"The Stitch" also known as ETAP (exercise transient abdominal pains).An article written by SDA (Sports Dietitians Australia) got me thinking about my experiences with “the stitch.” Many people probably do not know the struggles I have had over the last 9 years at almost every single run session. Only a handful of times in the past 9 years I have been able to run totally stitch free. I am stoked if I go for a run and I only get a mild pain in my side. It started back at school when I started to race triathlons. I competed for a number of years as one of the top competitors in my age group. I went to 3 Age Group Triathlon World champs and placed 2nd in U19’s in two of them. In 2012, I gave away triathlon for 2 reasons.

I wanted to purse surf lifesaving competing at the World Champs for the NZ team and achieve my goal of competing in the Kelloggs Nurtigrain Ironwoman series.
The 2nd reason, was that I would get the stitch so bad I just hated running and was just not fast enough on the run leg in a race to keep up with the other girls. I was unable to push myself to my full potential as a sharp pain was affecting me more than the burn of lactic acid.

Originally I was told I could be getting the stitch because I had a sudden growth spurt. One year I was sitting in the front row for class photos (with the shorties), then the next year I was standing in the back row with the tall people.A few years past and I hadn’t gown significantly and I was still getting the stitch, so I went to breathing works. Every time I ran on the treadmill in the clinic practising good breathing patterns at a low speed I was able to avoid stitch pains. However, when I tried to run on the road and continue practising good breathing patterns I could only last for so long until it went to shit and the stitch came back. For a month or so about half of my runs were stitch free.Next I tried a cortizone injection under my rib cage. Again this worked for a few weeks but the stitch came back again – Mostly I think maybe this time it was in my head.As well as the techniques explained above I started trying new techniques that I could control pre run such as:

using a power breather to try and strengthen my diaphragm muscles
Eating meals 2-4 hours prior to running
Being well hydrated prior to training.
Eating low fibre foods

During the run when I would get the stitch I have tried and still use some of these techniques:

Holding grass in my hand when I get the stitch
Pushing my finger where the pain is – which causes a counter stimulus
Controlling my breathing and trying to breath from my diaphragm, while running slower
Pursing my lips and exhaling forcefully
Lastly the one that works the BEST which I hate to do is, stop and bend over until the pain is gone. This is the most effective but slows my run time down! And let’s be honest no one wants to see my butt in the air. The toots I get on the side of the road are slightly embarrassing.

My latest technique has been running with an altitude mask. Before you ask, Yes I look like Darth Vader and I refuse to run on the road and around populated areas. My running has been limited to parks, turfs and forests. Since using the altitude mask I have not got the stitch. This makes me think that I need to go back to focusing on diaphragm breathing................................................?For years I have hated running training because of getting the stitch pain so bad I just end up walking the run. In the last few years training for surf and ironwoman races I have come to realise that running is the fastest way to get me fit. I can’t say that I enjoy going for a casual continuous run but I love interval training. I guess the reason is because I can bend over in the rest and get rid of the stitch before the start of the next rep.To this day I still get the stitch pain, more predominantly on my right hand side under my rib cage but sometimes the pain will spread down my stomach and/or it will start on the left hand side. When I do a long distance race I will run through the pain. If I get the pain bad enough it will last for a few days after, which I can feel even when I am walking.Summarizing what researchers speculate how the stitch is caused:

Reduction in blood supply to diaphragm
By our stomach, due to organs bumping into each other
By ligaments that are attached to the liver and the diaphragm become overstretched.
Cramping of abdominal muscles
Downhill running due to altered body posture and running biomechanics
Irritation of the parietal peritoneum- friction between abdominal contents and parietal peritoneum.
Weak core strength

In conclusion the causes are still not well understood.So if you have any other ideas or suggestions let me know. Huge thank you to all the people who have supported me through the high and lows of competitions and running. The times I have been frustrated and taken it out on my supporters because you told me to run faster.I'm sorry!Keep it real!Resourceshttps://www.sportsdietitians.com.au/factsheets/fuelling-recovery/cramps-stitches/?utm_content=buffer5f6ba&utm_medium=social&utm_source=facebook.com&utm_campaign=bufferhttps://coachdeanhebert.wordpress.com/2007/09/24/side-stitchescramps-and-running/http://www.ausport.gov.au/ais/nutrition/factsheets/hydration/cramps_and_stitchhttp://www.livestrong.com/article/528846-pain-under-right-side-of-ribs-when-running/

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