Mountain biking and side stitches don't mix

Credit: Phil Cole/Allsport
Dr. Burke,

Last year I raced mountain bikes at the Sport class level and had several top 5 finishes using periodization-based training. This season I am planning on racing at the expert level if my work schedule allows. Approximately 80% of my training is done on the road.

My concern is that during very hard efforts I get "stitches" in my side which are so painful that I have to stop riding for several minutes. This typically doesn't happen during training rides but it probably occurred during half of my races last season towards the end of the race.

You can probably understand how frustrating this is to put in all that training and then lose critical time at the end of the race. I have no idea how to avoid this. Should I be changing my diet several days before the race (e.g. eliminate caffeine and consume more water), changing my training workouts, or just dealing with it?



Dear Frustrated:

Soreness isn't the only muscle problem associated with hard riding. You may have been among the many cyclists who have experienced muscle cramps or a "stitch" in the side that prevented you from staying with the pack or sprinting at the finish of a race. Cramps are painful, involuntary contractions of muscles, while a stitch is a sharp pain or spasm in the upper side of your abdomen.

The most widely accepted theory about the cause of a stitch is inadequate blood and oxygen supply to the muscles used in breathing the diaphragm and the muscles between the ribs. When you're at rest, blood flows primarily to the liver, stomach, kidneys, spleen, and intestines.

However, when you begin to ride hard, blood flow shifts from these organs to the large working muscles of the legs. Because the adjustment is not immediate, some muscles in this case the respiratory muscles are asked to meet the higher energy output without adequate blood flow.

For example, at the beginning of hard effort in a race, you breathe deeper and faster and the demands on the respiratory muscles can be severe. The lack of blood flow may produce the stitch.

If you get a stitch during a race, try the following: Get in a safe place in the pack and stretch the arm on your affected side over your head. Blow out as hard as you can to empty air from your lungs or dig your fingers into the affected area of your abdomen and massage it.

Another method that has been successful for some athletes is to pinch their upper lip hard for about 30 seconds or longer while you back off the intensity of your effort.

Though these techniques sound fairly unscientific, they work for many people. If they don't work for you, you'll be forced to slow down to decrease your metabolic demand, or you may have to stop riding completely.

If your stitch occurs regularly, it may be indicative of liver or gall bladder problems or a muscle pull, and you should seek medical advice.

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