From: murphyc@bionette.CGRB.ORST.EDU (Chris Murphy)
Newsgroups: rec.sport.triathlon
Subject: Re: Help w/ Side Cramps???
Date: 14 Apr 92 01:43:45 GMT
Organization: Biological Computing Consortium, OSU, Corvallis, OR.

In article <23435.29e0f659@amherst.edu> mjwilson@amherst.edu writes:
>I frequently get some TERRIBLE side-aches/side-cramps during the run leg of
>races. 
>First question: what exactly is happening to me physically?  I feel sharp pains
>at the beginning and end of breaths, and worse when it's a deep breath.  The
>pain is located immediately below my rib cage, on one side or the other 
>(almost always the right) of my abdominals.  From my limited knowledge of
>physiology, that says "it's the muscles that move your diaphragm," but
>that's about all I know.  Can anyone give me a firmer diagnosis?
>
>Second question: what's causing it?  I initially assumed it was my running--
>my weakest and newest sport.  Since it almost always occurred after
>transitions, I began to focus on my riding form.  Then this spring, on
>my first two long rides I got the same cramps JUST riding the bike; this
>has never happened before.  So now I'm thinking it's some combination of
>my breathing pattern and riding form, with an emphasis on the former.  Help?
>Why did it start happening on the bike all of a sudden?  Also, what role
>might diet play (especially riding on an empty stomach)?
>
>Third: (obviously) what should I do?  Suggestions have included: running
>with my forearms lower; doing more sit-ups (MORE?); stretching my abdominals
>before exercise; avoiding citric acid; shallow breathing at the "bottom"; 
>shallow breathing at the "top"; regular deep breathing.  Quoth the trainer:
>"No one's really sure why they happen."

I had side cramps like the ones you describe several times in tri's.  After
being denied my first sub-40:00 triathlon 10K by having to stop because of
the pain (I finished in 40:26, grrrr...) I did some informal research into
to the causes and cures of "stitches".   Although this was 5+ years ago,
I do not think the great medical minds have spent their time pondering why
triathletes get side cramps, and I suspect the cause is still somewhat
undetermined.  

The most common and most likely explanation I found was that the blood flow
to the diaphragm was restricted, reducing the flow of oxygen to that muscle
and slowing the flushing of metabolic wastes.  Why the diaphragm cramps
just in that spot, no one seems to know.  

The obvious solution to me was to 1) figure out why there was restricted blood
flow, and 2) modify what ever it was that restricted the flow.  I noted that
my riding form was somewhat hunched, especially when I was going really hard
(this was in the days before aero bars).  After getting off the bike, I hunched
over either sitting or standing to put on my running shoes and started running
hard, not taking time to breathe deeply or stretch, of course.  I began 
concentrating on relaxing my breathing on the bike, straightening my spine and
letting my belly hang down as loosely as possible.  I also put a longer stem
on my bike so I would not be so constricted.  Both of these tactics seemed to
have helped, because cramping never was a problem after that.

Perhaps my solution of stretching out more on the bike, and paying attention
to breathing deeply while relaxing the abdomen will help some people.  I know
that once I paid attention to what my upper body was doing on the bike, I
relaxed more and put the energy I once put into tensing my upper body into
the work I was trying to do with my legs.  That in itself was helpful enough.

Chris Murphy  murphyc@cgrb.orst.edu
Oregon State University