The science of LeBron's cramping

Big exertion creates big needs for salt and rest, says the man called "Dr. Sweat"

ESPN—June 8, 2014

With a touch more than four minutes left in the fourth quarter of Game 1 of the 2014 NBA Finals, LeBron James crossed over Boris Diaw, drove hard to the rim and floated a layup. With 4:10 left to play, the ball dropped through the hoop, bringing the Miami Heat within two points of the San Antonio Spurs and setting up what was sure to be another memorable Finals finish from two teams that specialize in them.

And what happened next will indeed be forever remembered, but not for the basketball. What happened next was ... nothing. The most famous and best player in the world landed on the baseline and then stuck there, as if he had grown roots. Play continued at the other end as James eventually waved for help. He would be carried off and would not return.

n the Heat bench, sweltering in a June-in-Texas arena with nonfunctioning air conditioning, one of James' lesser-known teammates, Justin Hamilton, immediately began having flashbacks.

You have probably never heard of Hamilton. The 24-year-old has played in only seven games for the Heat and was in street clothes on Thursday. He was a D-League All-Star this season, averaging 19 points and nine rebounds for the Sioux Falls SkyForce -- the Heat's minor league affiliate -- which earned him the right to sit on the Heat bench since late March.

As Hamilton tells it, not long ago he worried cramps would end his career. If you watch the tape from Game 1, you'll notice Hamilton was one of the first players to come to James' aid -- not just because this is what benchwarmers do, but because Hamilton had been there.

The pain, the helplessness, the confusion. It all came rushing back.

Cramps should probably be called temporary muscle paralysis. That's what really happens. When it hits, according to athletes who experience it and specialists who have studied it, you cannot move. This is not the type of cramp that you get while, say, gripping your tennis racket too tightly or the knot in your neck from cradling the phone on your shoulder. What James and Hamilton have been plagued with is a different thing entirely.

So why was James the only one to cramp up?

In the aftermath of Game 1, there was a notion that because every player played under the same circumstances they should feel the same symptoms. But every human body is different.

And James' body is unlike anything we've seen in the NBA. He's built like an NFL tight end, runs around like a wide receiver and takes hits like a running back. In Game 1, he split time guarding everyone from Tony Parker to Tim Duncan. No one does what he does.

Meanwhile, he's enormous. Muscle mass generates heat in three dimensions, but it can get released only through the surface area on the skin. Imagine the interior of a huge house on a winter day -- it stays warmer because it's so far from an outside wall. The inside of LeBron's muscles are far from the walls.

That James suffers from cramps might seem like a systemic weakness to some, but not to Dr. James Wyss, who specializes in sports medicine at Hospital for Special Surgery and is the team physician for St. John's University athletics.

"I think it's the opposite," Wyss said. "He has such a higher metabolic requirement, and, because of his muscle mass and the way he's able to use his body, he utilizes fluids and energy resources at such a faster rate. Under those conditions, that's part of the reason you can't prevent it as well as a normal athlete."

To Wyss, this is just something that the four-time MVP will have to deal with.

"It's part of the fact that he's the most unique athlete on the planet," Wyss says. "And with that, and the way he uses his muscles beyond what other people can use it, probably makes him more prone to cramps."

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