Run Smarter: Side Stitches in Running - RCNW May eNewsletter

We have all been there. Everything is humming along just fine on our run or perhaps, even in a race... Then it creeps in like a very unwelcome stranger. Denial is followed by alarm leading you to the conclusion that you are now the victim of a side stitch. Not me (!) you think to yourself as the reality descends upon your abdomen. You review your fitness, diet and pre-run ritual in a nanosecond, which only further compounds your disbelief. At last it is accepted as a mysterious occurrence and the thoughts shift to management of this performance debilitating condition.

Side stitch, side ache, side cramp are all names for the same frustrating ailment most runners have been stricken with one time or another. What exactly is this condition and more importantly, how do we prevent it?


Referred to in research as Exercise-related Transient Abdominal Pain (ETAP), the side stitches occurrence has been reviewed in research on large samples of athletes via questionnaires. Interviews with athletes from various disciplines, including running, has shown us that ETAP appears to be a single condition manifested in the right or left lumbar regions of the abdomen. The sensation was described by these athletes as cramping, aching, pulling or even with greater severity in sharp stabbing pains. The research questionnaires have also illustrated that with these athletes that have more frequent training, ETAP is less often experienced. Additionally it was revealed that the groups most frequently afflicted with this condition were runners and horse back riders! Unfortunately, all current research has been able to provide is hypotheses as to what it may be by what ETAP is not. It is hypothesized that the Parietal Peritoneum (surrounds the abdomen just inside of the abdominal wall) and the innervations of this with branches of the phrenic nerve may play a significant role in the onset of the side stitch. Simply stated; the theory is that the irritation of a nerve stemming from the facet joints on the spine (the joints made by the little 'arms' coming off each section of vertebra) may receive friction from an unknown source triggering the pain we know as ETAP or a side stitch. This hypothesis was developed out of the coincidence with shoulder tip pain in many suffers of the side stitch. So what do we do with this knowledge?


What to do

Given this investigative research yielding no hard conclusions to the cause of the side stitch, what are we to do to prevent its onset? Before you consider voodoo or other supernatural solutions, consider the recommendations of researchers and other doctors in the field of sports medicine. The relationship with the spine has been associated with the possible explanation of the aggravation of the phrenic nerve. Researchers found that people with kyphosis (a curvature of the spine) and certain palpations of the facet joints of the spine would reproduce ETAP. Morton, a leading researching in the causes of ETAP, concluded by suggesting that: "These findings may indicate that efforts to optimize spinal integrity may be important in the management of ETAP."
There we have it; Morton has provided a new insight into a potential relief from the side stitch.

From this I have accumulated the current and comprehensive strategies for avoiding ETAP.

a. diet before run

b. diaphragm breathing

c. abdominal exercises prior to running

d. pressure when you exhale

e. adjusting the foot that falls on exhale

f. lying down elevate hips


Diet before the run
Long it has been thought that the pre-run diet is the culprit of the side stitch and this may be a contributing factor. Recent research on the association of fluids with ETAP saw an increased occurrence of ETAP with the ingestion of a variety of hypertonic fluids (concentrated solution: energy drinks, soda, etc.) directly before intense bouts of running. Therefore we can conclude one would be wise to avoid concentrated drinks and foods 2-4 hours prior to running.


Diaphragm breathing
Yoga or belly breathing is a technique that all runners should learn. In the Lore of Running by Tim Noakes, MD he describes this as "breathing with predominately the diaphragm, rather than with the chest muscles. With belly breathing the chest hardly moves at all. Instead, the abdomen (stomach) appears to be doing all the work, for as you breathe in, the stomach goes up, and when you exhale, the stomach retracts." A simple exercise for practicing belly breathing is to lie on the back and place a heavy book on your stomach. Inhale such that the book will rise then exhale allowing the book to come back down in a gradual manner. This takes the movement of the upper chest out of the breathing cycle and creates long fluid cycles of breathing like those practiced in yoga. If we are to embrace the possibility that the aggravation of nerves in the thorax play a role in the side stitch, I feel this breathing technique is instrumental in avoiding ETAP.


Engaging the abdominal and back muscles prior to running
If we accept that the position and movement of the spine may play a role in the occurrence of ETAP, then it is logical that ETAP may be avoided by development of the abdominal and back muscles. To maintain tone in these muscles and engage them prior to running, one can incorporate both pelvic stability and circuit training routines in to the training program before running.

What to do when ETAP appears
If, despite our best efforts, ETAP rears its ugly head during a run there are three strategies for managing it.

Forced exhale
When the location of the stitch is identified, exhale so as to produce pressure in the area of the stitch. With some practice this can be performed while running. This is an effective strategy when ETAP is first felt.


Switch the foot fall when you exhale
Whether you realize it or not, you likely have a series of breathing patterns that you engage while running. These breathing patterns may have you exhaling on the same foot fall with each breathing cycle. On your next run observe how many breaths you take for each footfall and on which foot you exhale. If find yourself exhaling on the same foot each time, then attempt to adjust the foot that lands on the ground during your exhale the next time ETAP appears. This may shift the jarring motion of your contact with the ground, adjusting pressure in the spine enough to squelch ETAP.

If all else fails, stop running
But not forever. If the above techniques prove ineffective at minimizing the effects of ETAP to allow you to run. Lie with your back on the ground and elevate your hips. This technique suggested by Noakes allows for rapid relief of the side stitch and for differentiation of the stitch from other ailments such as chest pain from heart disease.


Literally a pain in the side, the side stitch can seriously compromise your running. Although the exact origins of this trouble are still a mystery to researchers, armed with a regular routine of yoga style breathing, core stability training, and avoidance techniques to offset ETAP on the run, all runners should be able to keep ETAP at bay.


Long may you run,
Sean Coster

Complete Running Programs offers lactate threshold performance tests for runners and cyclists of various abilities. For more information check out this information on lactate testing.

For more writings on training, motivation and philosophies in distance running visit Sean's blog at www.seancoster.org/runningportland or www.crpusa.com

Copyright 2008 Complete Running Programs - May not be used without permission of the author.

Bloomsday Champion Aims for Fourth Win

(4-29-08) From Press Release - John Korir of Kenya is the only three-time men's champion in Bloomsday history, and this Sunday he returns to Spokane hoping to add a fourth title to his impressive road racing resume. Korir's previous titles came in 2003, 2005 and 2007, and a win in Bloomsday '08 would give him bragging rights as the greatest champion in Bloomsday history.

"John Korir is a great competitor," said Jon Neill, Bloomsday Elite Athlete Coordinator. "He knows the course well and is the clear favorite coming into this year's race. But he'll be running against a formidable field, so he'll have to be on top of his game to notch that fourth victory."

This year's elite field includes Bloomsday 2006 champion Gilbert Okari of Kenya, who was slated for a match-up with Korir in 2007 until he had to scratch from the race one day prior to the race due to injury. Okari's 34:14 finish in 2006 ranks 9th all-time on Bloomsday's list of fastest finishes. Korir ran 34:18 in 2007 12th all-time.

Okari and Korir will have a great matchup, but they'll also have their hands full with other notable competitors, including Micah Kogo (Kenya) and Dieudonne Disi (Rwanda). Kogo was the #2 ranked Running Times Road Racer of the Year in 2007, and ran 27:29 in the 2008 Brunssum Parelloop 10K on April 6th. Disi's resume includes a sixth place finish in the 2007 World Half Marathon championships, where he clocked 59:32. In addition to Kogo and Disi, Bloomsday 2007 2nd and 3rd place finishers, John Yuda (Tanzania) and Julius Kibet Koskei (Kenya), return and figure to be in the hunt for the title.

The strong men's field also includes Nicholas Kamakya (Kenya) and Riduanne Harroufi (Morocco), who are vying for the Professional Road Running Organization (PRRO) Championship Circuit bonus of $30,000. To be eligible for the bonus, a runner must win two of the circuit races and also the Peachtree Road Race on July 4, 2008 in Atlanta, Georgia. The circuit races are the 2007 Utica Boilermaker 15K, the 2008 World's Best 10K, the 2008 Cherry Blossom 10 Miler, and the 2008 Lilac Bloomsday Run. Kamakya, winner of the Boilermaker, and Harroufi, winner of the Cherry Blossom, need a victory at Bloomsday for a chance to win the $30,000 PRRO bonus at Peachtree.

The 2008 Bloomsday men's elite field will feature athletes who have run five of the ten fastest road 10K times in the world for 2008. Included in that list are Kenyans Micah Kogo; Moses Kigen (27:44), champion of the 2008 Crescent City Classic 10K and 2008 Azalea Trail Run 10K; Robert Letting (27:45), winner of the 2008 Cooper Bridge Run 10K; George Kirwa Misoi (27:48); and Linus Maiyo (27:52).

For the women's field, a new Bloomsday champion will be crowned, as last year's champion, Edna Kiplagat, will not compete. With the title up for grabs, Catherine Ndereba, 2007 World Marathon champion and 4-time Boston Marathon winner, will be one of two returning Bloomsday money winners from 2007. Her participation in Bloomsday comes on the heels of the Kenyan federation's April 23rd announcement that Ndereba will represent Kenya in the Olympic marathon. Ndereba placed 4th at Bloomsday last year in a time of 39:57.

Along with Ndereba, Genoveva Kigen of Kenya is expected to challenge for the victory on Sunday. Kigen's victories this year include the Azalea Trail Run 10K and the Crescent City Classic, and she also ran an impressive 15:41 at the Carlsbad 5000, where she finished 3rd.

"Genoveva's performances from this spring," noted Jon Neill, "along with her sizeable margins of victory in the races she won, show that she is coming to Bloomsday ready to challenge for the title."

Cherry Blossom 10 Mile Champion Lineth Chepkurui is the most likely challenger for Kigen and Ndereba. Bloomsday will mark the first time Chepkurui and Kigen have faced one another in 2008. Chepkurui placed 12th at the 2008 World Cross Country Championships held in late March. In addition, Ethiopian Genet Gebregiorgis, who is fresh off a first place finish at the Vancouver Sun Run, will also be a front-runner, as well as Kenyans Angelina Mutuku and Millicent Gathoni.

In the masters field, Bloomsday 1996 and 2002 champion Colleen De Reuck of Boulder, Colorado will be tough to beat. On April 26th De Reuck ran a 34:17 to earn the title of the 2008 USA Masters 10K Champion.

This year's wheelchair competition also promises to be hotly contested, as 2007 winners Saul Mendoza of Mexico and Amanda McGrory return to defend their titles. In addition, Bloomsday this year will host the second annual collegiate team competition, with strong wheelchair fields from the University of Illinois and University of Arizona vying for the team victory. Each team will be scored based on its top two male and top two female finishers, plus one quad competitor. Last year the University of Illinois won the inaugural title.

While elite athletes are vying for top placings and over $56,000 in prize money, over 47,000 runners, joggers and walkers are expected for the 12-kilometer trek, an increase of 3,000 over last year. There will be twenty-six entertainment stations along the course, and participants will be able to vote for their favorite performers by logging on to the Bloomsday website after the run. Entrants will also spend a fair amount of time during the run wondering what the 2008 Bloomsday T-shirt will look like. The color and design of the shirt are kept secret until entrants reach the finish.

For more information about the Lilac Bloomsday Run, visit www.bloomsday.org

WCSN.com to Offer Free Live Webcast of 112th Boston Marathon

(4-16-08) From Press Release - World Championship Sports Network (WCSN), the premier destination of Olympic and lifestyle sports, announced today it is joining forces with adidas and MarathonGuide.com to provide a free, first-ever global webcast of the 112th Boston Marathon. Through this partnership, fans worldwide can logon to WCSN.com to watch the live and on-demand webcast on April 21, beginning at 9:25 a.m. EST.

"We're excited to partner with adidas and MarathonGuide.com in offering this free webcast and to help foster worldwide awareness for this major race," said Carlos Silva, president and COO of WCSN. "Now, for the first time global road racing fans will have unprecedented coverage to see the top marathoners square off in one of the world's most prestigious sporting events."

On WCSN.com, running fans can also access Marathon Madness, a special editorial package that features original content, articles from road racing experts, interactive maps, results, highlights and more. Furthermore, WCSN.com will be offering special commentary from running legend and four-time Boston Marathon winner Bill Rodgers.

"Adidas is proud to join WCSN.com in providing a free internet broadcast of the 112th Boston Marathon," said Spencer Nel, head of global sports marketing for running and track and field at adidas. "As a Boston Marathon sponsor, adidas is especially pleased to help bring the oldest continuing annual marathon in the world to as many viewers as possible in every corner of the world. With its proven track record WCSN.com is the ideal partner to make that happen."

"Since 2000, MarathonGuide.com's mission has been to promote the sport by providing comprehensive coverage of and information about marathons and distance running. As part of that mission, we are proud to work with WCSN.com and adidas to ensure that the Boston Marathon broadcast will be available at no cost and can be enjoyed by as many marathon enthusiasts as possible," said John Elliott, founder and president of MarathonGuide.com.

Deemed one of the world's most prestigious and oldest annual road racing events, the Boston Marathon is the second stop on the World Marathon Majors, a marathon series offering a $1 million prize purse to be split between the leading male and female marathoners in the world.

WCSN.com is the home of the 2008 World Marathon Majors with complete coverage of the London, Boston, Berlin, Chicago and New York City races. Marathon fans around the globe can catch the action on www.wcsn.com where they can be part of the more than 500,000 spectators anticipated to be cheering on the runners as they dash through the streets of rural Hopkinton to the beautiful Boston Back Bay finish line at Copley Square. Fans will also have access to complete live and on-demand video footage plus free access to news, race results, photo galleries, behind-the-scenes features and more.

Race Report: 2008 Spring Classic Duathlon

(4-15-08) Submitted by Dave Campbell - What a beautiful day for a race! After a long, wet, cold winter of training, nearly three hundred Northwest athletes gathered joyously in warm, sunny weather Saturday, April 12 along the Columbia River just outside Portland. The Spring Classic Duathlon consists of a 5k Run, 15mi bike, and 5k run and although the roads are flat, the winds on Marine Drive make the race challenging for early season fitness testing. The courses are all simple out-and-backs with the run going in opposite directions and the bike course featuring frequently changing winds. Heading out to the first turn-around, even the strongest cyclists struggled to maintain 18 mph while going 30 in the opposite direction.

26-year-old Josh Monda from Vancouver, WA led the race from start to finish to win in 1:14:14 with a victory margin of over a minute and a half. Monda blasted through the first out-and-back run in an impressive 16:54 and was fifth-fastest on the bike behind uber-cyclist Matthew Wolpert, who laid down a blistering 36:41 en route to second overall and age group win. Monda closed out the race with the fastest second run of the day - an impressive 18:07 in the rising winds, to claim the victory. Jeff Henderson of Portland was third overall, just 28 seconds behind Wolpert. 41
-year-old Sean Campbell of Klamath Falls was the Masters winner after placing 5th overall in 1:17:27.

The Women's race was much closer with Jenn Mock of Camas, WA, leading in the first run in 19:22 and hot on the heels of many of the top men, including me. Kristy Aalberg posted the fastest bike split in 42:50, but 40-year-old Angela Thatcher was just four seconds slower, and the new leader going into the final run. Thatcher, of Sherwood, OR who had been a minute down in the first run was the second-fastest woman in the finale to take the victory overall and in the Masters, with 1:26:44 and Mock just 42 seconds back and winning her age group after a tough second run. Aalberg, another Masters athlete was third, just five seconds behind. 60-year-old Lauren Binder of Portland was one of the most impressive performers of the day, less than nine minutes behind the winner is a stunning 1:35:19.

The top relay team on the day were women: Nicole Gibbons (run) and Casey Holland (bike) of Tualatin paired up to post 1:29:50, nearly three minutes ahead of second place Team Thompson.

The next major multisport race in the area will be the Heart of the Valley Sprint Triathlon May 26 in Corvallis. The swim is in the Osbourne Aquatic Center's Long-Course Pool and should serve as a nice prep for athletes looking towards the Blue Lake Triathlon in mid-June. Despite the fabulous sun, the weather will still offer ample challenge so keep training, keep smiling, and I will see you at the races!

Record Turnout at Race for the Roses Raises More Than $175,000 for Local Charity

(4-10-08) From Press Release - With 3,414 racers it was a record turnout for the 10th Annual Race for the Roses on Sunday, April 6. The half marathon/5k raised more than $175,000 for Albertina Kerr Centers, a nonprofit organization based in Oregon for 101 years.

A volunteer committee was integral in planning the event, including Chairwoman Tiffany Hambro, Kara Bekooy, Rivah Feldman, Allison Gourley, Bob Gravely, Jeremy Hyatt, Terri Kunkel, Rochelle McIntire, Amanda Meyer, Heidi Nielsen, Rex Schultz and Jason Yamamoto.

Additionally, there were almost 200 volunteers on race day, and a total of 1,091 volunteer hours were dedicated to planning and implementing the race.

Title Sponsor was Regence BlueCross BlueShield of Oregon. Presenting sponsor was Health Net. Platinum sponsors were CLIF Bar, Entercom, Trimet and Mazama Capital Management. Gold sponsors were Legacy Health System, Stoel Rives LLP, Fit Right Northwest Running and Walking Store, Nike, Portland Valve & Fitting Co., RiverPlace Athletic Club, Team in Training, Tillamook and Willamette Week.

"An event of this magnitude isn't possible without the support of the entire community," said Chris Krenk, President and CEO of Albertina Kerr Centers. "We are grateful to everyone involved for helping us raise vital funding for our programs."

Albertina Kerr Centers is a leader and innovator in building stronger families, working together with the community to create healing for children with emotional or mental health challenges and to support self-determination for people with developmental disabilities. A private, non-profit organization headquartered in Portland since 1907, Kerr spends 91 cents of every dollar to help Oregonians. Private donations and community support make this vital work possible. Albertina Kerr Centers, 424 NE 22nd Avenue, Portland, Oregon 97232. 503-239-8101, www.albertinakerr.org.

Complete race results from the 2008 event, as well as results from past years can be found on RaceCenter.com. Additional information about the 2009 Race for the Roses will be posted on their Web site in the coming months at www.race4theroses.org.