The heat was a real problem for the Miami Heat and LeBron James during Game 1 of the NBA Finals. James was eventually carried from the floor due to cramping, according to NBA.com. With James sidelined and having only two days to recover, will the game's best player be kept from his third title by something as simple as muscle cramping?
Most muscle cramps are caused by exertion and dehydration in some combination. The increased heat in the AT&T Center in San Antonio contributed strongly to James' condition, in all likelihood, by creating an imbalance between the loss of fluids and the intake. While the body loses fluid with breathing and urination, increased sweat is usually the largest contributor to exertional cramping.
The body is not able to keep up, and the muscles start to lose function. At this point, the cramps are a signal from the body to shut down. With the cells screaming for hydration, the pain signal is caused by increasing tightness in the muscles as the normal feedback loop is broken. In the extreme, the muscles will go rigid and cease to function.
"I got all the fluids I need to get, I do my normal routine I've done and it was inevitable for me tonight, throughout the conditions, you know, out there on the floor," James told a pool reporter after the game. "I lost all the fluids that I was putting in in the last couple of days out there on the floor."
As with the body's response to cold, its response to dehydration tends to affect the extremities more. The body pulls fluid back toward the core and the brain as it prioritizes those functions. Smaller muscles like the calves and hamstrings tend to be the first place that exertional cramps hit.
It felt even worse than that to James: "It was the whole left leg, damn near the whole left side."
The muscles are at an increased risk in that zone between dehydration and the point at which the player can no longer play. The muscles are quite literally dry and unable to function normally, which can create strains. When the muscle begins to cramp, those sustained contractions can also create strains. In most cases, this isn't serious, but it will be closely monitored.
I asked Dr. Tim Kremchek, the team physician for the Cincinnati Reds, about this situation and he said "it is generally related to fatigue and dehydration. Dehydration can accelerate in hot conditions. We see this a lot with outdoor athletes in the summer because they will be inside all day where it is cool and they won’t feel like drinking water to hydrate. It is important to hydrate in advance. Once you start cramping up, it is too late."
Treatment is usually simple. B/R's Ethan Skolnick noted that James was receiving IV fluids after the game, which is very standard treatment. This is normally done with a simple Ringer's solution that gets sodium, potassium and other body chemistry into the bloodstream quickly and safely. Unless blood flow is impeded, which it isn't in most exertional cases, the body will recover very quickly.
Recovery is usually fairly immediate. Once the body has enough fluid, the cramping will cease rapidly and in a few hours, the muscles are back to full function. Remember, of course, that there was more than dehydration. There was exertion, so the normal recovery cycle has been complicated somewhat. The medical staff will often use massage or a device like a NormaTec unit to assist with getting the muscles to accelerate the recovery process.
There is a question about whether an athlete who recently cramped is more prone to this kind of issue and if an episode of exertional cramping is similar to exertional heat illness, where it is believed that in the short term, the athlete is at a higher risk of recurrence. The theory is that the body has a protective "memory" and is more likely to start having problems if there's another situation in the near term. In extreme cases, blood work can be done to monitor the body's chemical balance, but this is normally not necessary.
The medical staff for the Heat seemed to focus on the heat more than the dehydration. Several Heat players including James, Chris Bosh and others were seen with bags of ice on their heads and the back of their neck. Given that James said he changed uniforms at halftime—indicating that he was sweating significantly—that focus seems odd, though it is impossible to tell exactly what the medical staff was doing without watching them the entire game.
"Drank a lot at halftime, even changed my uniform, just tried to get the sweat up off of you," James told reporters. "Our training staff tried to do the best they could by giving us ice bags and cold towels on timeouts, keep us dry."
It's also interesting to note that James kept on his compression sleeves despite his cramping. James normally wears sleeves on both knees and one arm, but those serve to retain heat as well as provide compression. With a sleeve over the cramping leg, that would have retained heat and made the situation worse, and would have removed some of the surface area where the body could try to cool itself through sweat and convection.
Of course, the Heat will have to watch James and all their athletes more closely over the next few days. Dehydration is normally self-monitored, with this kind of chart fairly ubiquitous around urinals. A few years ago I was meeting with an NBA general manager and excused myself to use the restroom at the team's practice facility. Every single urinal had a similar color chart printed inside the urinal itself!
In some extreme cases—like high-temperature days on a football field in Texas—a team's medical staff will often resort to simple input and output calculations, asking players to measure their urine and their intake of fluid. A simple bottle can be used to measure the output before pouring it into a toilet or urinal. Hydration calculations are fairly standardized, such as this one from the Korey Stringer Institute, but clearly important.
LeBron James is always watched closely, but for the next few days, the medical staff will be watching him with even more focus.
"I need (the rest), I need it, I need it," James said in that postgame interview. "We're going to start tonight, continue to get the fluids in me and get me ready for Sunday."