What is a side ache?
This was the first question I asked myself, and surprisingly, one of the most difficult to answer. Technically, a side ache is considered Exercise-Related Transient Abdominal Pain, or ETAP for short. Sadly, this cool name gives very little information on what actually causes the achy or sharp pains that bother us as we run.
Currently, scientists remain uncertain of the actual biological origin of side aches, but one favored theory puts forward irritation of the parietal peritoneum (lining of the abdominal cavity) as a possible cause. (Merton)
What factors contribute to a side ache?
While it is difficult to pinpoint the causes of a side ache since we don't really know what they are, research does clarify some contributing factors:
- Age: Older athletes experience side aches less frequently.
- Training: Better trained athletes experience less frequent and less severe side aches.
- BMI: People with higher BMI experience more severe side aches.
- Type of activity: Runners are 13 times more likely to experience side aches compared to cyclists.
- Strength of transverse abdominal muscles- There is a significant decrease in incidence of side aches in people with stronger TVA muscles (The deepest of the abdominal muscles).
- Intake of food: Eating a large mass of food 1-2 hours before activity increases prevalence of side aches.
- Intake of liquids: Consuming liquids with high carbohydrate content (Sports drinks and juice) before and during activity increases the incidence of side aches.
How can I prevent a side ache?
Prevention is truly the best way to avoid problems in workouts and races. Fortunately, enough research has been done in this area to give us some answers.
1. Do not consume large amounts of food for at least 2 hours before running. If you have persistent issues, create a food log to help determine what kinds of food may contribute to your problems.
2. Do not drink sports drinks or juices before or during activity. Save these for after the workout and drink water before and during.
3. Strengthen your transverse abdominal muscles. While we routinely perform many of strengthening exercises together as a team, if you have persistent problems, you may want to add in some on your own. This site has some good suggestions.
4. Complete an adequate warm up before intense activity. This is especially important to pay attention to on race day!
What should I do if I get a side ache?
I hunted through all kinds of treatments and I have listed them below in order from most likely to effective to least. Try these out when you get a side ache and figure out what works best for you.
1. Deep lung breathing- Bring the air deep into the lower part of your lungs and exhale completely. This can help relax some of the tissues involved. This was found to be one of the more effective treatments in the scientific research.
2. Lean forward- You can't do this in a race, but leaning forward was cited as one of the more effective treatments in the research I found. I think this would be a great exercise to perform in conjunction with deep breathing.
3. Keep running with a focus on relaxation- It is very hard to relax while you have a stabbing pain in your side, but on race day you have very few options. Keep your mind off the pain and focus it on maintaining good, relaxed running form and deep breathing. Eventually, the pain will begin to relax away.
4. Stretch your side- In my experience, this has not been terribly effective, but for some, it produces results. It can't hurt, so give it a shot if the options above don't work.
5. Somersaults- I learned this trick from my college coach. Doing 3 somersaults in a row seems to reduce symptoms at least temporarily. If you have a side ache right before a race, this may be a good option to try. You only look a little silly.
6. Crunches- This may work by activating the TVA muscles. Like somersaults, this may be a good pre-race option. This only looks slightly less silly than somersaults.
Ultimately, when it comes to preventing and treating side aches, you will need to figure out what works for you. A smart move would be to record what and when you eat and drink and how you warm up when you experience a side ache. Odds are, you will find a pattern. On race day we need to make sure we are prepared to race, so finding solutions for you is essential to success.
Coach Cook
Citations
Darren P. Morton, Robin Callister, Influence of posture and body type on the experience of exercise-related transient abdominal pain, Journal of Science and Medicine in Sport, Volume 13, Issue 5, September 2010, Pages 485-488, ISSN 1440-2440, http://dx.doi.org/10.1016/j.jsams.2009.10.487. (http://www.sciencedirect.com/science/article/pii/S1440244009007129) Keywords: Posture; Somatotype; Exercise; Abdominal pain
Jason L. Mole, Marie-Louise Bird, James W. Fell, The effect of transversus abdominis activation on exercise-related transient abdominal pain, Journal of Science and Medicine in Sport, Volume 17, Issue 3, May 2014, Pages 261-265, ISSN 1440-2440, http://dx.doi.org/10.1016/j.jsams.2013.05.018. (http://www.sciencedirect.com/science/article/pii/S1440244013001448) Keywords: Sahrmann test; Referred pain; Peritoneum; Ultrasound; Runners
Morton, Darren; Aragon-Vargas, Luis Fernando; and Callister, Robin, "Effect of Ingested Fluid Composition of Exercise-Related Transient Abdominal Pain" (2004). Science and Mathematics Papers and Journal Articles. Paper 40.
http://research.avondale.edu.au/sci_math_papers/40
DP Morton, D Richards, R Callister, Epidemiology of exercise-related transient abdominal pain at the Sydney city to Surf community run, Journal of Science and Medicine in Sport, Volume 8, Issue 2, 2005, Pages 152-162, ISSN 1440-2440, http://dx.doi.org/10.1016/S1440-2440(05)80006-4.
(http://www.sciencedirect.com/science/article/pii/S1440244005800064)
Morton, D. P., & Callister, R. (2000). Characteristics and etiology of exercise-related transient abdominal pain. Medicine and science in sports and exercise, 32(2), 432-438.
Muir, B. (2009). Exercise related transient abdominal pain: a case report and review of the literature.
Morton, D. P., & Callister, R. (2000). Characteristics and etiology of exercise-related transient abdominal pain. Medicine and science in sports and exercise, 32(2), 432-438.
Morton, D. P. (2003). Exercise related transient abdominal pain. British journal of sports medicine, 37(4), 287-288.
Doheny, K. (2013, August 22). How to Stop Runner's Cramps. In WebMD.
photo credits:
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brentbrookbush.com
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