Tennis| Volume 6, ISSUE 1, P19-27, March 2003

Download started.


Heat cramps: fluid and electrolyte challenges during tennis in the heat

      This paper is only available as a PDF. To read, Please Download here.
      Sweat losses during tennis can be considerable. And while most players make a genuine effort to stay well hydrated to maintain performance and reduce the risk of heat illness, regular and copious water intake is often not enough. Besides an extraordinary water loss, extensive sweating can lead to a concomitant large electrolyte deficit too — particularly for sodium. Although a variety of other mineral deficiencies and physiological conditions are purported to cause muscle cramps, evidence suggests that, when a tennis player cramps in warm to hot weather, extensive and repeated sweating during the current and previous matches and a consequent sodium deficit are usually the primary contributing factors. Heat cramps often begin as subtle “twitches” or fasciculations in one or more voluntary muscles and, unless treated, can rapidly progress to widespread debilitating muscle spasms that leave an afflicted player on the court writhing in pain. If sufficient preventive measures are taken well before and during play, such cramping is avoidable in most cases. Appropriate and sufficient salt and fluid intake will enhance rehydration and fluid distribution throughout a player's body, so that heat cramps can be completely averted, even during long matches in the most challenging environments.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Science and Medicine in Sport
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Finn R
        Sampras's 5-setter: ‘It's so hot, it's a joke’.
        The New York Times. 1997; 21 (January): B11
        • Bergeron MF
        Keeping your players hydrated: what are the key points?.
        High-Performance Coaching. 2000; 2 (available from the United States Tennis Association, 7310 Crandon Blvd., Key Biscayne, FL 33149, USA): 10-11
        • Bergeron MF
        Optimal hydration — is water enough?.
        in: Crespo M Pluim B Reid M Tennis Medicine for Tennis Coaches. International Tennis Federation, London2001: 106-107
        • Bergeron MF
        Playing tennis in the heat: fluid and electrolyte balance.
        in: Renström Per AFH Tennis: Handbook of Sports Medicine and Science. Blackwell Science Ltd., Oxford, UK2002: 65-74
        • American Academy of Pediatrics
        Climatic heat stress and the exercising child and adolescent.
        Pediatrics. 2000; 106: 158-159
        • American College of Sports Medicine
        Position stand on exercise and fluid replacement.
        Med Sci Sports Exerc. 1996; 28: i-vii
        • National Athletic Trainers Association
        Position statement: fluid replacement for athletes.
        J Athl Train. 2000; 35: 212-224
        • González-Alonso J
        • Mora-Rodríguez R
        • Below PR
        • et al.
        Dehydration markedly impairs cardiovascular function in hyperthermic endurance athletes during exercise.
        J Appl Physiol. 1997; 82: 1229-1236
        • Hargreaves M
        • Febbraio M
        Limits to exercise performance in the heat.
        Int J Sports Med. 1998; 19: S115-S116
        • Sawka MN
        Physiological consequences of hypohydration: exercise performance and thermoregulation.
        Med Sci Sports Exerc. 1992; 24: 657-670
        • Sawka MN
        • Latzka WA
        • Matott RP
        • et al.
        Hydration effects on temperature regulation.
        Int J Sports Med. 1998; 19: S108-S110
        • Armstrong LE
        • Curtis WC
        • Hubbard RW
        • et al.
        Symptomatic hyponatremia during prolonged exercise in heat.
        Med Sci Sports Exerc. 1993; 25: 543-549
        • Hiller WDB
        Dehydration and hyponatremia during triathlons.
        Med Sci Sports Exerc. 1989; 21: S219-S221
        • Speedy DB
        • Noakes TD
        • Rogers IR
        • et al.
        Hyponatremia in ultradistance athletes.
        Med Sci Sports Exerc. 1999; 31: 809-815
        • Bergeron MF
        • Armstrong LE
        • Maresh CM
        Fluid and electrolyte losses during tennis in the heat.
        Clinics Sports Med. 1995; 14: 23-32
        • Gisolfi CV
        Is the GI system built for exercise?.
        News Physiol Sci. 2000; 15: 114-119
        • Shirreffs SM
        • Maughan RJ
        Rehydration and recovery of fluid balance after exercise.
        Exerc Sport Sci Rev. 2000; 28: 27-32
        • Costill DL
        Sweating: its composition and effects on body fluids.
        Ann New York Acad Sci. 1977; 301: 160-174
        • Allan JR
        • Wilson CG
        Influence of acclimatization on sweat sodium concentration.
        J Appl Physiol. 1971; 30: 708-712
        • Bergeron MF
        Heat cramps during tennis: a case report.
        Int J Sport Nutr. 1996; 6: 62-68
        • Wenger CB
        Human heat acclimatization.
        in: Pandolf KB Sawka MN Gonzalez RR Human Performance Physiology and Environmental Medicine at Terrestrial Extremes. Benchmark Press, Indianapolis, IN1988: 153-197
        • National Heart, Lung, and Blood Institute
        The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
        in: NIH Publication No. 98-4080. National Institutes of Health (NIH), 1997
        • Sacks FM
        • Svetkey LP
        • Vollmer WM
        • et al.
        Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet.
        New Eng J Med. 2001; 344: 3-10
        • Benda C
        Outwitting muscle cramps — is it possible?.
        Physician Sportsmed. 1989; 17: 173-178
        • Eaton JM
        Is this really a muscle cramp?.
        Postgrad Med. 1989; 86: 227-232
        • Levin S
        Investigating the cause of muscle cramps.
        Physician Sportsmed. 1993; 21: 111-113
        • Liu L
        • Borowski G
        • Rose LI
        Hypomagnesemia in a tennis player.
        Physician Sportsmed. 1983; 11: 79-80
        • Miles MP
        • Clarkson PM
        Exercise-induced muscle pain, soreness, and cramps.
        J Sports Med Phys Fitness. 1994; 34: 203-216
        • O'Toole ML
        • Douglas PS
        • Lebrun CM
        • et al.
        Magnesium in the treatment of exertional muscle cramps (abstract).
        Med Sci Sports Exerc. 1993; 25: S19
        • O'Toole ML
        • Lebrun CM
        • Laird RH
        • et al.
        Magnesium for athletes resistant to usual IV treatment (abstract).
        Med Sci Sports Exerc. 1994; 26: S205
        • O'Toole ML
        • Douglas PS
        • Laird RH
        • et al.
        Fluid and electrolyte status in athletes receiving medical care at an ultradistance triathlon.
        Clin J Sport Med. 1995; 5: 116-122
        • Stamford B
        Muscle cramps: untying the knots.
        Physician Sportsmed. 1993; 21: 115-116
        • Williamson SL
        • Johnson RW
        • Hudkins PG
        • et al.
        Exertion cramps: a prospective study of biochemical & anthropometric variables in bicycle riders.
        Cycling Sci. 1993; 5: 15-20
        • Ogletree JW
        • Antognini JF
        • Gronert GA
        Postexercise muscle cramping associated with positive malignant hyperthermia contracture testing.
        Am J Sports Med. 1996; 24: 49-51
        • Bentley S
        Exercise-induced muscle cramp: proposed mechanisms and management.
        Sports Med. 1996; 21: 409-420
        • Schwellnus MP
        • Derman EW
        • Noakes TD
        Aetiology of skeletal muscle ‘cramps’ during exercise: a novel hypothesis.
        J Sports Sci. 1997; 15: 277-285
        • Layzer RB
        The origin of muscle fasciculations and cramps.
        Muscle Nerve. 1994; 17: 1243-1249
        • Simchak AC
        • Pascuzzi RM
        Muscle cramps.
        Seminars Neurol. 1991; 11: 281-287
        • Nadel ER
        • Mack GW
        • Takamata A
        Thermoregulation, exercise, and thirst: interrelationships in humans.
        in: Gisolfi CV Lamb DR Nadel ER Perspectives in Exercise Science and Sports Medicine: Vol. 6 Exercise, Heat, and Thermoregulation. Brown & Benchmark, Dubuque, IA1993: 225-256
        • Jansen PHP
        • Joosten EMG
        • Vingerhoets HM
        Muscle cramp: main theories as to aetiology.
        Eur Arch Psychiatry Neurol Sci. 1990; 239: 337-342
        • Hubbard RW
        • Armstrong LE
        The heat illnesses: biochemical, ultrastructural, and fluid-electrolyte considerations.
        in: Pandolf KB Sawka MN Gonzalez RR Human Performance Physiology and Environmental Medicine at Terrestrial Extremes. Benchmark Press, Indianapolis, IN1988: 305-359
        • Vaamonde CA
        Sodium depletion.
        in: Papper S Sodium: Its Biological Significance. CRC Press, Boca Raton, FL1982: 207-234
        • Costill DL
        • Cote R
        • Fink W
        Muscle water and electrolytes following varied levels of dehydration in man.
        J Appl Physiol. 1976; 40: 6-11
        • Bergeron MF
        • Maresh CM
        • Armstrong LE
        • et al.
        Fluid-electrolyte balance associated with tennis match play in a hot environment.
        Int J Sport Nutr. 1995; 5: 180-193
        • McGee SR
        Muscle cramps.
        Arch Intern Med. 1990; 150: 511-518
        • Bergeron MF
        Sodium: the forgotten nutrient.
        Sports Sci Exch. 2000; 13 (available from the Gatorade Sports Science Institute®, 617 W. Main St., Barrington, IL 60010, USA): 1-4
        • Maughan RJ
        • Leiper JB
        • Shirreffs SM
        Factors influencing the restoration of fluid and electrolyte balance after exercise in the heat.
        Br J Sports Med. 1997; 31: 175-182
        • Mitchell JB
        • Phillips MD
        • Mercer SP
        • et al.
        Postexercise rehydration: effect of Na+ and volume on restoration of fluid spaces and cardiovascular function.
        J Appl Physiol. 2000; 89: 1302-1309
        • Nose H
        • Mack GW
        • Shi X
        • et al.
        Role of osmolality and plasma volume during rehydration in humans.
        J Appl Physiol. 1988; 65: 325-331
        • Mulloy AL
        • RJ Caruana
        Hyponatremic emergencies.
        Medical Clinics North Amer. 1995; 79: 155-168
        • Vrijens DM
        • Rehrer NJ
        Sodium-free fluid ingestion decreases plasma sodium during exercise in the heat.
        J Appl Physiol. 1999; 86: 1847-1851