Tuesday, February 05, 2008

Let's Talk Stitches

You probably guessed what my next post was going to be about. That's right, bitches. Let's talk about stitches! (Sorry to use such language, especially directed right at you, but it rhymed and I couldn't resist. No more salty language in this post. Promise!)

So here's the deal. I've mentioned my stitchy problem periodically, most notably in the post about my last marathon. But I want to devote posts exclusively to my nemesis in the hopes of slaying the beast once and for all. And please, do comment any potentially relevant information from your own experiences or advice or insight that might help us get to the bottom of this incredibly annoying problem.

For starters, I think the problem is complex. It's not just a matter of breathing out on the left foot, which I do, or pushing in on my abdomen, which I've tried to no avail, or not eating or drinking x y minutes before running. I am really not sure what contributes to it, but I think it's multiple things and there are potentially multiple causes. So, I am going to start by describing my general history with the stitch. I think there's got to be some clues about why this happens to me in there.

My History with the Stitch

Every once in a while I go through a stitchy period. Back in 2004 when I started running I occasionally got a stitch. I remember a few months after starting up I was running on the treadmill and one came on. I tried to ignore it and keep going. I made it maybe another mile and quit. The next day my side still hurt. So, the next time I got one on the treadmill I immediately jumped off and headed for the elliptical to avoid having my side hurt for a couple of days. The problem at this point was to the level of a very occasional annoyance.

The status of the problem did not change much until I moved to New York in August of 2005. I suddenly had a lot of free time during day light hours as a student so I took the opportunity to start running longer than I ever had before. However, I soon realized that any time I went over 9 miles or so I'd develop a stitch. I thought maybe it was a dehydration problem or something and tried to drink more, but it really didn't help. I only managed about 4 or 5 longer runs like this before getting injured so I never really worked out the kinks of the problem.

I was rebuilding my base for most of the late fall of 2005 through the beginning of 2006. In late January 2006 I started training for my first half marathon. I did track workouts on a track along the East River or workouts on the resevoir path and long runs on the Central Park bridle path. I was stitchy quite often during this time. In my running log I often noted "no stitch!" When I remarked about a particularly bad stitch, I also read things like "exam stress is getting to me" or "feeling really homesick." The stitches tended to be during the ends of long runs or during workouts. Hmmm. Could it be life stress compounded by hard running stress? I moved back home at the beginning of May and ran the half marathon that same weekend. I got a stitch at mile 10 and managed to work it out and still finish a little over a minute under my goal of 1:40.

After moving back home and starting to train for a full marathon, the stitchiness seems to have improved. There's no mention of stitchiness in my running log other than the half marathon in May, June or July of 2006. I recall getting one a few times on an easy run in the evenings on the trails, but I also recall having stressful conversations with mrp about stuff at the park before running too. I know I was still stressed out that summer because I was living with my parents and mrp was living with his parents as we house hunted. It sucked. But, the problem was definitely better than it had been in New York, that is for sure.

Now here's where things get a little weird. In July mrp and I closed on our house. We would go over there on the weekends to work on getting it ready for our move in. One Sunday afternoon was particularly sunny and wonderful and I found myself cartwheeling in the back yard. Here's a tip: if you're over 30, think before doing gymnastics. OUCH! I stretched my side out good and it hurt. I was worried about it, but the pain subsided pretty quickly, so maybe it was no big deal. But then a few days later I caught a cold and a few days after that I started noticing that my side hurt. This is the same side where I get stitches and the same side I hurt doing the cartwheel. I chalked it up to the cartwheel. I didn't even realize it really but the pain kept getting worse and I could no longer sleep on my right side. After sitting for a while I would wince when I stood up. Hmm. One Saturday morning it felt like I was getting stabbed. But I would not be deterred. I suited up to go for a run, but came home after one mile sobbing it hurt so bad. I ended up being diagnosed with pleurisy. It lingered for about 3 months after the diagnosis until it finally went away.

Meanwhile, I hardly ever felt stitchy. There is no mention of stitches in my log from pleurisy diagnosis to my first marathon. And the marathon came and went with no stitches. In fact the next mention of a stitch in my training log is March 31, 2oo7. I got stitchy during miles 13 and 14 of my last long run before Boston. Four days later I got stitchy in the middle of a 3 x miles at marathon pace workout. The next week I again got a stitch in my marathon pace workout. And then shockingly, a week later I battled a stitch from mile 6 to the finish of the Boston marathon. Hmm. Me thinks someone got a little worked up about the marathon!

After Boston, during my Columbus 2007 build-up, stitchiness was almost exclusively relegated to the cool down after a hard run in very hot humid weather. Basically, my abs cramp up when I get dehydrated. The first log entry mentioning a stitch in any other circumstance is a workout on 10/10/07. I did a half-marathon paced wave workout and got stitchy over the second half. It was windy and so I chalked it up to that. I know I had at least one more before Columbus but I was afraid to ackowledge it for fear of making it into a big deal and worrying about it. And of course, I ended with a nasty one at mile 19.5 in Columbus.

Since Columbus, I felt stitchy towards the end of the five mile cross country race I ran in November and over the last 1200 meters of Club Nationals. However, I figured that was from running in muck and having to use my upper body much more than I'm used to. Since the New Year, I've been stitchy a couple of times on a couple of windy runs and of course over the past weekend in New York when I had very little sleep and was under stress from traveling. This past weekend I noticed my back felt stiff, my posture felt off, and my breathing felt weird. I had very little sleep too. Hmm.

So, from all of this I think the common thread is stress. I am wondering if maybe I'm one of those people who carries the tension in my back, which messes up my posture, which in turn messes up my diaphragm. Something to think about, anyway.


Mindi said...

Stitches suck. I went through a period of stitchiness too. And it usually seemed to hit me hard during the middle of a race, just like what happened to you last weekend. I have no idea why I was having a lot of them during that time period (the six months building up to my first marathon). However, I do know they were most likely to hit right after running a downhill hard. Weird? Yes, but in every race I got them, that is when it happened.

I also had some "stitchiness" in the Boston marathon, but I was also nauseated, so I'm not sure what to make of it. But at that time I had a head cold, was definitely stressed (50 mph winds will come!!!!), and of course lots of down hills.

And of course one time I got a horrible stitch during a run or race (I can't remember), and it was so bad it lasted for about 3 days post run. That really freaked me out.

So I'm not very helpful. But I remember during the time I had them a lot I read about them incessantly and the information out there is far from helpful.

What I can do is commiserate. Stitches suck.

Joseph P. Wood said...


I have no advice to offer, sadly, as this sounds like a real bitch of an injury. You do, however, get a healthy dose of sympathy on my end :).

Anyhow, here's what I wonder: is there anything that you can do to try to address this issue: would some basic core work help? A couple sessions of yoga a week? I know you're not swimming in free time and it may eat into a little of your mileage, but if it'll solve the stitch problems.

Likewise, there's always valium...

Greg said...

Here's a probably useless thought. Are the stitches in any way correlated with your diet? I find I get stitches if I run in the afternoon and still have food in my stomach or if I nuts/high fiber food.

Unfortunately, as this article says, "Researchers aren’t sure what exactly causes this pain."

Stitches, I think, are in the same category as Plantar Fasciitis -- everyone is different.

Tom said...

Ok, so I lost a long response in the ether. Short summary - I don't ever get stitches like that, mine are just up and under my ribcage and directly correlate with running too fast and being out of shape.

I'm thinking along the same lines as Joseph - this sounds more muscular. Maybe consider seeing a PT and seeing if you might have a core injury, or a weakness in your core or your back that's manifesting this way?

Good luck with it.

TrainingtoTri said...

I think you assumption about stress is a good one. I get an awful stitch in my shoulder sometimes b/ I think when I am stressed I carry my shoulders too high and don't relax when I run. But if it is stress, it's a hard one to get over! Best of luck.

The Salty One said...

Thanks everybody! Keep those great ideas coming!

Mindy--it is helpful to know it happens to other people too. Sometimes I feel like I must be some sort of freak because you just don't hear about this happening to other competitive runners.

Joseph--yeah, I think a weak core and back may be a factor too. Everything seemed better this summer when I was regularly working on my abs. Perhaps I need to get back to the abs class at the gym. Also, Tinman suggested yoga-type stretches for my abdomen and back so I've added yet more stretches to my daily routine.

Greg--that article is one of the better ones I've read. Thanks! I plan on dedicating a post to what the experts say about stitches. I really don't think diet has much to do with mine since I pretty much have the same routine all the time. But I definitely considered that as a possibility too!

Tom--yeah, I've thought maybe that it's more like an injury than what one typically thinks of a stitch. I have wondered if there is some medical explanation or even a treatment for it. That would be nice!

training--thanks for stopping by. Yeah, stress sucks. I think I need to relax generally so I'll work on that aspect even if it's not the main cause of this problem ;)

DaisyDuc said...

Wow, these sound real annoying. I really have not had too many issues with them. I will get them randomly but they have never been severe enough that I could not focus on my breathing to get past them.

Stress seems like a good logic, expecially after under-going some testing back in 2006.

I wonder if massages would help you at all before big events.

Mindi said...

In continuing Greg's thought....I started getting stitches when I began running higher mileage. I was so hungry so I'd snack on a big bowl of corn & peas a couple hours before running. Yeah, nutritionally it was great, but the extra fiber caused me to have problems so I quickly nixxed it. Too much salad? Seems crazy, but it could possibly cause a problem

Sarah said...

Ok, I feel REALLY bad that you have to deal with these, but almost relieved that I found someone else that gets them as bad as I do. I'm training for a half-marathon, and I have to admit I get pretty pissed off when I know the rest of my body/lungs/muscles can TOTALLY handle it (in fact I feel invigorated, and ready to pick up the pace), but a stupid stitch under my right ribs forces me to stop. Everyone always says "oh, it's just a runner's cramp, just run through it" ...hah....hahaha

No matter how long you run, it only gets worse! And it's not just a little cramp; it's a really intense, acute pain that makes it hard to breath! Here's what I've heard (this may also answer some of your questions, Mindi)..

The "stitch" may actually have to do with the stretching that occurs between the liver and the diaphragm. This is why landing on your left foot as you exhale can help and why running downhill makes it worse. When you land on the foot that's on the same side as the pain, you are basically forcing your liver downward..if you're not breathing out fully, you're also not allowing your diaphram to drop all the way. In all, this causes a huge stretch between the two which might be causing the pain.

What I'm curious about is why I feel the pain in my side for at least a day after...in fact, I only ran 3 or 4 miles yesterday, and I still feel the pain today when I walk or shift my side/lungs at all. THAT is annoying!

Good luck Salty One! All I can say is that I completely understand, and hope that you find something that helps to share with us!

Here is a link where I found some of that information: