Does HotShot Sports Beverage Decrease the Incidence and Intensity of

Exercise-Associated Muscle Cramping in College Level Athletes?

Patrick Szyller 991320000
Bachelor of Applied Health Sciences Athletic Therapy
patrick.szyller@gmail.com ; 416-301-2943

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 Table of Contents
Abstract 1
Literature Review 2
Causes of Exercise-Associated Muscle Cramps 2
Treatment Options Hydration 3
Electrolytes 5
Muscle Release 6
Hyperventilation 6
Supplementation 6
Experimental Treatment HotShot 7
Methods 8
Limitations and Future Directions 9
References 11
Appendix 13

Abstract
Exercise-Associated Muscle Cramps (EAMC) can be a tremendous nuisance for all
athletes and in some cases, can be strong enough to prevent participation in sport. Although there
are many ways to inhibit EAMCs after they have already formed, there is no definite method to
completely prevent them from forming altogether. A recently released product called HotShot,
composed of a combination of cinnamon, ginger and capsaicin, claims to prevent EAMCs before
they even form. The purpose of this study is to determine the validity of this claim as prior
research on this method is erratic at best. For this study, 2 different collegiate level sports teams
(one soccer team and one football team) will track their incidence and intensity of EAMC
throughout a whole season (practice and games) using a journal. The following season, those
same athletes will consume either the HotShot beverage or a control beverage before every
practice and every game for the entirety of the season and once again track their incidence and
intensity of EAMCs. This between subject design will track the change in incidence and intensity
of EAMCs over the span of two years after consumption of the HotShot beverage. It is theorized
that HotShot beverage, based on its components will bring an end to the formation of EAMCs.

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However, this hypothesis can be challenged, with the notion that both beverages used in this
study will be equally effective in halting the formation of EAMCs.

Literature Review
Causes of Exercise-Associated Muscle Cramps
Exercise-associated muscle cramps (EAMC) are a very common occurrence in all types
of sport. In most cases muscle cramps, will hinder athletic performance, but on some occasions,
EAMCs can become truly debilitating. EAMCs have been defined as painful spasmodic
involuntary contraction of skeletal muscle that occur during or immediately after muscular
exercise;1-6 these muscle cramps self-extinguish within seconds to minutes and are often
accompanied by a palpable knotting of muscle.2 By this definition it would appear that EAMCs
are only developed in athletes, however that is not the case. The first cases of muscle cramps
developed post physical exercise were reported over 100 years ago in miners working under hot
and humid conditions.1,3 During those times, dehydration was often given as the explanation for
muscle cramps occurring in workers and athletes.3 It was easy to make that connection between
hot and humid working conditions and muscle cramps, as it was quite obvious that the miners
were dehydrated and sweating profusely during their shifts. This logic however does not remain
so sound in our modern times, as EAMCs are known to occur in individuals exercising in

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moderate to cool temperatures, and exposure to extreme cold has also been associated with
EAMC in swimmers.1 Delving further into the initial theory of muscle cramp development,
passively heating tissue at rest does not result in EAMC and cooling of tissue does not relieve
muscle cramps.1 With this initial theory having been refuted, what are the causes of EAMC?
Researchers are conflicted by this topic, but there are two generally agreed upon theories for the
development of EAMC.
The first hypothesis for EAMC formation is that cramps result from the hyperexcitability
of motor neurons induced by afferent input, establishing a positive feedback loop (central origin
hypothesis).2,3 This central origin hypothesis is based on the development of constant inward
currents in spinal motor neurons after contraction of sensory afferents.3 This formation of
constant inward currents modifies the relationship between synaptic input and motor neuron
output, creating an amplification of afferent inputs converging on motor neurons during cramp
development.3 Additional support for this theory is provided by findings that cramp-generated
EMG and voluntary EMG are both inhibited by stimulation of tendon afferents.2 In simpler
terms, during muscle cramping there is a huge number of sensory information being sent up to
the central nervous system creating an overload in the motor neuron of the muscle creating a
cramp. The second hypothesis for EAMC formation involves spontaneous discharges of the
motor nerves or abnormal excitation of the terminal branches of motor axons (peripheral origin
hypothesis).2,3 This theory is supported by previous studies in which scientists blocked peripheral
nerves from sending signals to the central nervous system and still being able to create EAMCs
distal to the nerve block by using high frequency stimulation.2 Although these are two opposing
views on EAMC formation, there are some studies that have shown support for both hypotheses.3
More recently there has been a new proposed hypothesis on altered neuromuscular
control for the etiology of EAMCs.3 The hypothesis is based on the observation that
susceptibility to cramping increases after fatiguing exercise.3 In a study conducted by
Schwellnus, it was found that sustained muscle contraction resulted in biceps brachii cramps in
18% of 115 subjects before 20-30 minutes of fatiguing exercise and in 26% following exercise.3
This hypothesis is a further enhancement of the central origin hypothesis, but it takes into
account the time in which muscle cramps usually occur during activity (approaching the end of a
race or game). The timing of the incidence of EAMC may be able to tell researchers what
physiological aspects affect EAMCs.

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 These three hypotheses are different in nature, yet they all depend on the influence of the
nervous system in the formation and development of EAMCs. Although these theories are
heavily reliant on the nervous system, most of the current methods of treatment of EAMCs are
not.
Treatment Options Hydration
The initial theory of EAMC involved dehydration and profuse sweating as the main
causes. The best way to combat dehydration and profuse sweating is to ingest water and
rehydrate in order to rebalance hydration levels in an individuals body. Rehydration is still the
most commonly used method for combatting EAMC, it is predominantly used by laypeople and
often taught to children at a young age. In the field of competitive sport, rehydration is slowly
becoming secondary to electrolyte replenishment in managing EAMCs. In a 2003 study
conducted by Stone, a survey was conducted of 997 ATs in the USA.4 This survey consisted of 4
questions regarding the cause, treatment, success of treatment and prevention of EAMC.4 The
responses were tallied up and ranked to determine the importance of specific factors causing
EAMC and what methods are best at preventing/dealing with EAMCs.4 Through this study, it
was found that despite evidence suggesting there is a neuromuscular origin of muscle cramping,
67.8% of athletic therapists still identified fluid replacement as a top treatment in muscle cramp
recovery.4 89.8% of athletic therapists also identified fluid replacement as a successful
prevention strategy when it comes to EAMCs.4
Another article by Schwellnus, conducted a review on current literature in regards to
EAMC causes and their treatments.1 Through this review article it was found that there is not a
single published article that shows athletes with acute EAMCs are more dehydrated than
controls.1 By measuring pre-event and post-event body weight as a measurement of dehydration,
it was found that those athletes who did experience EAMCs were not more dehydrated than their
control counterparts.1 It should also be noted that the dehydration hypothesis for EAMCs
formation is flawed in that dehydration is a systemic abnormality that occurs in the whole body
during exercise.1 As such, it is unlikely that localized EAMCs would be affected by this systemic
abnormality.1
A further study looked at the effects of serious levels of dehydration on muscle cramp
threshold frequency.7 The study used hydration guidelines laid out by the National Athletic
Trainers Association (NATA). The NATA defines significant and serious hypohydration as 3-5%

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and >5% body mass losses.7 Participants performed maximal voluntary isometric contractions of
their flexor hallucis brevis (FHB) muscles in a hydrated state to determine the threshold
frequency needed to experimentally induce muscle cramps using electrical stimulation.7 On a
separate day the participants returned to complete 60 minutes of intense activity and had their
FHB stimulated again to see if the threshold frequency needed to create EAMCs had decreased
in a dehydrated state.7 The study found that significant or serious hypohydration did not alter
threshold frequency or cramp intensity.7 This further refutes rehydration as an effective
prevention/treatment method when dealing with EAMCs.
Although there is no evidence to suggest that hydration plays a role in EAMC, current
literature also cannot identify with 100% certainty the actual causes of EAMCs. Therefore, it
would be irresponsible to abandon over 100 years of anecdotal evidence regarding the role of
dehydration with respect to EAMC.8 It is in an athletes best interest to be well hydrated before
beginning any type of athletic endeavour;8 even if hydration does not play a role in EAMC, it is
still important for maintaining peak athletic performance and diminishing the effects of fatigue
during sport participation.

Electrolytes
Electrolyte balance has long been thought to play a part in EAMC. It is often spoken of in
conjunction with dehydration as a main player in the creation of EAMC; it is easy to see the
relationship as electrolytes are most commonly lost through sweat amongst other means. Many
studies have documented serum electrolyte changes that occur during endurance exercise,
leading some to believe electrolyte balance has an effect on EAMC. Of the commonly referred to
electrolytes (magnesium, sodium, potassium), magnesium has been shown to play an important
role in muscle and nerve function.9 It is also promoted as the most important electrolyte
supplement for preventing skeletal muscle cramping in athletes.9 A study was conducted in 2004
on ultra-distance road runners where their blood samples were taken before the race,
immediately post-race, and 60 minutes after the race.9 The blood samples were analysed for
biomarkers, specifically sodium, potassium, calcium and magnesium concentrations.9
Researchers found there to be no significant relation between any clinically significant changes
in serum concentrations of sodium, potassium, calcium, or magnesium and the development of
EAMC in ultra-distance runners before or immediately after a race or during the period of

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clinical recovery (Na 139.2 mmol/l pre vs 139.8 mmol/l post vs 140.3 mmol/l 60 min post; Mg
0.81 mmol/l pre vs 0.73 mmol/l post vs 0.75 mmol/l 60 min post; K 4.5 mmol/l pre vs 4.9
mmol/l post vs 4.7 mmol/l 60 min post; Ca 2.2 mmol/l pre vs 2.3 mmol/l post vs 2.2 mmol/l 60
min post).9
Other research articles working with populations that were in heavy depletion of certain
electrolytes (hypochloraemia, hyponatraemia, hypocalcaemia) found that altered serum
electrolyte concentrations can cause generalized skeletal muscle cramping at rest.1 This is only
true however in those specific populations. When looking at athletes with acute EAMC, they are
neither hypochloraemic, hyponatraemic, or hypocalcaemic and do not have abnormal serum
osmolality.1 There is no evidence to support the claim that athletes with a history of EAMC have
higher sweat sodium concentration than their respective controls.1 When considering electrolyte
depletion, one must regard it as they would dehydration in that electrolyte depletion is a systemic
abnormality and therefore cannot explain the localized expression of EAMC.1 Only under
extreme circumstances will the loss of certain electrolytes elicit EAMC, but by the time an
individual reaches that state, they will have many other issues to deal with.

Muscle Release
Slightly less common of a method for dealing with EAMC is muscle
release/massage/stretching. Most often seen in soccer and football fields, athletes will often be
found on their backs with their therapist stretching their calf or hamstring near the end of the
game. A very recent review of the literature found that among other things, massage therapy and
stretching were very commonly used to eliminate EAMCs.10 It has been proposed that the
mechanical pressure during massage alters neural excitability, and that these neural changes may
reduce the potential for cramping.10 Massage was found to decrease spinal reflex excitability
with significant reductions in subjects who received 30 seconds of tapotement.10 With that being
said, further investigation is needed to determine whether treatment variables, such as relative
timing of massage, depths of pressure, speed of stroke, and type of massage stroke, influence
EAMC without negatively impacting performance.10
The review goes on to discuss stretching as a common treatment method and its merits. It
appears that stretching is the most effective treatment in relieving acute fatigue-induced muscular
cramping.10 It has been suggested in this case that passive stretching may increase tension in the

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Golgi tendon organ, resulting in increased afferent reflex inhibition to the alpha motor neuron.10
This treatment would go back to deal with EAMC through the central origin hypothesis.
Hyperventilation
One research study recently looked at hyperventilation as a treatment method for treating
EAMC. The researcher found that after deliberately hyperventilating (taking deep frequent
breaths, 20-30/minute), they were able to resolve their muscle cramp completely within 1 minute
without recurrence.11 Through this result, the researcher hypothesized that hypoventilation and
the resulting respiratory acidosis may be a precipitating factor in muscle cramp development.11
This article is interesting in that the researcher frequently experienced muscle cramps in his legs
during sleep. The author claims that these cramps are exercise-related even though they occurred
in the middle of the night.11 Because of that, it is difficult to relate hyperventilation to the
treatment of EAMC. This would be an interesting treatment method to study further under
conditions of true EAMC in the future.
Supplementation
Supplementation can go hand in hand with electrolyte depletion as many of the
supplementation methods for dealing with EAMC require supplementing electrolytes. In a
review article from 2007, a number of different supplements were discussed for their
effectiveness in dealing with muscle cramps.12 The review article found numerous studies citing
that magnesium, potassium, calcium, vitamin E, vitamin B complex, taurine, and vitamin C all
aid in relieving muscle cramping.12 The main caveat with these findings is that few of them were
in relation to EAMC. Magnesium was found to reduce the severity and frequency in 14 trained
swimmers.12 Apart from that study, the others were conducted on elderly populations
(specifically women post-menopause) or populations with severe illnesses (ie. cirrhosis).12
Experimental Treatment HotShot
With so many varieties of treatment options available for EAMC, it is difficult to think
that there is one product that surpasses all other methods. That is the claim brought forth by Rod
MacKinnon, a renowned Nobel Prize winner, who created a sports drink called HotShot in 2016.
This HotShot beverage is composed of among other things, cinnamon, ginger, and capsaicin.13
This beverage was created after a life-altering experience kayaking off the coast of Cape Cod,
where the creator experienced life threatening muscle cramps (life threatening because he was
far from shore, unsure whether he would be able to make it back).14 Although he had taken

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known preventative measures before leaving shore (magnesium tablets, sports drinks, bananas),
he was still plagued by muscle cramps.14 Using his knowledge of neuroscience, he was able to
hypothesis that muscle cramps are not created at the muscle, but at the nerve.14 By using this
sports beverage before an athletic event or while experiencing a cramp, it will eliminate the
muscle cramp within minutes.14
The HotShot sport beverage works by stimulating neurons in the mouth, esophagus and
stomach.14 These stimulated neurons will send impulses to the spinal cord, overpowering and
inhibiting repetitive signals coming to and from the cramped muscles.14 This series of steps stops
repetitive signals and prevents and/or treats the cramp.14 Essentially, the beverage uses its
spicy/pungent flavour to shock the central nervous system in an attempt to reset it and
terminate/prevent EAMC. Essentially, this product relies on the central origin hypothesis in its
treatment of EAMCs. However, while researching this topic, it has been proven difficult to find
Rod MacKinnons research on this product. Apart from a very pretty website for HotShot, there
is no other reliable, scientific, peer-reviewed information on the product.
That is what lead to this research proposal. The lack of reliable information on HotShot,
is troubling at best, and before recommending this product to athletes it is important to determine
whether or not this product works. And so, the purpose of this study will be to determine the
validity of the claim that HotShot will prevent/eliminate EAMCs when ingested before an event
or during a cramping episode. It is believed that based on the central origin hypothesis, HotShot
will be effective at eliminating EAMCs.
Methods
For this experiment, the participants will consist of ideally 68 collegiate level (18-24
years of age) male football and soccer athletes from McMaster University. To be included in the
study, only those athletes who have not sustained injury from the pre-season onwards will be
permitted to participate. This is to make sure that any decrease in cardiovascular capacity during
injury rehabilitation does not play a role in the incidence of EAMCs. Any athletes who sustain an
injury during the season will be immediately dropped from the experimental protocol.
This experiment will take place over the course of 2 seasons. During the first season, the
participants on both the soccer team and football team will track their incidence and intensity of
EAMCs during all practice sessions and game days. This information will be tracked in a journal
created by the experimenter (Appendix). On every page of the journal the athletes will record the

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date of activity, the type of activity (practice or game, season vs playoff), the incidence of
EAMCs during the activity (amount of muscle cramps experienced), and the intensity of the
EAMC. The intensity of the EAMC will be recorded in one of three categories: nuisance
experience a cramp but able to continue, burden experience a cramp and after less than 5
minutes of recovery time/stretching able to return to play, or debilitating experience a cramp
and unable to return to play that game/training session or return after greater than 5 minutes of
recovery time. At the end of each teams respective first season, the journals will be collected
from all players still included in the study and the number of each category of EAMC will be
tallied.
During the next season, the same players who participated the year prior (barring new
recruits and graduating athletes) will be split up into a control group and an intervention group
based on their journal recordings (researcher will split athletes evenly between both groups so
that there is a near equal distribution of each intensity in both the control and intervention
groups). Once the athletes are separated, the intervention group will be given the HotShot
proprietary sports shot, in an unlabelled container, to consume prior to every game and practice
session during the second season. After each practice session and game, the athletes will once
again record the incidence and intensity of EAMCs experienced during practice and games using
the same journal format as the previous season. The control group will receive the experimental
control beverage (containing a mixture of 1 fl oz of mint extract, 1 fl oz of lemon juice, half a
teaspoon of nutmeg, and 3 fl oz of water), in an unlabelled container, to consume prior to every
practice and game throughout the season. After each practice session and game, the control group
like the intervention group will record their incidence and intensity of EAMCs experienced. At
the end of both seasons, the journals will be collected and compared to the participants initial
journal entries from the first season. This comparison will determine if HotShot truly does impair
the incidence and intensity of EAMCs in collegiate level male athletes. The data will then be
recorded in the form of a bar graph to compare the amount of each intensity of EAMC (nuisance,
burden, debilitating) between the first season and the second season between both groups.
Limitations and Future Directions
This study is going to be a pilot study on the effectiveness of HotShot sports shot in
inhibiting the formation of EAMCs. As such there are not many variables to be adjusted for. With
that being said, future studies on this product or products like it will need to make sure they take

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into account participants diets, as this study will not. It will be important to see if participants
who already have a regular intake of spicy stimuli in their day to day life are at all affected by
HotShot. It would also be interesting to see if individuals who have a diet high in spicy stimuli
have a lower incidence rate of EAMCs than others.
Further down the line, future studies can also look at developing a within subject design.
This proposed study will be a between subjects study. This is important to note as there are a few
disadvantages to conducting a between subject study that are not factored into this proposal.
Firstly, a large number of participants are required to effectively determine if the conclusions of
the experiment are significant. In this proposal, it will also be difficult to control the participants
diets, as they will be free to eat the way they have eaten before the experiment. A future study
should be conducted controlling for intake of cinnamon, capsaicin, or ginger. This will help
determine if the components of the HotShot beverage are the main influencers in inhibiting
EAMC formation.
The components found in HotShot include cinnamon, ginger, and capsaicin. Previous
studies have found these ingredients to be effective anti-inflammatory agents in the body. If this
sports beverage is found to inhibit the formation of muscle cramps in this proposed study, it may
create a link to inflammation being one of the causes of EAMCs. Future research could then look
to see if inflammation during sport can be considered a cause of EAMCs, and if the
reduction/control of inflammation will decrease the incidence of EAMCs altogether.

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 References
1
Schwellnus MP. Cause of Exercise Associated Muscle Cramps (EAMC) altered
neuromuscular control, dehydration or electrolyte depletion? Br J Sports Med. 2009;43:401-408.

2
Minetto MA, Holobar A, Botter A, Ravenni R, Farina D. Mechanisms of cramp contractions:
peripheral or central generation? J Physiol. 2011;589(23):5759-5773.

3
Minetto MA, Holobar A, Botter A, Farina D. Origin and Development of Muscle Cramps.
Exerc. Sport Sci. Rev. 2013;41(1)3-10.

4
Stone MB, Edwards JE, Stemmans CL, Ingersoll CD, Palmieri RM, Krause BA. Certified
Athletic Trainers Perceptions of Exercise-Associated Muscle Cramps. J Sport Rehabil.
2003;12:333-342.

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5
Schwellnus MP, Drew N, Collins M. Increased running speed and previous cramps rather than
dehydration or serum sodium changes predict exercise-associated muscle cramping: a
prospective cohort study in 210 Ironman athletes. Br J Sports Med. 2011;45:650-656.

6
Ge HY, Zhang Y, Boudreau S, Yue SW, Arendt-Nielsen L. Induction of muscle cramps by
nociceptive stimulation of latent myofascial trigger points. Exp Brain Res. 2008;187:623-629.

7
Braulick KW, Miller KC, Albrecht JM, Tucker JM, Deal JE. Significant and serious dehydration
does not affect skeletal muscle cramp threshold frequency. Br J Sports Med. 2013;47:710-714.

8
Buskard ANL. Cramping in Sports: Beyond Dehydration. Strength Cond J. 2014;36(5):44-51.

9
Schwellnus MP, Nicol J, Laubscher R, Noakes TD. Serum electrolyte concentrations and
hydration status are not associated with exercise associated muscle cramping (EAMC) in
distance runners. Br J Sports Med. 2004;38:488-492.

10
Nelson NL, Churilla JR. A Narrative Review of Exercise-Associated Muscle Cramps: factors
that contribute to neuromuscular fatigue and management implications. Muscle Nerve.
2016;54:177-185.

11
Murphy PM, Murphy CA. Hyperventilation as a Simple Cure for Severe Exercise-Associated
Muscle Cramping. Pain Medicine. 2011;12:987.

12
Gaby AR. Nutritional Interventions for Muscle Cramps. Integr Med. 2007;6(6):20-23.

13
Eichner ER. Fighting Muscle Cramps with Two Spices and One Hot Fruit. Curr Sports Med
Rep. 2016;15(5):304-305.

14
Flex Pharma Inc. Team HotShot Web site. www.teamhotshot.com. Accessed Sept 27, 2016.

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 Appendix
Journal Data Entry Page

Date:
Type of Activity (circle that which applies): Practice Game Season Playoff
Number of Exercise-Associate Muscle Cramps Experienced:
Type of EAMC: (nuisance able to play with it, burden able to return after <5 min of
recovery, debilitating unable to return or returned after >5 min)

Cramp Nuisance Burden Debilitating

0 ----------------- ------------------- --------------------

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3
4

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