Ouch! A Pain In My Side!

Anyone who runs, swims, bicycles or plays a running sport has experienced a side ache, a SHARP, intense pain in your lower abdominal area.  This week I had two clients that inquired about side aches which peaked my interest in what a side ache is, why we get them, and how we prevent and/or get rid of one.

A side ache may be called many things:  side stitch, a side cramp, a side crampie, a side sticker or simply a stitch; but its scientific term is “exercise-related transient abdominal pain (ETAP)”.  Whatever it is called it can bring your activity to an immediate halt.  A side stitch is a cramp or spasm in your diaphragm–a dome-shaped muscle that separates the organs in your abdominal cavity from the heart and lungs in your chest cavity. As you inhale and expand your lungs, the diaphragm sinks down. When you blow out a breath, it expands upward. Your liver is attached to the diaphragm by two ligaments, and sometimes running or even brisk walking–which can mean almost 200 pounds of force with each foot strike–can yank the diaphragm downward even as it is expanding upward with each exhalation. The result: a sharp twinge below your ribs, usually on the right hand side, where the liver is located. (www.prevention.com)

Side aches may be caused by many things and research does not provide a definitive explanation, only theories.  Listed below you will find the top four CAUSES of a stitch in your side:

1. Timing of pre-activity meal.
2. Consuming reconstituted fruit juices and beverages high in carbohydrates and osmolality (a measure of concentration).
3. Stretching the ligaments that extend from the diaphragm to the internal organs, particularly the liver. The jarring motion of running while breathing in and out stretches these ligaments. Runners tend to exhale every two or four steps. Most people exhale as the left foot hits the ground, but some people exhale when the right foot hits the ground. It is the later group who seem more prone to get side stitches. Exhaling when the right foot hits the ground causes greater forces on the liver (which is on the right side just below the rib cage). As the liver is dropping down the diaphragm rises for the exhalation and it is believed this repeated stretching leads to spasms in the diaphragm. (Reference Ask.com article)
4. Dehydration.

How to PREVENT a side ache may take some experimenting for each individual.  Below are the most recommended ways to decrease your risk of incurring a stitch:

• Drink water or fluids before and during exercise.
• Two-3 hours before:  15-20 fluid ounces.
• Ten to 15 minutes before:  8-10 fluid ounces
•  Every 10-15 minutes during, 8-10 fluid ounces
• If exercise is lasting longer than 90 minutes it is recommended to drink 8-10 fluid ounces of a sports drink every 15-30 minutes.
• Limit drinks of high carbohydrate and osmolarity, like reconstituted fruit juices, two to three hours before exercising.
• Proper timing of pre-activity meals for digestion.  Eat a light snack 1 hour prior to exercise.  Also, experiment with the types of foods that you eat/drink before exercise (solids vs. liquids).
• Improve your fitness.
• Warm up properly:  start off slow then gradually get faster (increasing exercise intensity) as you jog/run.
• Strengthen core muscles: abdominals, lower back & obliques.
• Run on soft surfaces and go easy on the downhill running, which increase foot strike force.
• Breathe with full exhalation and deep inhalation, focusing on expanding your belly. You can practice this by lying on the couch with a book or magazine on your stomach and lifting it up and down as you breathe. Belly breathing also puts more air in your lungs, giving you more oxygen with each breath.
• Change your breathing ratio.  Your breathing ratio is the ratio of breaths you take in to the number that you breathe out. Since it takes longer to pull air into your lungs than to expel it, you’ll notice that you have a ratio of a certain number of steps breathing in to a certain number of steps going out. Usually this will look something like 2:1 (two steps while breathing in to 1 step while breathing out). If the pattern always results in you breathing with the same foot hitting the ground, this can cause side aches. Practice to change the pattern so that the other foot hits the ground. (Coach Joe English, Portland Oregon, USA.  Running Advice and News)

How to ELIMINATE or LESSEN a side ache once you get one:

• Slow the pace of exercise and breathing, until pain lessens.
• Stop running and place your hand to the right side of your belly and push up while inhaling and exhaling evenly.  Massaging or press on the area where you feel pain, while bending forward slightly.
• Raise your right arm straight up and lean toward the left to stretch your side. Hold for 30 seconds, release, and then stretch the other side.
• Raise both hands above your head and inhale fully, expanding your abdominal and thoracic cavities, then exhale fully, tightening your core muscles to do so until pain subsides.

As local Portland runners prepare for Hood to Coast, in August; the Portland Marathon, in October; my clients and training partners for the Sisters Happy Dirty Girl Half Marathon, in November; and as fall sports training ramps up I hope that this information helps to prevent and /or provides you relief from a side ache.

Jennifer is the owner of PEAK fitness NW and 20 year Certified Personal Trainer & Health Coach.  Her soon to be released 12-week PEAK Ski Conditioning program will include additional hydration and nutrition tips for on the mountain.  Receive new ski, fitness, health and nutrition tips weekly by sharing your name and email to the right side of this blog!

Summer PEAK fitness NW Ski Conditioning programs have begun, in the Portland Metro area!  You can still take advantage of the 2 for 1 Outdoor Fitness Training special.  Go to www.peakfitnessnw.com/events for all the details!  If you have any questions on how you can kick-start an active lifestyle that incorporates the outdoors contact Jennifer Lockwood.  She can be reached at jenn@peakfitnessnw.com or 503.913.8385.