Chronic Side Stitches in Experienced Runners: This Ain’t Middle School Anymore

TL;DR

Does anyone else get shooting pain in their abs when they run hard, despite being in the best shape of their life? Me too. But I can help! After seeking a LOT of medical attention, I want to share the things that actually worked for me. Scroll to the bottom for those.

The Problem

On your first day of middle school track practice, as you trudge in dirty slush from the melting snow outside and run 15 wind sprints across the gym floor, you’re pretty much guaranteed to get a side stitch. On day one, there’s a 100% chance that the coach hears this excuse. On day two, and three, and four, it’s still a near guarantee. When you’re very new to running, your body fights back.

Side stitches normally originate in the diaphragm, the sheet of muscle that aids in breathing. Reduced blood flow or muscle spasms can cause intense pain that is nearly impossible to run through. In fact, running through a side stitch, in my experience, can cause soreness for days or even weeks. The only guaranteed solution is to stop running–and, of course, try again later!

A quick google search of “How to get rid of side stitches” yields suggestions like core exercises, deep breathing, better nutrition, hydration, better warm-ups, getting in shape, etc: all important things, and great first steps to combat a side stitch.

But what happens when you’re a strong, experienced athlete who is occasionally completely disabled by shooting side-stitch-like pain during race efforts?

My Back Story

My junior year of cross country, I was standing on the line of the NCAA Regional Cross Country Championships. My teammates were lined up beside me, tattoos displayed on our shoulders like war paint. We were a top-10 team, and we were ready to prove it.

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My first 2 years of collegiate cross country had been an amazing, but by no means smooth, experience. I crashed and burned at Regionals as a freshman, running my worst time of the season.

As a sophomore, I started the season with foot surgery, and entered the Regional Meet with only 3 months of running in my legs. I was sitting in the top-5 until the homestretch, when I became disoriented and blacked out 50m from the finish line. Miraculously, my male teammates were standing on the side of the course right beside where I had collapsed. Their desperate yelling brought me just enough sense to stand up and teeter to the line. I couldn’t manage a cooldown. Instead, I sat on the dusty grass by the timing tent, waiting for the official results. After the official posted the paper, I ran my finger down the results, breathlessly looking for a “Q”… and there it was. I had grabbed the 7th and final individual spot for my first NCAA Championship. A coach from a rival school said she still remembers my face as I broke down into tears. I have found  that breakthroughs happen on their own time frame, and often when you least expect them.

But here I was in my third Regional race, clicking my watch and taking my frantic first steps as the smoke from the Starter’s gun drifted into the wind. My body fell into the rhythm that it knew well… until suddenly–without warning–shooting pain in my right ab. A mile in, coach could tell that something was wrong.

“I have a side stitch” I mouthed, panic filling my voice. I was nowhere near where I needed to be, and falling quickly. He caught us again as we swooped back towards the starting line. I shook my head. I heard his voice fading behind me, “No, you can’t give up now. You need to go for it.” Here I was, crying again. But this time, I wasn’t finished yet. By the time I passed the halfway point, his tone had changed. “Alright Hannah. Don’t lose any more ground. The team needs you.” I ran with my fingers digging under my rib cage, desperately trying to ease the pain.

I finished the race, grateful at least that our team had finished well. I didn’t run again for almost two weeks. You know how it feels when you do WAY too many box jumps and suddenly you’re limping backwards down the stairs? That’s how it felt… But in my abs.

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After that race, it became a constant struggle: Hannah v. abs. Long runs, cross country races, and many track workouts resulted in unrelenting, shooting pain. I saw chiropractors and massage therapists. Trainers and physical therapists. Even a sports specialist at the University of Virginia.

During my senior year, I thought my running career was dying a slow and painful death. But eventually, I (mostly) figured it out. Thank goodness. It still gives me trouble sometimes, but here’s what I’ve got:

Here’s What Works

FIRST. DOC.

If you have abdominal pain, you need to see a doctor. There’s a lot of organs in there, and you don’t want to take any chances. Even if it feels superficial, don’t risk it. Find a sports specialist if possible.

SECOND. STRENGTH/STRETCHING.

Core strength is about much more than just your six-pack. Focus less on crunches. You need to make sure that you have balanced trunk strength in your hips, glutes, low back, and obliques. This is critically important for runners.

Some examples: https://www.active.com/running/articles/13-essential-core-exercises-for-runners

Tight hip flexors can put additional strain on your diaphragm. If you sleep on your side, curled in a ball, or sit down for much of your day, your hip flexors will shorten. If this is the case, take a minute of every hour during the day to stand up and perform this stretch, given to me by Dr. Neider in Harrisonburg, VA (http://functionalchiro.com/):

Do a standing lunge. Maintain the 90-degree angle in your front leg while straightening out your back leg. Keep 90% of your weight on your front leg.

  1. Reach your opposite arm above your head and lean side-to-side in the frontal plane (10x).
  2. Reach both hands in the air and lean forward-and-back in the sagittal plane, making sure to keep weight on your front foot (10x).
  3. Perform trunk twists, making sure to keep your hips squared forward (10x).

Repeat on the opposite side.

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Make sure to feel the stretches in your hips, not your lower back. You don’t need to get as low as this woman, especially in the beginning. These are small, gentle movements.

If you’re in the Harrisonburg, VA area, you can also check out the Center for Hand and Physical Therapy: http://www.center4hpt.com/. They are great! But expensive, just a warning.

THIRD. SELF MASSAGE.

This is pretty critical. Palpate the area where you have pain and see if you can find a muscle knot. If you can, go at it. Use a ball, your fingers/knuckles, or even the end of a rolling pin. Find the spot where it hurts and just apply pressure until it starts to let up. Don’t be afraid to massage under the rib cage or deep into the muscle layers.

You can do this while watching TV, lying in bed, warming up, or even in the middle of a workout if you are having pain.

Again, make sure you get an ok from a doctor before doing this aggressively. But if they rule out any more serious problems, you can be more aggressive than you’d expect.

FOURTH. ROCKTAPE.

I tried K-Tape before I found Rocktape, and it is NOT THE SAME. Seriously, if you’ve tried Kinesiotape and been unimpressed, give Rocktape a chance. It has made a huge difference for me–perhaps bigger than anything else.

Experiment with tape configurations. The most important part is to make the tape “crinkly”. Apply it when the area with pain is stretched, so that when you return to resting position, the tape is pulling the skin away from the fascia. Tight tape has generally not been helpful for me.

Here’s what works for me:

Cut a piece of tape that is about 9 inches long. The tape will originate on the iliac crest and end at the superior end of your abdominus rectus, right where the rib cage ends. To apply, twist away from the painful side and lean backwards for maximum stretch. Do not apply a stretch to the tape.

Cut a second piece of tape that’s approximately 7 inches long. Find the source of the pain and center the tape over it. Lean backwards and apply starting on the lateral side and laying the tape as it falls towards and across the linea alba.

Looks stupid, feels great!

Purchase Rocktape through my referral link: https://shop.rocktape.com?rfsn=903635.cd8cd.

FIFTH. ACTIVE RELEASE TECHNIQUE.

This ish hurts. But it WORKS. Find yourself someone who is not afraid to dig their fingers deep. More importantly, find someone who has a good sense for where your imbalances are. I’m not sure if this is intuition or training, but some people can just “feel” things better.

My favorite ART practitioner is Dr. Donna Sands Annicelli: http://www.wellbodybasics.com/. You can look up ART practitioners in your area here: http://www.activerelease.com/find-a-provider.asp.

SIXTH. BREATHING/FORM.

Lower your arms. Relax your shoulders. Keep your elbows in. Breathe into your stomach. Breathe out sharply when your foot hits the ground. Don’t let your back arch. Push your rib cage down towards your belly button. Push your belly button down towards your low back. Tilt (thrust) your pelvis posteriorly to shorten the length of your rectus abdominis and reduce strain.

Here are some breathing exercises: http://running.competitor.com/2017/09/training/breathing-exercises-every-level-runner_167857

Here’s What Doesn’t Work (For Me)

Kinesiotape

Gentle Massage

Traditional Chiropractics

Salt Tablets

Water

Eating More Before Runs

Eating Less Before Runs

Only Running in the Evening

Icy Hot

Heat

Ice

Mario Jumping and Shouting “WHEE” (Actually this did work once–thanks Kat)

Crying

Praying

Quitting Running (Well this would work but… no.)

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