s) supported

• Ride Leader name and contact information; Co-leader name(s)

• Any additional logistical information (e.g., parking, rest rooms, planned stops)

• If the route is not included in the posting, how and when the route will be communicated to registered riders (the link to Ride with GPS route may be emailed directly to registered members)

• Any ride group email list must be easily joined, with instructions to do so included in the event posting

Remember: You want to reach your intended rider audience AND members need enough information to determine if a ride is “for them”.

2. Post your ride on the CRW Ride Calendar. Remember to set registration number limit, if needed.

3. Register yourself using the Ride Leader ticket type.

Can someone win in multiple categories?

No. An individual may only win in one category. If someone is in the top three in multiple categories, the one where they have the highest rank is the one where they will win. The category (ies) where they ranked lower, the next leader after them will be awarded the prize.

What if there are other rider leaders on the ride I am leading? Do they get a Ride Leader credit?

No. There is only one Ride Leader per ride. The Ride Leader must be listed in the ride listing and registered for the ride using the Ride Leader ticket type.

How do I get credited as a Co-leader?

Co-leader(s) will be confirmed with the Ride Leader ahead of time and registered for the ride using the Co-leader ticket type before the ride takes place. 

I am leading a pace group for someone else’s ride, do I get Ride Leader credit?

No. However, if you are listed as a Co-leader and registered for the ride using the Co-leader ticket type, you will receive a Co-leader credit. For our Century rides, all participating Ride Leaders leading a pace group are Co-leaders, as the Ride Leader responsibilities were fulfilled by the club.

How is this data being tracked?

Data will be drawn from the CRW calendar/registration system so that everything can be tracked automatically. Data cannot be submitted in any other form.

When do rides need to occur to be considered for 2024?

Winners will be selected based on CRW Ride Calendar data from Jan 1, 2024 through the day before the annual Ride Leader party in November 2024.

When are the winners announced?

Winners will be announced and rewarded with their prize at the Ride Leader party in November. Winners do not need to be present to win. Winners will receive an email with information on how to collect their prize and they will be recognized in WheelPeople.

As you know, CRW thrives on the passion and enthusiasm of its members, and we believe there’s no better way to highlight this than by sharing your incredible experiences on our social media platforms. 

Whether it's a stunning sunrise ride, an exhilarating trail, a group photo from a club event, or just beautiful scenery captured during your journey, we want to see and celebrate it all.

Here’s how you can participate:

1. Choose your best photos or videos that represent your biking adventures and our club spirit.

2. Email your images or videos to social@crw.org with a brief description of the moment and any interesting details you’d like to share.

3. Include your social media handles if you’re comfortable with us tagging you in our posts.

By sharing your moments, you’ll help inspire fellow members and potential new riders, and you’ll contribute to a vibrant and engaging online presence for our club. 

We can’t wait to see your photos and celebrate the joy of biking together!

By John Allen

45 years ago, proper bicycle helmets first went on sale. Not long after, CRW member Jacek Rudowski collided with a car, went over the hood, landed on his helmet in the street and survived without serious injury. That story spread through the club, and there were others. Soon, nearly everyone on CRW rides was wearing a helmet.

Helmet use remains contentious for people who want to make bicycling as convenient as possible. This is especially so in connection with urban bike-share systems, where a person stepping up to a bike-share kiosk probably isn’t carrying a helmet. There have even been claims that helmet promotion decreases safety, because safety in numbers will make motorists more attentive. You are supposed to decrease your own safety in pursuit of some benefit which may occur to society at large. It’s balderdash. The safety increase actually reflects increasing skill with more riding, and most bicycle crashes don’t involve a car at all.

A couple of the CRW helmet stories were my own. I had to replace a helmet in 1978, after being sideswiped by a drunk driver, and again in 1984, when a fallen tree branch got caught in my front wheel. In 2005, I crashed due to a pothole. It then should be no surprise that I care about good helmet selection, fit and adjustment. As a CRW member, you probably are already conscientious about this, but it deserves a refresher anyway.

The photo below is of my Bell Biker helmet after the 1984 tree branch incident. Note the scrape, and how the foam liner is compressed at the front. I needed a few stitches below my nose but walked out of the hospital emergency room three hours after the crash, carrying this helmet under my arm. It had been adjusted correctly and it protected me.

Having your helmet do its job is about more than just going through the motions of wearing one. So, this is my call to you (and friends) to check and adjust the helmet’s fit as needed. The helmet needs to be the right size; you need to adjust the strap so it divides just below the ears.

Properly adjusted, the helmet will sit level on your head. A snug strap was easy to achieve with my early Bell helmet. Its double-D-ring buckle would automatically adjust the strap every time I put the helmet on. I could add or remove a watch cap under the helmet in winter, without fiddling with the strap, and I could loosen the strap to rest the helmet on my back when I was off the bicycle. Bell abandoned this design early and no other manufacturer has taken it up. The likely reason is that the helmet couldn’t be unbuckled with the strap under tension. Children had helmets catch in playground equipment and as I recall, at least one died. All newer helmets I have seen or worn have had a “snap-shut” plastic buckle. The strap has an adjustment that slips and loosens, repeatedly needing attention to maintain good fit.

How tight should that strap be? A test demonstrated at a League of American Bicyclists conference in 2005 sets the standard: You need to feel the strap under your chin, to the extent that it feels uncomfortable when you open your mouth wide. Also, you can test by placing the palm of your hand on the front of the helmet and pushing back. The helmet should stay in place.

Recall that the helmet may need to stay put for more than one impact in a crash. Many newer helmets have a dial in the back to adjust fit. This is a nice feature, but it is a stabilizer, not part of the retention system. It will pop open in a crash. I can sort of get away with adding or removing a cap underneath while adjusting only the dial. There is a warm Gore-Tex cap that is very thin and serves the purpose well.

Oddly, the conventional information on strap adjustment has slackened (figuratively and literally) since the conference in 2005. Multiple sources now including the League of American Bicyclists are advising people to leave enough room under the strap to slide two or three fingers between it and the chin. I don’t understand where this trend got started, and I don’t agree with it. Again, you should not be able to push the helmet back and uncover your forehead. Check and adjust your helmet so it can work for you if you need it!

The text and illustrations from a page in the Specialized support center give good classic advice on strap adjustment. You want to avoid injury and Specialized wants to avoid lawsuits!

The nonprofit Bicycle Helmet Safety Institute, https://helmets.org, is the go-to Web site for information on bicycle helmets. The Web site holds standards, laws, performance tests, statistics, reviews of new models,  and more.

All helmets sold for use on bicycles in the USA must meet Federal Consumer Product Safety Commission standards, but test results and reviews at BHSI show some helmets to be more protective than others, heavier or lighter, more ventilated, or less available to fit different head sizes and shapes. Some helmets are more suitable for bicycling, others for skateboarding. An expensive helmet does not necessarily work better. The Bicycle Helmet Safety Institute states that the MIPS feature, designed to reduce rotational shock to the brain, “may or may not help you avoid brain injury in a crash.”  Testing of old helmets shows that performance actually deteriorates very slowly with time, regardless of what manufacturers would like to tell you.  A wealth of information!

And BHSI says to snug up that strap!

By Nancy Clark

In today's food culture, we've demonized certain types of foods, such as those with abundant carbs, fat, salt, sugar. The latest demon is ultra-processed foods. You've seen the headlines: Ultra-processed foods linked to heart disease, diabetes, mental disorders and early death, study finds. Eating processed foods tied to shorter life. You should stop eating ultra-processed foods.

Such fear-mongering headlines influence many athletes to steer clear of ultra-processed foods (UPFs). While that is often the nutritionally wisest choice, the words ultra-processed foods get tossed around way too loosely.

Clickbait headlines can fail to offer a balanced overview. Sports drinks, gels, protein bars, as well frozen meals, store-bought bread, and vanilla yogurt (all UPFs) can be helpful additions to a busy (and budget-minded) athlete's food plan. Will these foods really ruin your health?

This article looks beyond the headlines and offers information to help you better understand what UPFs are and what they are not. Nutrition communicator Liz Ward RD shared this UPF information at the Mass. Academy of Nutrition & Dietetics Annual Meeting (March 2024).

Definition: What is an ultra-processed food?

Foods are categorized by the NOVA (not an acronym) system according to how they have been processed. NOVA has four categories—none of which consider a food's nutritional value:

Group 2. Processed Culinary Ingredients (also called Oils, Fats, Salt, and Sugar)— includes foods from Group 1, but in a different form. Olive oil (vs. olives), white sugar (vs. sugar cane), maple syrup (vs. sap), butter (vs. cream). Again, no mention of nutritional value.

Group 3. Processed Foods—home-cooked & commercially made food with salt, sugar, oil, plus preservatives to extend the shelf-life in foods from Groups 1 and 2. Examples include many foods thought to be good for us: smoked salmon, canned beans, canned tuna, and fresh cheeses.

Group 4. Ultra-Processed Foods— "industrial formulations" with fat, oil, sugar, starch, flavor enhancers, colors, and food additives. This group includes sports and energy drinks, cookies, baked chips, candy, as well as chocolate milk (excellent for recovery after a hard workout); tofu and salted nuts (protein for vegetarians); and packaged whole-grain bread. Many UPFs are nutrient-rich and positive choices for athletes. Hence, you want to think about nutrient density more than NOVA classifications!

What does the science say about ultra-processed foods?

While click-bait headlines proclaim UPFs are linked to heart disease, diabetes, brain health, and early death, the science is less definitive. Most UPF research looks at what people eat—and may overlook other factors that impact health: stress, economic status, exercise, and lifestyle. Research indicates ultra-processed foods such as breakfast cereal and (sweetened) yogurt can—and do—have health benefits.

To date, only one well-controlled study has compared the impact of two-weeks of eating an UPF diet (80%of calories) to a diet with minimally processed foods but nutritionally similar foods (in terms of carbs, protein, fat, and fiber). The results suggest the subjects ate more calories with the UPFs and gained two pounds during the two-week UPF diet and lost two pounds during the two-week minimally processed food trial.

Does this mean the media can rightfully declare UPFs are fattening? No. Research done under highly controlled conditions differs from athletes' "real life" eating patterns (which could easily have fewer calories from UPFs, given the typical US diet gets 60-67% of calories from UPFs ). Plus, two-weeks is a short trial. (This type of research is difficult to do.)

Is processing the problem— or is something else the culprit?

• Emulsifiers (cellulose gum, polysorbate 80) have been linked to negative changes in rats in the gut microbiome. Stay tuned for human studies.
• PFAs are endocrine disrupting chemicals that resist grease, oil & water. They are in food packaging: shiny wrappers on energy bars, grease-resistant microwave popcorn bags, and paper take-out food containers. As of Feb. 2024, PFAs are no longer allowed in food packaging in the US—but has their metabolic damage already been done?
• Is hyper-palatability the problem? Foods made with sugar and fat are more pleasing than sugar-free and fat-free foods—and even sugar and fat itself. Chocolate, for example, offers an appealing mix of sugar and fat that makes it very easy to overeat...

Food for Thought

Before demonizing all UPFs, we really need to look at the whole picture. We know chronic health issues are linked to eating patterns that lack fiber from fruits, vegetables, whole grains, beans, legumes, nuts. We also know that eating excess calories of salt, added sugars, and certain kinds of fat commonly found in UPFs can harm health. But despite popular belief, it is possible to choose a food plan with 90% UPFs and still consume a quality diet.

Ultimately, your overall dietary pattern—what, when, why, how much you eat—and not just UPFs will impact your health. We need to figure out why some people eat too many "addictive" UPFs such as salty snacks, sweets.  We'd also like NOVA to add a category for nutrient-dense processed foods to help resolve the demonization of all UPFs. Sausages and hot dogs should not be in the same category as tofu and peanut butter!

When making your nutrition game plan, there's little doubt that munching on Group 1 nuts and fruits (instead of pre-wrapped bars), and spending more time cooking homemade foods with fresh, locally grown Group 1 foods will be the ultimate winning diet. But convenience is a key reason people reach for UPFs. Try keeping your pantry stocked with minimally processed foods, so you can just as conveniently assemble a quick meal:

— whole grain bread + all-natural peanut butter + banana + yogurt

— rye crackers + canned tuna + cherry tomatoes + cheese.

As always, you want to eat more of best and less of the rest, keeping balance and moderation in mind.

Nancy Clark MS RD CSSD  counsels both fitness exercisers and competitive athletes in the Boston-area (617-795-1875). Her best-selling Sports Nutrition Guidebook is a popular resource, as is her online workshop. Visit NancyClarkRD.com for more information.

Resources:

For a handout on the NOVA Food Classification System with examples of foods in each group: https://ecuphysicians.ecu.edu/wp-content/pv-uploads/sites/78/2021/07/NOVA-Classification-Reference-Sheet.pdf

For more information on hyper-palatable foods: https://www.thinkingnutrition.com.au/food-addiction/?utm_source=substack&utm_medium=email

By Gabe Mirkin

Heat stroke during exercise is a rapid uncontrolled rise in body temperature that can cause you to pass out and can even kill you. It is a medical emergency that can cause permanent organ damage, kidney failure and seizures. It should never happen to you because your body sends you plenty of warning signals as your temperature rises. In 1965, I almost died from heat stroke in an unimportant local race in Arlington, Virginia. I passed out during the race, and I am still embarrassed by the stupidity that I showed when I ignored all the warning signs as my temperature continued to climb.

First your muscles are affected, then your lungs and then your brain.

• Muscles: As your temperature starts to rise, your muscles feel like a hot poker is pressing against them. It is normal for intense exercise to make your muscles burn, but hard exercise does not cause painful burning that feels like fire. Furthermore, the burning of hard exercise is relieved by slowing down, while the muscle burning of impending heat stroke does not go away when you slow down. 

• Lungs: As your temperature rises further, the air that you breathe feels like it is coming from a furnace and no matter how rapidly and deeply you try to breathe, you can't take in enough air. When you exercise intensely, you can become very short of breath, but the air you breathe will not burn your lungs. Burning in your lungs, not relieved by slowing down, signals impending heat stroke. When you feel that the air is so hot that it burns your lungs, stop exercising. This sign means that your heart cannot pump enough blood from your exercising muscles to your skin so heat is accumulating and your temperature is rising rapidly. Your temperature is now over 104 degrees F, and continuing to exercise will raise your body temperature even further so it will start to cook your brain. 
• Brain: When heat stroke begins to affect your brain, your head will start to hurt, you may hear a ringing in your ears, feel dizzy and have difficulty seeing. Then you will end up unconscious. Your temperature is now over 106 and your brain is being cooked just like the colorless portion of an egg that turns white when it hits a hot pan.

Mechanism
During exercise, more than 70 percent of the energy used to drive your muscles is lost as heat, so your heart has to pump the heat in your bloodstream from your hot muscles to your skin where you sweat and the sweat evaporates to cool your skin to dissipate the heat. The harder you exercise, the more heat your muscles produce. Everyone who exercises, particularly in hot weather, has to sweat to keep their body temperature from rising too high.

Risk for heat stroke is increased by:

• any pre-existing illness
• heart disease
• use of various stimulants and recreational drugs such as cocaine, and some prescription drugs
• lack of fitness
• not drinking enough fluid
• exercising for extended periods without eating
• wearing excess clothing that traps heat in your body
• not listening to your body when you feel the warning signs described above

Many cases of heat stroke during exercise occur when a person suddenly increases the intensity of exercise, such as a sprint at the end of a long distance running or cycling race, or an intense run down the field in soccer.

Treatment
When a person passes out from heat stroke, get medical help immediately. Any delay in cooling can kill the person, and you may need an expert to help decide if the person has passed out from heat stroke or a heart attack. Carry the victim rapidly into the shade and place them on their back with the head down and feet up so blood can circulate to their brain. Once it has been established that the person is not having a heart attack, they can be cooled by pouring on any liquid. As you cool them, they may suddenly wake up and talk to you and act like nothing has happened. Don't stop cooling them, because while they are sitting or lying there, their temperature can rise and they can go into convulsions or pass out again. They must be watched for several hours after they are revived.

My Recommendations
When you exercise in hot weather, stop exercising if you start to feel any of the symptoms of heat stroke described here, and find a shady spot to recover. Stay well hydrated, but realize that too much fluid can result in low blood sodium (Hyponatremia), which can also be harmful.

Dr. Mirkin's reports and opinions are for information only, and are not intended to diagnose or prescribe. For your specific diagnosis and treatment, consult your doctor or health care provider.

For more information visit DrMirkin.com
We DO NOT sell, rent or give your e-mail address to anyone.
Copyright 2024, The Sportsmedicine Institute, Inc.

Dr. Gabe Mirkin May 19, 2024

About 60 percent of North American adults suffer from occasional night-time leg cramps, a sudden painful contraction usually of the calf muscles that can last from a few seconds up to 10 minutes or more. Doctors do not know what causes most cases of leg cramps, but usually they are not caused by dehydration or lack of minerals. The leading theory is that most leg cramps come from the lack of a normal nerve reflex that causes a muscle fiber to relax when it is held in contraction. That is why people who suffer recurrent leg cramps should be checked for conditions that can cause nerve damage, such as vitamin B12 deficiency or diabetes. Cramps occur most often at night when you are sleeping, when you exercise vigorously, when you tear a muscle, or when you keep your leg in an awkward position, such as sitting in a chair in the same position for a long time. If you have frequent night-time leg cramps, check with your doctor for a medical workup to look for a cause.

What is a Muscle Cramp?

When you turn during sleep, you contract your calf muscles, which stretches their tendons. This stimulates nerve stretch receptors in the tendon and sends a message back to the spinal cord, telling the calf muscles to contract. After you contract a muscle, reflex messages are sent along nerves to the spinal cord to relax that muscle. If the message to relax is blocked, the muscle stays contracted and you develop a cramp. Cramping during sleep is usually due to an exaggeration of the normal muscle reflex that causes the muscle to stay contracted and hurt.

Older people and those who do not exercise are at increased risk for cramps because they have smaller and weaker muscles. Cramps are more likely to occur in hot weather because muscles fatigue earlier with higher temperatures. Cramps are more likely to occur during intense exercise that requires you to use your fast twitch strength fibers that fatigue earlier than your slow twitch endurance fibers.

What To Do When You Develop a Leg Cramp 

When you get a leg cramp, you should gently try to walk it out while you massage the contracted muscle with your hands. Don't put great force on the contracted muscle because you may tear it. If the cramp continues, apply cold compresses, which can relax the contracted muscle and numb the pain. Keep on gently massaging the muscle.

Preventing Leg Cramps

You can often prevent night-time leg cramps if you:

• exhaust the stretch reflex before you go to bed by stretching your calf muscles 
• apply a heating pad for 10 minutes before you go to sleep 
• start a regular exercise program to strengthen your calf muscles. If you are a non-exerciser, the best exercises may be a stationary bicycle or a spinning class.

Quinine may be used to treat night-time leg cramps (Brit Med J, Jan 7, 1995; 310(6971):13-17), but the U.S. Food and Drug Administration stopped over-the-counter marketing of this remedy because of concerns about irregular heartbeats. Doctors can still prescribe quinine pills for relief of leg cramps, but they can cause birth defects and miscarriages, so they should not be taken by a pregnant woman. Quinine can also cause ringing in the ears, headache, nausea, disturbed vision, chest pain, asthma and other problems.

Work-Up for Frequent Leg Cramps

Most causes of leg cramps are harmless, but if you suffer frequent leg cramps, you need a detailed medical workup; check with your doctor.

Treatable causes of frequent leg cramps include:

• all conditions that can cause blood vessel damage such as arteriosclerosis
• partially obstructed blood vessels
• pinched nerves in the back
• muscle damage
• nerve damage
• kidney disease
• abnormal mineral levels such as lack of potassium or calcium
• vitamin B12 deficiency
• abnormal hormone levels such as low thyroid
• diabetes
• dehydration
• medications such as birth control pills, diuretics (which are often prescribed for people with high blood pressure), steroids, asthma medications such as albuterol, pain meds such as naproxen or pregabalin, statins to lower cholesterol, and so forth (BMJ Clin Evid, 2015, 1113; Am Fam Physician, 2012, Aug 15;86(4):350-3). 
• about 30 percent of night-time leg cramps may be due to venous insufficiency or varicose veins. Vein specialists can do an ultrasound evaluation of valves to see if they gap, allowing stretching of the vein to create contracture (a cramp). This can be easily treated using laser or chemicals to close the inefficient valves or veins.

My Recommendations

When you get a leg cramp at night, get up and start walking cautiously while gently massaging the cramped muscle. The cramp should ease up within a few seconds. Stop walking immediately if the pain worsens because you can tear the muscle. For the next few nights, before you go to bed, try stretching your calf muscles to exhaust the stretch reflex with "wall push-ups." Stand about an arm's length from a wall or countertop with both feet flat on the ground. Place your hands on the wall and slowly bend your elbows to bring your upper body closer to the wall. Hold for the count of ten and then push your self away from the wall by straightening your elbows. Repeat several times. Stop immediately if you feel sudden pain.

Dr. Mirkin's reports and opinions are for information only, and are not intended to diagnose or prescribe. For your specific diagnosis and treatment, consult your doctor or health care provider.

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