What is Arm Pump?
Chronic exertional compartment syndrome (CECS) is colloquially known as “arm pump” in the motocross world and is a condition that actually affects athletes across a number of different sports where prolonged gripping is required.
However, it’s especially common in motocross, where riders have to make countless throttle and brake inputs over the course of a race. On top of that, they also have to contend with wrestling a 50+ horsepower bike around a variety of challenging obstacles. The cumulative effects of all that can really add up on your forearms.
What Are the Causes of Arm Pump?
Arm pump is thought to be caused by the inability of blood to properly circulate into and out of the muscles in your forearms when you’re riding. In some cases, it can be so bad that riders completely lose their capacity to manipulate their bikes.
Ultimately, CECS happens after your muscles swell up to a point in which they become constricted within their enclosure. Your muscles are actually encapsulated by connective tissue known as fascia.
You can think of your muscles kind of like a sausage, with the meat of the sausage being the muscle belly and the casing of the sausage being the fascia. The issue is that the connective tissue surrounding your muscles isn’t all that stretchy.
So as your muscles continue to swell, they become more constricted by the surrounding fascia, creating a build-up of pressure inside of your forearms. Ultimately, the blood trying to circulate back to your heart cannot escape your forearms quickly enough to be replaced by fresh, nutrient-rich blood when pressure builds up.
Symptoms of arm pump range from minor pain and discomfort, all the way up to complete loss of functioning in the affected area. However, the condition is self-resolving, usually clearing up completely within an hour of inactivity.
Does Arm Pump Affect Everybody?
Arm pump is not a condition that affects all riders equally. While most riders have likely experienced the sensation at some point, it’s a regular occurrence for some and a rarity for others. (1) There are likely a number of different factors -- both genetic and environmental -- that contribute to this general observation.
7 Tips for Preventing Arm Pump
1. Arm Pump Surgery
“Arm pump surgery”, which is technically referred to as a fasciotomy, is becoming increasingly popular in the world of motocross. It’s become so popular in fact, that there have even been multiple studies examining the effectiveness of the surgery on motocross athletes (and athletes from other sports) both in the short and long terms.(2)
Most studies have overwhelmingly concluded that fasciotomy surgery is an effective treatment for chronic exertional compartmental syndrome, otherwise known as arm pump.(3)(4)
Why does surgery work so well? The fascia that covers the muscle is mostly inelastic. This means it cannot stretch to accommodate swelling in the muscle.
Releasing the fascia is much like taking out a seam in your clothes in order to make them larger. It gives the muscle more room to expand.
Having performed several fasciotomies for CECS myself, it is actually quite impressive at the relief patients feel from the procedure.
There are two different forms of the surgery: wide-open fasciotomy (WOF) and mini-open fasciotomy (MOF). Over 90% of recipients of either type of surgery reported being happy with the results one year after the procedure.(5)
Although most research shows that both forms of surgery can be equally effective in the long-term, it’s generally believed that MOF may be better in instances in which a faster recovery period is required by the athlete.
While arm pump surgery appears to be an effective avenue for athletes across a number of different sports, it’s simply not an approach that’s going to appeal to everyone. So what else can you do if you don’t have the desire or means to get arm pump surgery?
2. Make Hydration a Priority
It’s not exactly a secret that in order to perform at your best, whether it’s on the race track or in training, you need to be properly hydrated. Without an adequate supply of water, your body simply won’t be able to meet the rigorous demands that are being asked of it -- that includes your forearms.
3. Get Your Diet Right
Hydration is a good start but in order to really reduce to likelihood of experiencing arm pump when you’re riding, you need to be eating right. Come race day, the average racer will burn as much as 5,000 calories after all is said and done.
While meeting your calorie requirements is an important part of the picture, you also need to be making sure that they’re coming from the right sources. Having a healthy balance of macronutrients in your diet is critical both when it comes to fueling your performance and supporting your recovery afterward.
Carbohydrates are your bodies primary fuel source and should make up somewhere between 45% - 65% of all the calories you consume in your diet. However, all carbs are not equal.
While sugary carbs may give you quick spikes in energy, they also lead to quick crashes, which is certainly not ideal for sports like motocross.
Instead, the majority of your carbs should come in the form of complex carbs, which provide a more gradual supply of energy over a prolonged period of time.
Protein provides the building blocks upon which your muscles are built. Without enough of it in your diet, you run the risk of losing lean muscle mass, which is not what most riders want.
While you want to be nice and lean so that you have a solid power to weight ratio when you climb on your bike, you also need to have the muscle mass it takes to handle your bike with expert precision, which requires a lot of strength.
In order to maintain the kind of muscle mass it takes to do that though, you need to be consuming enough protein in your daily diet.
According to the NIH, between, 10 - 35% of your total calories should be coming from healthy protein sources -- athletes will likely want to stay on the higher end of that range.
Even if you’re eating healthy protein sources like chicken or fish, you still may not be consuming enough protein in your daily diet.
Muscle loss is a problem many motocrossers face come season time and it’s largely due to the fact that eating all that food on top of getting in all of your training both in the gym and on the track can be really tough.
But that’s where whey protein supplementation comes into the picture. Whey is a complete protein derived from milk. Researchers have found it to be amongst the best proteins sources at preventing protein breakdown and muscle loss.
While many people view dietary fat as the enemy, you actually need an adequate supply of it in your daily diet to keep your body and all of its major systems up and running. Organizations like the USDA recommend that between 20 - 35% of your total daily calories should come from healthy fat sources, like nuts, avocado, and olive oil.
4. Do Strength Training
On top of getting your diet dialed in, another thing you can do to prevent arm pump is weight training. However, most riders will want to focus on building strength, not muscle mass when they’re in the gym.
Again, it all ties back into power to weight ratio -- you want to be as strong as you possibly can but also as light as possible. There is no evidence to suggest that having more muscle mass helps to reduce arm pump. However, there is plenty of evidence to demonstrate that too much muscle mass will slow you down on the track.
Motocross is no different than any other sport in that the exercises you incorporate into your routine should have direct applications to your sport. That is, you should be doing exercises that challenge your muscles in similar ways to riding a bike.
So if you’re trying to build strength in your forearms to prevent arm pump, you want to focus on movements that challenge your grip. Exercises like deadlifts, farmers walks, and weighted pull-ups can all be effective for improving grip strength.
Working on lower body and core-related movements like squats and various kettle-bell stability exercises can also help to take some of the strain off of your forearms when you’re riding.
However, you don’t want to just lift as heavy as possible all of the time. Anaerobic endurance is an important component of motocross racing -- you don’t only need to be strong but you also need to be able to maintain that strength over the entire duration of a race.
Therefore, for at least some of your training sessions, try lightening the weight you’re lifting and extending the amount of time you’re holding onto it for.
5. Improve Your Cardiovascular Endurance
Not only do you need to be plenty strong but you also need to have incredible aerobic endurance to be competitive in motocross. Improving your cardio will help to improve your circulation, helping more blood to escape from your forearms when they’re under pressure.
Many motocrossers focus on mountain biking for their cardio-related training because of the crossover between the two sports. However, traditional exercises like jogging can be just as effective for building cardiovascular endurance.
6. Take Supplements to Improve Your Performances
While there are plenty of supplements out there making lofty and even dubious claims, there do appear to be a few different substances that can help with arm pump.
Beta-alanine is an amino acid that your body uses to produce the biochemical carnosine. Carnosine helps your muscles function more efficiently during periods of intense activity by blocking the build-up of lactic acid. (6)(7) Because of its buffering effects on lactic acid, beta-alanine may help to reduce the effects of arm pump in some riders.
The most common myth is that creatine can cause additional water retention in your muscles, which in turn, adds to the pressure build-up in your forearms. However, arm pump is a traumatic condition which is separate and unrelated to any water retention that may or may not occur as a result of taking creatine.
Creatine actually helps to boost your body's production of the adenosine triphosphate (ATP), which is an energy-providing biochemical that plays an important role in muscle contractions. Several studies have demonstrated that creatine supplementation can lead to increases in both strength and endurance over time.
7. Ride as Much as You Can
One thing that can dramatically increase the likelihood of experiencing arm pump is inactivity. Staying active in between competitions is absolutely crucial if you want to reduce the chances of experiencing arm pump come race day.
Logging regular time on your bike will keep your body acclimated to the demands of riding, reducing the likelihood of arm pump creeping in and crippling your performance when it matters most.
- "Chronic exertional compartment syndrome of the forearm in motocross racers: findings on MRI" Gielen, J.L., Peersman, B., Peersman, G., Roelant, E., Van Dyck, P., Vanhoenacker, F., Roeykens, J. Skeletal Radiology. Dec. 2009.
- "Chronic exertional compartment syndrome of the forearm in elite rowers: a technique for mini-open fasciotomy and a report of six cases" Harrison, J.W., Thomans, P., Aster, A., Wilkes, G.,Hayton, M.J. Hand (NY). Dec. 2013.
- "Chronic exertional compartment syndrome of the forearm: a case series of 12 patients treated with fasciotomy" Brown, J.S., WHeeler, P.C., Boyd, K.T. Journal of Hand Surgery. Feb. 2011.
- "Chronic compartment syndrome of the forearm in competitive motor cyclists: a report of two cases" Goubier, J.N., Saillant, G. British Journal of Sports Medicine. Oct. 2003.
- "Surgical Decompression of Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Racers: Comparative Long-term Results of Wide-Open Versus Mini-Open Fasciotomy" Berrera-Ochoa, S., Haddad, S., Correa-Vazquez, E., Font Segyra, J., Gil, E., Lluch, A., Soldado, F., Mir-Bullo, X. Clinical Journal of Sport Medicine. Mar. 2106.
- “beta-Alanine supplementation augments muscle carnosine content and attenuates fatigue during repeated isokinetic contraction bouts in trained sprinters.” Derave, W., Ozdemir, M.S., Harris, R.C., Pottier, A., Reyngoudt, H., Koopo, K., Wise, J.A., Achten, E. Journal of Applied Physiology. Nov. 2007.
- “Effects of Beta-Alanine on Muscle Carnosine and Exercise Performance: A Review of the Current Literature” Culbertson, J.Y., Kreider, R.B., Greenwood, M., Cooke, M. Nutrients. Jan. 2010.
- “Creatine supplementation improves sprint performance in male sprinters.” Skare, O.C., Skadberg. Wisnes, A.R. Scandinavian Journal of Medicine and Science in Sports. Apr. 2001.
- “The effect of longer-term creatine supplementation on elite swimming performance after an acute creatine loading.” Theodorou, A.S., Cooke, C.B., King, R.F., Hood, C., Denison, T., Wainwright, B.G., Havenetidis, K. Journal of Sports Sciences. Nov. 1999.