René’s Joy in Japan

Getting Unstitched


One of the most common afflictions to affect
endurance athletes is cramping of the muscles in the thoracic (ribcage) and
abdominal regions. This is particularly true for runners, due to the excessive
jarring in this area. Not only are the causes misunderstood, but there are no
effective short-term ‘treatments’ other than some debatable (although often
effective) methods.


Cramping, which is muscular in origin, can affect
both skeletal muscle, particularly the stitch that occurs in the chest region,
as well as smooth muscle, such as in the large intestine (causing bloating,
pain and so-called ‘runners gut’).



In the chest, the cause of cramping is normally
fatigue or poor conditioning of the intercostal muscles between the ribs.
During the run, these muscles have two important jobs:

Allow full and effective

Assist with postural and
movement control of the chest and thorax.


This is why stitches are so common at the beginning
of a training programme, or after a lengthy lay-off. The intercostals have
become de-conditioned and fatigue sets in early – the muscles react to the
overload by causing a painful cramp as they run out of energy, normally on the outer
sides, where these muscles are most active.


The cramping will subside when you stop or slow
down, and oxygen and fuel reserves within the muscle return to normal.
Stretching can help, if you need to keep going, but is not a permanent fix. In
the long term, development of correct core stability, postural control and
breathing mechanics during the run are required to prevent this affliction.



Cramping elsewhere is likely due to another reason.
Discomfort and pain in the centre of the chest can often be due to heartburn. If
it occurs on the upper left side of the chest and spreads to the left arm or
neck, and you have a history of cardiovascular issues and poor physical
condition, this may be a form of angina or a cardiac event. Seek medical
assistance before continuing!


Cramping in the lower abdominal region is normally
associated with disturbances of the gastro-intestinal tract. The major causes

Poor diet: Cramping is mainly a response to protect the large intestine from
damage due to jarring and excessive movement, particularly if there is a large
amount of heavy food and fluid in the colon prior to the run. The solution is
to eat appropriately prior to training and racing.

Poor physical
Correct core stability and
abdominal strength reduce the jarring and vibration of the abdominal contents.
Correct posture whilst running, as well as all-round function of the joint
stabilisers and a running style that reduces the up-and-down movement of the
body will also help.



It occurs with increased incidence in older
runners, as the abdominal membranes that keep everything together get more
relaxed as you age. The colon responds to this extra movement by trying to
remove the ‘offending’ items. Peristalsis (the rhythmical contraction of the
smooth muscle around the intestines) goes into overdrive, which manifests as
painful cramping. In addition, the body also increases the amount of fluid in
the colon to assist with the removal of the irritation, which can increase the
risk of dehydration in hot conditions.


In many cases the result of cramping is a
diarrhoea-like condition, and the cramping can continue for long after the
session or race. In many cases you can try to soldier on in immense discomfort,
but may have to end or modify the training session, or pull out of the race.



Eat and drink wisely in the
four to six hours prior to your run.

Reduce acidity levels in
your diet, and improve the microbial flora in the system.

Maintain normal fluid
intake during the run (don’t over-hydrate).

Improve your all-round
strength and core stability.

Reduce body mass and body
fat levels if they are excessive.

Work on correct running
posture and style.

Don’t go out too hard, as
this will likely start off the disturbances.

Reduce the frequency of
hard runs, and make use of alternative exercise (such as cycling) to allow the
system to recover in between.

If the above solutions
don’t improve the condition, seek medical advice.


Zac holds a Bachelor of
Physical Education degree as well as a Master of Science degree in Medicine
(Exercise Physiology). He has worked extensively with both local and
international athletes and teams, and is the founder and co-owner of Exercise
Solutions at the Morningside Centre for Sports Medicine in Johannesburg.