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May 13th, 2015 | By: Dr. Carvalho | Categorized Under: Blog, Pain Management, Running

Since leg cramps occur for different reasons while running, we must first define the situations they occur in the most. Defining these different situations will ultimately help us understand strategies to both avoid cramps and resolve cramps when they do occur.

“Cramps” are involuntary full muscle actions, in which one’s willpower to relax that muscle is not possible.

Here are two examples that explain when and why leg cramps occur:

1. At Rest: Situations such a sleeping, sitting or standing, are all instances where leg cramps could occur while at rest. When a person is at rest, they are not exerting much effort with any particular muscle.

2. “Exercise-Induced Muscle Cramps (EIMC),” is experienced most often during a lengthy exercise such as running, fast walking, cycling, swimming, or hiking to name a few. The EIMC is also very common in high intensity sports, especially when the performance is of repetitive high-intensity exercise such as tennis, basketball, grappling, downhill skiing, or sprint running (several bouts of 100-400 meters).

Muscle cramps that occur in the legs while at rest, are most commonly caused by impaired “nutrients” that allows the leg muscles to stop contracting. These impaired nutrients include oxygen, fuel (glucose), and electrolytes such as potassium, sodium, calcium, and magnesium. Another common cause of leg cramps at rest, are problems with the nerves that supply the muscles in the legs. These “nerve cramps” most often affect one leg more than the other, but can also affect a person’s legs on both sides.

The delivery of these nutrients to the leg muscles at rest can become compromised by decreased blood supply to the leg muscles due to dehydration leading to low blood volume, low blood pressure. Affected blood circulation to the leg, can also occur because of circulatory problems caused by vascular disease, diabetes and/or smoking.

Impaired blood supply to the legs, can also be related to over-training where the higher intensity, long duration (or both) of the muscle work leads to micro-injuries to the muscles of the legs. As a result of the trauma caused to the unprepared muscles, swelling sets into the soft tissue a few hours later, causing a decrease in blood flow.

The other common cause of muscle cramping at rest, is the low nutrient content in the blood that can be corrected by supplementing a proper mixture of electrolytes and balanced nutrition. Also, several medications can make you more prone to experience cramps at rest, such as certain blood pressure and diuretic medications (water-pills), corticosteroids and others (check the list of potential side effects).

In the past, runners have put effort towards supplementing their fluid intake with electrolytes and energy nutrients, in an attempt to avoid exercise-induced cramps in their legs and feet. These efforts have shown to be somewhat helpful for the less-seasoned runner.

Unfortunately, “unexpected” cramps are known to occur with both the recreational runner and the experienced performers, despite the supplemental intake during training and races.

Dr. Robert K. Clark, professor of Human Physiologist, summarizes the cellular mechanisms for muscle action and describes that energy is needed for both contraction and for relaxation of all muscles. He specifically describes how muscle relaxation can occur after a voluntary contraction while exercising. He explains that energy in the form of adenosine triphosphate (ATP) is necessary to induce the release of calcium in order to generate the contraction of a muscle fiber. However, in the relaxation phase, those released calcium’s need to be “actively” transported out of the sarcoplasm, so the muscle action stops. The transport of these calcium ions is performed by specialized “pump” channels (Calcium ATPase), which also requires the same energy molecule, ATP. Also, the nerve action to the muscle is dependent on another “active pump” (Sodium-Potassium-ATPase) to regulate the rate of muscle contraction-relaxation cycles.  If the concentration of ATP is undesirable, the calcium ions remain concentrated in the sarcoplasm and the nerve is unable to induce the muscle into relaxation. This then results in a sustained and uncontrolled muscle fiber contraction (muscle cramp). The ATP molecule, which is needed to begin muscle contraction, is also needed to cause the muscles to relax. The ATP (adenosine triphosphate) is then highly concentrated and stored in the muscle tissue in much lesser amounts during aerobic metabolic pathway from the common nutrients: glucose, amino acids, and fatty acids.

Our current scientific knowledge and cumulative experience regards exercise-induced muscle cramps as the following:

  • Balance between the ATP production and ATP use is imperative to maintain a long performance. Thus, increasing running intensity (higher speed or running on a leveled changed course) and increasing running distance to an untrained level, is the most common cause of ATP depletion.
  • Early: ATP depletion leads to impaired ability to contract the muscles in the desired fashion, leading to compensation and poor form.
  • Late: ATP depletion leads to sustained involuntary muscle contractions (muscle cramps).
  • ATP concentrations are directly related to the muscle readiness to perform. Lack of adequate rest (recovery) prior to the race or training session is the second most common reason to reach ATP deficit during a race or training.
  • ATP muscle stores increase with specific endurance training.
  • ATP concentrations are poor in damaged muscles.
  • Waste of ATP is found when compensatory running mechanics (poor form) is used due to fatigue, injury or weakness.
  • Nerve supply compromised (like in sciatica), will lead to further muscle damage, decreasing the ATP stores.
  • Muscle imbalance will lead to joint and muscle damage leading to poor electrolyte and ATP storages, and to decreased blood supply due to local muscle swelling.

Solutions: When cramps happen during exercise:

  • Gentle stretching
  • Massage the area to increased blood flow
  • Elevate the legs to decrease blood pulling
  • Hydrate with electrolytes, glucose, and amino acids
  • Rest and decrease the intensity (pace) in order to decrease lactic acid and to ultimately replenish the ATP storage in the muscle.


  • Specific training must be given to the affected muscles, similar to the way muscles work during running. For example, the calves, hamstrings, and shins, have to be trained using ECCENTRIC contractions (CONTROLLING higher load during the “negative” movement phase of the exercise), such as in Lunges Forward, Lunges Sideways, and Lunges Backwards. Perform these exercises and keep track of the difference in strength and or control when loading the right leg versus the left leg. The main goal of these exercises is to achieve near the same strength and endurance on both sides.
  • Train these muscles to perform in both endurance (20-30 reps) and strength exercises, in order to maintain proper mechanics and an efficient running form during the last part of the training session or race.
  • Allow for a full ATP recovery to the largest loaded muscles in running (i.e., calves, hamstrings, shins, feet, hips, low back) before a race with optimal rest, nutrition and hydration.
  • Seek advice from your sports medical professional if these symptoms do not improve despite corrected training and nutritional efforts.



August 23rd, 2014 | By: admin | Categorized Under: Blog, Dr. Claudio Carvalho, Running

  Walking and running is very important as part of an overall fitness and health plan. However, doing these exercises correctly is an even more essential concept to understand. Over the weekend, Dr. Carvalho, Medical Director of FORMA, held a Gait Analysis Review at FORMA for members of A Snails Pace Running Academy - Strength & Conditioning for Runners (SCR) groups from Fountain Valley  and Brea.  SCR athletes were able to receive a detailed analysis of their running and walking biomechanics by viewing video footage captured earlier in the week. Unlike some forms of analysis that merely watch a person walk and run, Dr. Carvalho and A Snails Pace Coaches, Michelle Montiel (Fountain Valley) and Gaby Underwood (Brea), had each athlete view their own analysis on a computer screen that enables them to see their movements in slow-motion and from four different angles. This allowed the SCR Team and the athlete to closely see the details of their “bodymechanics” while walking and running, which reveals in real time the problem areas that affects each athlete’s ability to perform pain-free. The Computerized Video Gait Analysis gives each SCR athlete a visual feedback of the way they walk and run, uncovering each athlete’s limitations and compensatory forms of walking and running. This information is the most objective tool to allow for the coaches to plan training strategies to walk and run pain free… And, to ultimately enhance their performance,” Dr. Carvalho said.

Computer Screen during the Slow motion 4-View for Running Analysis

Computer Screen during the Slow motion 4-View for Running Analysis

May 11th, 2012 | By: Dr. Carvalho | Categorized Under: Blog, Pain Management, Patient Testimonials, Running

When patients leave our facility with smiles on their faces, we can’t help but smile with them.  It seems that many patients experience this pleasure point much earlier in the treatment timeline since we incorporated the Alter-G Anti-Gravity Treadmill into rehabilitation protocols. For most, walking or running never felt so good!

The Alter-G helps patients transition back to their normal, active lives by providing an opportunity to walk, jog and run in a controlled environment sans the painful impact on joints, injury and surgery sites.  Muscles stay strong, normal gait is maintained, recovery is expedited, and most of all, patients feel better about how they look and feel while in recovery.


To date, the Alter-G treadmill has been integrated into the rehabilitation programs of over 70 FORMA patients, with most benefitting greatly in both body AND mind.  First-time users like Susan, an active woman experiencing lumbar pain, said walking on the Alter-G gave her a sense of “floating while working out.”  She said it was the first time in a while that she was able to exercise without suffering from the pins-and-needles sensation she typically feels even after walking her dog Teddy, each night.

There is also a consensus among patients that the Alter-G concept makes perfect sense, adding a more active element to therapy.  Mostly, patients like that they are able to stay fit while rehabilitating, or even improve overall fitness, giving them a head start on a new and more active lifestyle.  This is especially true for those who have been nursing old injuries for years. For those who have been carrying around unwanted pounds, the Alter-G “unweights” them so they can experience what it would be like to weigh less.  Talk about a great motivator!

Rocio’s Story (more…)

April 6th, 2012 | By: Team FORMA | Categorized Under: Blog, Dr. Claudio Carvalho, Nutrition

One of the best gifts you can give your body is to feed it nourishing food full of immune strengthening phytochemicals and traditional nutrients. But what if the apple you eat everyday is hurting you rather than helping? Is it possible for a fiber-filled fruit packed with beneficial antioxidants to kick your immune system into a constant and harmful state of overdrive?

It certainly is! In fact, people are finding everyday the food they once thought supported their health, is slowly deteriorating it. Biochemical individuality plays an enormous role in how our bodies react to certain food and environmental stimuli making what we eat and breathe critical factors in our overall health including, injury recovery, sleeping patterns and weight management.

We also know that eating the same foods everyday, as opposed to rotating foods, can create intolerances and nutritional deficiencies leading to a host of undesirable problems due to an overactive and exhausted immune system. Digestive problems, migraines, sore joints, allergy symptoms, and sinusitis, just to name a few. Can’t loose the 15 pounds that has taken up residence in your body for the past two years? It may not be that you are eating too much; you may just be eating the wrong foods for your body.

Since 80% of the immune system (white blood cells) resides in the gut, food compatibility is crucial. Ingesting incompatible foods pushes the body into a constant “fight mode,” where it continually tries to win over the enemy food invaders. This creates a chronic state of inflammation, and the body loses its ability to properly process ingested foods. This means that instead of efficiently burning fat, the body stores it. The immune system’s job is to attack enemy invaders, but food shouldn’t be one of them.

Medical science now has the tools to detect food, chemical and environmental invaders at a cellular level, in turn, allowing us to assist each patient in customizing their food and lifestyle choices. Typically, within days of initiating an optimum food rotation and irritant elimination plan, patients feel less pain, experience better recovery, begin losing unwanted pounds, and are on the road to a speedy recovery.

The ALCAT Test is one of the amazing tools we use at FORMA that helps pinpoint diet and environmental culprits wreaking havoc on certain bodies. Because the technology measures the body’s cellular response to challenges, the results are incredibly specific making food selection and environmental management easy.

A 2009 study conducted at Baylor University Sports Medicine and Performance Institute in Houston, Texas, found that 98 percent of participants either lost weight and/or improved body composition by following the ALCAT Test.

The ALCAT helps us target each patient’s compatible and incompatible foods, chemicals, and environmental stimuli, as well as outlines a way to utilize this new information. Over 350 foods, medicinal herbs, chemicals, molds, antibiotics, and additives are tested. The process is simple.

  • Your doctor at FORMA determines at what point an ALCAT is indicated to aid in your wellness and injury recovery.
  • A blood sample is taken in our office and sent to a lab where it is combined with various food, chemicals and other factors.
  • Changes in the volume and size of white blood cells are measured in response to the stimuli.
  • Results are available in two weeks and outlined in an easy-to-read format showing incompatible and safe foods/elements, which are broken down by level of reaction.
  • Each patient receives the Standard Test Results, a Rotation Diet, Results Guide, and Wallet-Size Results Card.
  • A four-day rotation diet is specified as a way to reduce or eliminate sensitivities and intolerances over time.
  • Each patient meets with Dr. Carvalho to discuss his or her personalized results and to establish an “action plan.”
  • Most insurance companies cover the ALCAT Test.

There is often confusion about the difference between food allergies and intolerances/sensitivities. A true food or environmental allergy is typically brought on immediately after ingestion or exposure causing severe symptoms such as shortness of breath, swollen tongue, hives and intense diarrhea. Even a small amount of the offender can’t be tolerated. If you know or suspect you have true allergies to certain foods, chemicals or medications, please check with your primary care physician to undergo specific allergy tests (IgE anti-body tests).

Sensitivities and intolerances generally cause delayed reactions sometimes up to two weeks after ingesting errant food or coming in contact with incompatible stimuli. Because of this delay, targeting the offenders can be difficult and time consuming unless a testing tool such as the ALCAT is utilized.

The ALCAT Test is just one of the many tools available at FORMA to help your doctors treat the whole body in efforts to optimize recovery time, and promote long-term well-being and overall quality of life. There is nothing more rewarding or emotionally charging than seeing a patient’s life change dramatically as he or she moves from a pain-filled to a pain-free life.

For more information on the ALCAT Test, or to find out if the FORMA medical staff feels it’s right for you, please call 949.999.0777 today.


Middle East Journal of Family Medicine, 2009; http://www.mejfm.com/mejfmApr09_vol7-iss3/alcat.htm

ALCAT Worldwide, 2012; https://www.alcat.com/clinical_info.php

December 2nd, 2011 | By: Dr. Carvalho | Categorized Under: FORMA Announcements, Marathon Training

Get ready for access to the most cutting edge run training and injury rehab technology the Anti-Gravity Treadmill.  FORMA now offers what until now only a small group of world class runners secretly practice – NASA technology that defies gravity.

The Alter G-Trainer offers personalized precision un-weighting benefits that build run specific endurance without the pain and risk associated with full-weight impact on joints, bones, tendons, and muscles. With a simple touch of a button, a runner can reduce bodyweight in 1% increments, all the way up to 80% of bodyweight.

How does it work?

An air sealed cushion around a runner’s midsection uses air pressure to un-weight the runner – imagine a cork being pushed up through a wine bottle.  Meanwhile, the runner enjoys normal run range of motion – minus those pounds that the runner wishes to eliminate.

Who can benefit from running with Alter G technology?


May 23rd, 2011 | By: Dr. Carvalho | Categorized Under: Marathon Training, Running

Marathon Taper

Prior to any competition , the science of exercise and human performance have shown that better performance is achieved if the athlete schedules a well planned tapering of his or hers training intensity and volume (quantity) just prior to competition, and will follow with a psychological and nutritional preparation, in order to aim for their “peak” in performance on the day of the event. On course, every athlete is a different person and all sports will have a distinct tapering strategy. The objective of the tapering is to maximize ones training gains allowing the body to be fully restored and “recharged”, with a focused mind in order to provide the best output, which the body was trained to do. Veteran athletes and those with a well coach-supervised training plan will for sure have their tapering workouts in their planner. (more…)

May 7th, 2011 | By: Dr. Carvalho | Categorized Under: Blog, Dr. Claudio Carvalho, Running

By Claudio Carvalho, DO, edit by Christy Shaver
Most of us can appreciate the idea to increase our potential of longevity we need to maintain good health. But several studies have shown that weakening muscle strength is directly related to the progress of aging and decline in active life style. Potentially increasing our longevity should include maintaining enjoyable quality of life?

Muscle Strength
We all understand that skeletal muscles are made up of thousands of cylindrical muscle fibers that are bounded together by connective tissue and are responsible for the movement of our bodies. It is also the primary responsible for maintaining our respiratory health through the diaphragm, and dictates our body posture throughout the years. With the exception of the muscles in our heart and the smooth muscles in our arteries, veins and digestive organs, the contraction of skeletal muscles is voluntary, controlled by the spinal cord and orchestrated by the brain. Therefore, by diversifying the exercises with our muscles, we are also promoting the health of our nervous system. (more…)