The Side Stitch Follow-up Self-Test

It occurred to me after my last entry that though I have been running every day, it has been quite a long time since I got a side stitch during a run. This could be due to the fact that most of my runs are at medium to low intensity and for my minimum three miles. Or could my form have improved recently so that I run more smoothly now?

Since reading Dean Karnazes' book Ultramarathon Man I have also allowed myself to eat before a run more regularly. Karnazes' bragging about eating an entire pizza before a run made me realize that I could train myself to do this. I used to refuse to eat 2+ hours before a run, but now I can have dinner and be on the run before the last swallow is down. One would think this would cause me to have stitches more often, but I honestly can't remember the last time I had one.

Last night on my run I checked my breathing to see if I was a right-side or left-side breather, assuming I would be at a 4:1 steps-to-breaths ratio. To my surprise, I seemed to be holding a 3:1 pattern, meaning I was breathing in on my right foot and then out on the second left foot strike, then in on the second right foot strike after that. Could this be a reason I am not getting a stitch? Is this like breathing every 3 in swimming? Swimmers, do you notice you get stitches more often when you are following a certain breathing pattern? Coaches, do you have the same athletes getting side stitches repeatedly? I would love to hear your observations.

In Stitches

Monday I spent some time with our 12 & under age groupers putting them through their paces in dryland. Their dryland includes some running, ab exercises, and some body-weight strength exercises like push-ups, squats, etc.

The run required them to complete eight lengths of an approximately 80m distance back and forth along an outdoor corridor near our pool. Ignoring my instructions to start at warm-up speed and go faster each length than the one before, they took off on the first length sprinting for all they were worth. Interestingly, as they returned to the place where I stood after 2, 4, and 6 laps, several of them began complaining of a pain in their side.

As a runner for the past 13 years, I know that pain well. In the running community, we call it a "side stitch." Watching these kids get stitches just 30 seconds after beginning exercise got me thinking. What is a side stitch exactly and why does it happen? I did a little research and the answers I found were interesting.

A stitch actually has a scientific name, exercise related transient abdominal pain (ETAP). Pain from a stitch can be under the ribs, behind the back, or even in the shoulder and can lead some to believe they are having a heart attack.

There are essentially 3 theories about the causes of the "side stitch":

1. Tugging of the spleen, stomach, and liver on the underside of the diaphragm. The diaphragm is the muscle that pulls the bottom of your lungs downward on inhalation. The spleen, stomack, and liver are all held in place in the abdomen by ligaments attached to the diaphragm. Vertical displacement of these orgams (like during running) causes spasm in the diaphragm as the ligaments pull at it from below. Apparently, side stitches occur most often on the right side, presumably because that is the liver's location (it has the largest mass of the three). Maximum tugging would occur as the runner's foot strikes the ground when the diaphragm is at its highest point, during full exhalation. This all makes perfect sense to me, but does it explain why stitches can happen during swimming, too?

2. Diaphragmatic ischemia. This means there is a lack of blood flow to the diaphragm, causing it to cramp or spasm. Basically, the lungs and your internal organs pinch the blood vessels leading to the diaphragm.

3. Wikipedia says that imbalances in the thoracic spine can cause a stitch, but doesn't elaborate. I suppose this is due to some unnatural tugging on internal organs due to things being misaligned.

I was interested to find that the cures for a stitch:

1. Put your hand on it and squeeze. This stabilizes the tendons/organs and prevents the tugging.
2. Lay down on on your back. This will make the stitch go away immediately.
3. Improve your abdominal strength and lower back strength. Could the sudden stitches in our swimmers be an indication that they have weak abs? With this information, our age group coach correctly predicted on the first try which swimmer was the first to mention a side stitch. Interesting, huh?
4. Warm-up gradually and completely before exercising.

Other interesting facts and implications:

One source I found stated that 70% of humans breathe when their left foot hits the ground, and only 30% breathe when their right foot makes contact. Why is this? The rough percentage of right and left handers in the world is somewhere around 90 and 10.

Runners generally breath in a 2-1 stride-to-breath ratio while jogging and a 4-1 ratio while running at a faster pace.

Nowhere did I find anything saying that a stitch should be a reason to stop activity or that any damage would be done by a prolonged stitch. Did you read that, swimmers?

So how does this relate to swimming? And why do swimmers get stitches? I suspect that swimmers get stitches mainly due to ischemia (theory #2) due to shallow breathing during training. It is also possible that the reaching and pulling down motion of free, back, and fly could cause the tugging mentioned in theory #1. Perhaps the aspect of all of this that most piques my curiosity is the relationship of breathing to striding in running, and how this relates to swimming. What percentage of swimmers prefer to breathe on which side during freestyle? Does this relate to their handedness? Is there a correlation between this preference and getting side stitches while swimming?

Don't you just love it when a question leads to not to an answer but to even more questions?

The Six Myths of Fast Swimming

1."There is an easy way, I just haven't found it yet." There is no easy way. All fast swimming for everyone comes as a result of hard work. There is value in always trying to find a better way (the reason for this blog), but there will never be an easy way. Realizing this is key to tapping your motivation to give maximum effort every day.
2."That swimmer is fast because he/she is just talented." These words are usually spoken by somebody who believes in myth #1. If you find yourself believing or maybe even saying this myth out loud, consider your own talents and find a way to maximize them to better achieve your own goals. This is far more effective than bemoaning your talent deficiency.
3."This is just practice, I will do it correctly/faster at the meet." This myth is perpetuated by those who have poor practice habits. When it comes to anything technical, only perfect practice makes perfect. The pressure and excitement of a competitive situation tend to exacerbate your bad habits rather than magicly improve them. Factor in the fatigue you will feel in a swimming race, and you can see that you are truly only as fast as your habits will let you be. Strive daily to eliminate your bad habits and practice good technique at all times.
4."Swimming is an individual sport." Ironically, this myth is usually believed by someone who has always been in a good team situation. Though it is true that we mostly compete as individuals in a race, the social nature of our sport cannot be totally discounted. If you believe this myth, try training by yourself. Better yet, imagine swimming at a meet where the only people in the building are you and your 7 competitors. Make the most of your teammates by supporting them, and they will support you.
5."That little technical thing won't make a difference." This myth is believed by people with poor attention to detail. This "pennies on the sidewalk" mentality leads them to believe myths #1 and 2, because only big improvements are worth the effort.
6."I messed up my taper." Usually stated after the meet or season concludes by someone who is unhappy with his performance. Though it is possible to not hit a taper correctly, the far more likely culprit is poor preparation all season long. Many swimmers and coaches who believe this myth don't honestly evaluate what came before the taper.

If you find yourself buying into one of these myths, honestly evaluate where this belief comes from and whether it truly holds any water (pun intended).

Stop and Think About the Flop

Forty years ago a lanky American made headlines and captivated the crowds when he won the gold medal in the high jump at the 1968 Mexico City Olympic Games using an innovative technique. His name was Dick Fosbury and his unusually daring maneuver has since been immortalized as the Fosbury Flop. Until Fosbury came along, the prevailing high jump techniques included the scissor kick and the straddle. In the scissor kick, the jumper elevated and then kicked first one and then the other leg over the bar. Using the straddle, the jumper passed over the bar face-down, essentially rolling over the bar with one arm and one leg at a time. Fosbury’s technique involved him passing over the bar on his back while passing his head, shoulders and then his hips and legs over the bar. Thus he was actually able to pass his center of gravity under the bar even as his body travelled fully over the bar. The Flop was a sensation, even distracting the crowd’s attention from the finish of the marathon, traditionally one of the Games’ most celebrated events. Some decried his technique as foolishly dangerous and mocked its awkwardness even as his jump broke the existing Olympic record and put him on top of the podium.
The most fascinating part of the story isn’t as well known. The fact is that Fosbury didn’t debut his technique in 1968 at the Games. He had begun perfecting his Flop five years earlier in 1963. Though he had never jumped higher than 1.6m using the scissor technique, by 1965 Fosbury was clearing 2m with his flop. Incredibly, most high jumpers continued using their old techniques rather than adopt the Flop method. According to Fosbury, "most of the elite athletes had invested so much time in their technique that they didn't want to give it up.” It took a gold medal winning performance at 2.24m (7 feet 4 ¼ inches) for people to sit up and take notice. Even then, it took a decade for the new technique to be fully adopted by the sport.
This story is interesting but not surprising to me. The high jumpers of 1968 are not altogether different from the swimmers of 2008. The most common reason I hear from a swimmer about why he won’t change his technique is that “it will make me slower.” True, it probably will. At first. Consider that in a swimmer’s career he might perform a stroke literally millions of times. Thus, the chances are high that by performing a stroke in a manner that he has never tried before, he will immediately go slower. Now imagine Fosbury trying his flop for the first time. Do you think he magically jumped a foot higher than when using his previous method? Not likely.
Swimmers are not the only ones to blame. I am amazed by the number of good coaches who allow obviously poor technique (even injury-causing technique) to persist in swimmers simply because we are unwilling to risk going slower in the short term in order to achieve long-term gain. We become comfortable with a swimmer’s level of performance and fear that if we change a swimmer’s technique he won’t be able to change it back!!! This irrational fear is paralyzing.
I believe the reason for this hesitant attitude in both swimmers and coaches lies in the lack of a change mentality. By being afraid of change and unwilling to risk the short-term loss, we prevent ourselves from reaching our long-term performance potential. If we are truly intent on achieving excellence, this cannot be.
Coaches, we must first adopt the belief that change is beneficial. Second we must realize that change is not merely beneficial but necessary. Third, we must have the wisdom and the foresight to see the changes that will maximize a swimmer’s long-term performance. Finally, we must impart the value of change to our athletes at a young age and instill it as one of their core swimming beliefs.
Swimmers, you must be willing to change and understand that the point of practice is not to become a better practice swimmer. You must be willing to be a bit slower in training if it means following your coach’s vision for a change you need to make. This is the beauty of practice. It is a place to not only train but to rehearse, to experiment, to attempt, to fail, to attempt again, and to innovate.
Fosbury's technique is still in wide use today, though it has been modified and improved as jumpers go ever higher. Thanks to Fosbury's change mentality, the course of an entire sport was altered. We too must develop a change mentality. This is a frame of mind that welcomes change as a positive necessity to helping us achieve our swimming excellence. This is a risk that requires courage and faith, and it is a risk we must not be afraid to take.

Swim Like a Monkey

In this first video, the monkey has very little wasted motion and there appears to be very little energy expended. Now check out this video of Alexander Popov, perhaps the most efficient sprinter the world has ever seen:

Popov clearly has tremendous hip and shoulder rotation, and though the video is in slow motion, he shows incredible fluidity of movement. He has very little wasted motion and when racing appeared to barely be trying.

This swinging "monkey bar" action looks a lot like swimming freestyle if you turn it on its side. As the monkey anchors his hand on the bar, Popov anchors his foreharm and hand in the water. As the monkey turns his hips and shoulders and trades gravity for forward momentum, Popov rotates his hips and shoulders and trades gravity (from one hip being elevated) for leverage on his forearm anchors. Whereas the constant force for the monkey is gravity, this constant force for Popov is his legendary kick.
So to swim with fluid efficiency of a swinging monkey like Alexander Popov it is vital that one use 1) a high elbow catch to establish a solid anchor, 2) a fluid, connected rotation of the core to get from one stroke to another with maximum length and leverage, and 3) a powerful kick.

The Key

It’s been pouring rain in Chapel Hill for about 48 hours straight it seems, and as I left Home Depot today, the deluge seemed to have reached its peak intensity. Despite barely being able to see my car halfway across the parking lot, I made a dash for it. I ran clutching my purchase in one hand and my keys in the other, stooping as though being shorter would keep me from getting as wet. At my car, I fumbled with my keys for a moment before picking the right one. As the raindrops blew hard into my face and the wetness soaked through my t-shirt, I tried to quickly put the key into the lock. I missed. Tried again, missed again. Now, getting frustrated, soaked and even more hurried, I tried again and finally the key went straight into the slot. I quickly hopped in and slammed the door behind me. Totally wet and out of breath from the run, I wondered why that was so difficult. Why was putting my keys in the door, a task I performed at least 6 times every day without messing up, so difficult for me to do in the rain?

At practice, most of the yardage we swim is at easy or medium intensity. This has to be the case, because it is just not possible for us to do everything fast. So we must do some things easy. Most of the time when I put my key in the car door, I am not in a hurry. I do it slowly, and I do not miss the keyhole. But today when I was hurrying, I messed up not just once, but twice. If I want to get better at putting the key in correctly in a hurry, I should gradually work on doing it faster and faster correctly each time.

The same is true about our technique at swim practice. We need to start by doing things correctly when we swim slowly, for this is the easiest time to do things right. Next we must focus on doing them correctly as we begin to go faster. And faster. And faster. And eventually at maximum speed.

Almost anyone can use proper technique at slow speeds. Swimmers who can use great technique at any speed including all-out racing speed have a tremendous advantage at the race. And that could be the key to helping you unlock your potential!

How Good Do You Want To Be?

After watching what I deemed to be an average performance by one of our senior swimmers the other day, I was exhorting this swimmer to improve his effort in training. "If you can learn to train better, you could be really good at that event," I said, hoping to awaken in him the desire to fulfill his potential. "But I am already pretty good," he said.
I paused for a moment. In a way, he was right. He has already ascended to the Senior I group, the top training group within NCAC. Just by doing that he proved his ability beyond probably 99.999% of the people on the planet. Still, he is only the 9th fastest swimmer on NCAC in that specific event, and nearly 2,000 swimmers in the USA his age are faster than him.
"You are missing the point," I responded. "How 'good' do you want to be? Are you satisfied with where you are at right now? Or do you want to be better?" Letting the thought sink in, he walked to the warm down pool, and I turned toward the next race which had already begun.
Each of us is faced with the same question in any endeavor we undertake; how good do we want to be? Are we so happy with what we have already accomplished that we are satisfied to sit right where we are? Or, are we willing to give ourselves a quick pat on the back for a job well done and then get back to the business of achieving our goals? Surely along the way we will experience success and we will suffer failure. Our response to success is as important as anything. Whether we sit back and stagnate or keep climbing the ascent is largely a matter of attitude. How good do you want to be?