Side Stich and Inspiratory Muscle Training
By Coach Matt RussAfter completing a running base phase of predominantly aerobic level training, your first “warm up” race of the season looms ahead. As with all races you want to produce a good result that demonstrates progress in exchange for the effort you have put forth. The gun goes off and you are running hard, but after a while a pain starts to develop just under your rib cage. It starts on your right side and grows in intensity, perhaps spreading. The harder you push, the more acute the pain becomes, but if you slow down it abates just slightly. It precludes you from taking a full breath and makes the race fairly miserable. After crossing the finish line, the pain subsides after a few minutes.
If this scenario sounds familiar, you have likely experienced “runners stitch,” a fairly common malady that affects as much as 60% of all runners (although not exclusive to the sport of running). There are many theories as to what causes runners or side stitch but the exact cause remains unknown. Theories include stress in the suspensatory ligaments, particularly on the right side where the (heavy) liver is located, friction of the parietal peritoneum of the abdominal wall, or ischemia (lack of blood flow) of the diaphragm; the latter theory probably having the most traction. There is evidence that eating too much several hours prior to an intense race or work out can exacerbate the side stitch. This is perhaps a result of the increased bulk of food in the gut, or perhaps because the digestive process pulls blood away from the diaphragm.
As a coach I have noted a few circumstantial situations in which side stitch is much more prevalent:
• During races in which running intensity is high. Side stitch seems much less prevalent during training or in longer events in which relative intensities are lower (ex. 5k vs marathon).
• Early in the season or after a transition phase in which high intensity training is not as present and the body is not acclimated to it.
• When the athlete is racing “out of bounds” or at an intensity that they have not trained or peaked for, or if there is a large discrepancy between training and racing intensity.
If you believe that side stitch is caused by spasm or lack of blood flow to the diaphragm then these circumstances make logical sense. The diaphragm is a muscle and if it is not trained for the work load it is being forced to do it will overload. As higher intensity training is introduced, the diaphragm adapts, becomes stronger, and is more able to work harder or at a faster rate of respiration. This is a simple adaptation of training.
Can the inspiratory muscles be trained or strengthened without undergoing intense sport specific training? This is currently under study and the results are compelling. One study showed that under stress, blood is diverted away from the limbs and to the inspiratory muscles , giving them perhaps a higher priority over skeletal muscles. If this is true, in theory, strengthening them would promote more blood flow to the working skeletal muscles. An inspiratory muscle training device is an ergogenic aid that forces you to breathe against resistance, as if breathing through a small straw. Air flow can be adjusted as the diaphragm strengthens, essentially adding more “weight” to overload the muscles.
If you are experiencing side stitch, training the inspiratory muscles may help overcome it. Although not a proven clinical means of preventing side stitch, the logic of training the inspiratory muscles is sound and there is little downside. Training devices are relatively inexpensive and portable, training protocols require only a few minutes per day, and a stronger diaphragm is a desirable training outcome. The devices may also help improve deep breathing technique and are used in treating exercise induced asthma (EIA).
[1]
Journal of Physiology 2001; 537:277-289
Matt Russ has coached and trained athletes up to the professional level, domestically and internationally, for over 15 years. He currently holds an Expert license from USA Triathlon, an Elite license from USA Cycling, and is a licensed USA Track and Field Coach. Matt is Head Coach and owner of The Sport Factory, and works with athletes of all levels full time. He is a free lance author and his articles are regularly featured in a variety of magazines and websites. Visit www.thesportfactory.com for more information or email him at coachmatt@thesportfactory.com
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