The Side Stitch

Wednesday, December 9, 2015

We have sequenced the entire human genome. Scientists have all but eliminated Small Pox from the face of the earth. We've even landed a spacecraft on the surface of a comet using rockets, harpoons, and math. But no one really know what causes a side stich when running. Surprised? Yeah, me too. Scientists don't really know what they are, what causes them, or how to fix them. There's plenty of bro science out there giving you tips on how to avoid them but there's no real scientific evidence for their origin. The only thing scientists agree on is what to call side stiches. The official name is "exercise-related transient abdominal pain", because "side stitch" was just too simple.

So what exactly causes a side stitch? There are several main theories. One is that the ligaments under your diaphragm are being stretched. Another theory says it is caused by friction on the peritoneal tissue which is just behind your abdominal muscles. And perhaps the most popular theory is that your diaphragm is spazzing out due to a shortage of blood supply and oxygen when exercising. I don't really care all that much about what causes them. I just know they hurt and I want to avoid them like a Justin Bieber concert.

I've had a side stitch in the last two half marathons I ran. Both times it significantly affected my pace  for a few miles. If you've never had one let me explain what it feels like. On the right side of your abdomen, just below your rib cage you will start to feel pain. The pain comes on slow then develops into a raging furnace of torture. It feels like someone is taking a spoon and scrapping the inside of your rib cage. Not fun. So you want to PR? "No", says Mr. Side Stitch. You want to run fast? "Not today", he retorts.

Common causes guesses of where the side stitch comes from include:
  • Eating or drinking before or during a workout
  • Going too fast
  • Not warming up
  • Breathing too hard
  • Having weak core muscles
  • An imbalance of electrolytes

My last side stitch happened after drinking water at mile 5 of a half marathon. In fact, 50% of side stitches occur after drinking fluid. The pain was severe and it literally made me walk for a few seconds. My pace for the next three miles was over a minute less than normal and I only managed that with considerable pain. There is one sure way to stop side stitch pain; stop running. But that's not really practical in a race.

Some Bro Science ways to avoid and prevent a side stitch include:
  • Stop running (yeah, right)
  • Stretching
  • Control your breathing
  • Slow your pace if you can't stop running
  • Be careful what you eat before a race
  • Make sure you have enough electrolytes before a race
This is my 'post' side stitch face. I had just recovered from a side stitch and was trying to get back on pace.

Now that I've had two side stitches in two consecutive half marathons I'll offer my advice for how to deal with them during a race:
  • Don't drink anything unless you have to.
  • If you have to drink, don't water-board yourself. Stop, take a few controlled sips and swallow before you start running again. Losing 15 seconds for a drink is better than losing 5-10 minutes for a side stitch.
  • It hurts, but it's not causing you injury. You can run through the pain but it's best to stop and stretch and try to relax for 30 seconds.
  • If you are in a race and it doesn't seem to go away after you've tried stretching, run through it. Your pace may be hampered but the pain won't last forever. The side stitch will eventually release after a few miles (or at the finish line). At least that's what you have to keep telling yourself.
  • Concentrate on relaxing and take controlled breaths.
  • Think about something other than the feeling of being prodded with a butter knife on the inside of your ribs.
  • If you feel one coming on but it's not fully arrived yet slow down your pace. This could help prevent a full blown episode.

I hope you never experience the side stitch. They are painful and frustrating especially on race day.  If you've had one, how did you deal with it? What worked/works for you? Have you ever just 'powered through' one?

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