Author: Nadia Zaman, DO
Co Author #1: Russell F. Camhi, DO; Primary Care Sports Medicine, Department of Orthopedics, Northwell Health
Co Author #2: Anthony P. Geraci, MD; Institute for Neurology and Neurosurgery, Northwell Health
Senior Editor: Marc Hilgers, MD, PhD, FAMSSM

Patient Presentation:
A 17-year-old male senior football player with no significant past medical history presented to a sports medicine physician's office with bilateral lower leg cramping that began approximately four years ago. The patient stated the cramps started in his calves usually during the third quarter of football games and radiated superiorly into the hamstrings and lower back and were so severe that he was unable to continue playing. The cramps only occurred during football games and not with any other activities. He also played basketball and did not recall having these symptoms. They lasted for three to four days until they resolved on their own. He denied any leg weakness, cramping in the upper limbs, or any dark urine during or after the cramping began. Prior to this appointment, he was seen by his pediatrician and referred to a podiatrist, who prescribed orthotics which provided no relief. He also tried massages, stretching, foam rolling, heat and extra hydration before games without any significant change in his symptoms. He denied taking any new medications, any previous surgeries, or family history of neurological or neuromuscular disorders. Review of systems was otherwise negative.

History:
No significant past medical or surgical history. Mother revealed patient started walking at 9 months of age and was a toe walker from the ages of 2-5 years.

Physical Exam:
BP 115/70 HR 73 H 5ft 8in W 200lbs BMI 30.4
Constitutional: Well-nourished, well-developed, in no acute distress
Musculoskeletal: Range of motion full and painless in bilateral lower limbs
No erythema or edema in the bilateral lower limbs
5/5 strength throughout
Nontender to palpation along medial and lateral malleoli, Achilles tendon, gastrocnemius muscle, or anterior shin.
Reflexes 2+ in Patella, 3+ in Achilles
Sensation intact to light touch throughout

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