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Date: June 11, 2000 | Categories: | Running | Topic: Side Stitches

Q. I'm 23 and training hard for several sports from triathlons to marathons. I want to be as competetive as possible. My problem is that when I run mile repeats at a fast pace or when I have a long run where I run faster at the end, I start to dry heave but never throw up. It makes me have to stop running to get my breath back. I think it could have something to do with my breathing, but I am not for certain. I don't know any other people with this problem. I thought you might possibly have heard of this before.

"Retching Yetchen" in USA

A. Assuming you have no specific horrible medical malady - dry heaves have been associated with training that goes into the anaerobic realm and a buildup of lactic acid used to be considered one of the causes of it.

In years gone by, some coaches would keep a bucket at the side of the track for runners who threw up or had the dry heaves. If you didn't stop at the bucket he'd think you weren't giving it your all.

Most of the training today for long distances is done below or just at the AT level. Faster than AT level is only held for a short period of time. Faster than race pace or at faster than 5 K pace should usually not be held for more than 5 minutes. So if you can't do 5 minute mile repeats, then consider 1200 or 1000 meter repeats at your mile pace (usually at 5 K - 10 K pace or a few seconds faster).

While running fast at the end of a long run may mimic race conditions, you are also at a risk for injury at that time. And in your case, you may have exhausted your energy supply. Make sure you stay hydrated on long runs and also use a carbohydrate supplement, such as gels or gu every 40 minutes or so. That will likely give you more energy to go fast at the end of the run. However, you might be very specific in your training and use a long run as just a long run. Run those 16 - 22 milers at 60 - 90 seconds or even 120 seconds slower than marathon pace. Don't run at marathon pace longer than 8 to 12 miles. (and the 12 might be pushing it). And do that on your drop back weeks or no more often than every other week. Use once a week tempo runs to run at your Anaerobic Threshold which is around 6 to 12 seconds or so slower than your 10 K pace. This can be done for up to 20 minutes at a time and may also be a reasonably good speed to do some mile repeats at. Much faster than that won't help a lot for the marathon, although some repeats at 5K pace wouldn't hurt either - faster than that and you won't be helping your marathon program and may be apt to get an injury (or the dry heaves).

Returning to the idea of going fast at the end of a long run: while many elite runners will do mile repeats at 10K pace after a 20 mile run - that would probably not be possible or a good idea for the rest of it. Their mileage base of 120+ miles per week also allows more speedwork to be possible for them.

A couple of books I'd recommend are: Jack Daniel's book Running Formula and Glover's "Competitive Runner's Handbook. They both have good programs and a reasonably good approach to training. Daniel's has formulas to determine what your pace speed should be for training. Online: Hal Higdon's website has some good marathon training programs.

In the meantime - go a little easier on the repeats and think specificity for each of your training sessions: what system are you training and what are you gaining specifically from each workout.

Side Stitches are a little different, but the information is related and is included to be comprehensive.

Side stitches are pains that occur usually just under the ribs when running. It seems that an unconditioned diaphragm is the cause of this pain more often than not. Some other causes for this pain include food allergies (often milk), "gas", or just having eaten before running. Either running a greater distance than usual or at a faster pace than usual will bring this pain on.

The diaphragm is a muscle that separates the chest cavity from the abdomen. It moves down when you inhale and moves up when you exhale. When it is subject to more or faster exercise than it is accustomed to it can "cramp" and cause pain.

Side stitches seem to occur most often on the right side of the body. It is possible that the liver may alter the motion of the diaphragm more on that side because of the larger right lobe.

Treatment:

When it is caused by lack of conditioning a few strategies can be employed. First run slower and longer. Breathe fuller and try "belly breathing" where you allow your stomach to be "relaxed" and pushed out as you inhale and then contracted slightly as you exhale fully. Breathe rhythmically and make sure that you are not holding your breath. You can also try counting your breaths 6 in hold 3 out with a forceful exhalation for a 4 count or whatever seems to work best for you and your running rhythm.

Another breathing tactic that is tried is exhaling against resistance through pursed lips. This combined with belly breathing may be the best approach. To conditioning related stitches.

Also I suggest adding an abdominal strengthening exercise to your regimen such as "Crunches".

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1998 Stephen M. Pribut, D.P.M. All rights reserved. Materials copyrighted by Stephen M. Pribut may be reprinted for personal use only. Permission to reprint or electronically reproduce any document in part or in its entirety for any other reason is expressly prohibited, unless prior written consent is obtained from Dr. Pribut.