Injury Prevention and Treatment

Stitches: What causes them, and how to get rid of them

You’d be hard pressed to find someone who has never experienced a stitch before, yet despite this, to date, we are still not sure what causes stitches, nor how to prevent them. Not what you wanted to hear, I know!

In the literature, stitches are known as Exercise-related Transient Abdominal Pain (ETAP). According to researchers Morton and Callister, 70% of runners experience stitches, and in a running event, 20% of participants can expect a stitch. (2)

What Do We Know About Stitches?

Side stitches can range from a dull ache to a crampy stabbing feeling, or a pulling sensation
They occur most commonly on the right side in the middle third of the abdomen, adjacent to the navel
The next most common area is in the left, middle area of the abdomen
The next most common area is around the navel
Around a third of people report non-injury related shoulder tip pain (STP) associated with stitches
The prevalence, severity and frequency of stitches decreases with age
BMI does not affect prevalence and frequency of stitches, but athletes with higher BMI have reported more localised stitches, and more severe
Men are more likely to report a stitch as an achy type of pain, and women report it more as a stabbing, sharp pain
The frequency of stitches seems to decrease with frequency of training, but frequency of training has little effect on severity or prevalence of stitches.
The frequency and severity of stitches seems unrelated to number of years of training and training volume
Athletes of all levels, from inexperienced to elites are just as susceptible to getting a stitch, however elite athletes will tend to have fewer stitches

The location of exercise-related transient abdominal pain (ETAP) reported by the combined symptomatic subjects (N = 818) in the studies by Morton and Callister [1] and Morton et al. [2].

What Don’t We Know About Stitches?

Exactly what causes them, and therefore how to prevent and treat them!!

Some Theories on What Causes Stitches

Diaphragmatic Ischemia

More simply put, limited blood supply to the diaphragm.

This would account for some of the things associated with stitches like shoulder tip pain. The diaphragm is mostly innervated by the phrenic nerve, which refers pain to the shoulder tip region. The outside portions of the diaphragm are innervated by other nerves which could account for the sharp and localised pain in the region just below the ribs.

But the evidence against this theory is quite strong. Stitches are reasonably common in activities that don’t demand a lot of the respiratory system, such as horse riding and off road car racing, so a lack of blood supply to the diaphragm is not very likely.

Also, it is very unlikely that the blood supply to the diaphragm would be limited, whilst blood supply to the working muscles would not be limited. The good functioning of the diaphragm is more important to sustaining life than is the use of the legs and arms for running, so the brain is more likely to shut off supply of blood to the working muscles before blood supply to the diaphragm shuts off – as a working diaphragm is necessary for breathing, therefore life!

Mechanical Stress on Ligaments Associated with Organs

Some of the organs in the abdomen, of note the liver and stomach, are supported by ligaments that attach onto the diaphragm. One theory on the causes of stitches is that there is mechanical stress on these ligaments, causing pain.

This does explain why you can get a stitch in activities that have a jolting nature but low demands on the respiratory system, such as horse riding. Also, eating and drinking prior to exercise could cause a stitch by the increase in the mass in the digestive system loading the ligaments that support the stomach. Also, when you take in beverages with a high sugar content, you increase your risk of a stitch. Higher sugar content drinks (over about 10% carbs) can slow down gastric emptying, causing the fluids to stay in your stomach for longer, and therefore put more stress on the ligaments supporting the stomach.

But… this theory does not account for stitches lower in the abdomen, nor does it account for the fact that increased BMI, which would likely put more stress on those ligaments, does not correlate with an increase in the prevalence of stitches. And another nail in the coffin for the mechanical stress theory. Pain arising from these ligaments would be likely to be similar to pain related to organs, which is usually dull, and diffuse. The pain of a stitch is more often localised and sharp.

Gastrointestinal Disturbances

The main reason stitches have been thought of as a gastrointestinal problem is because they have been associated with eating prior to exercise. But, the pain is also commonly felt when nothing has been consumed several hours prior to exercise. Typical pain of gastrointestinal problems usually results in writhing movement to try to get relief from the pain, whereas with stitches, reducing movement and/or pressing on or massaging the area of pain has been reported to help. So the pain patterns of a stitch aren’t consistent with gastrointestinal problems.

Muscle Cramp

In a couple of large studies, 25% of stitch sufferers described the pain as “cramping”, which led to subsequent studies which measured localized electromyographic (EMG) activity while a stitch was present. Muscular cramps are associated with high levels of EMG activity . EMG activity was not elevated at the site of the stitch during an episode of the pain, which means the muscle cramp theory is also a no go.

Pain Causes By Nerves

This one does have some legs.

It does seem that stitches can be affected by poor posture, particularly in the thoracic region. That’s the mid region of the back, between your neck and your lumber region (the lumber region is the bit above your backside that curves inwards).

It’s been found that putting pressure on the vertebrae in this region of the back, specifically T8-T12, which innervates the abdominal wall, can reproduce symptoms of a stitch. In one study, a stitch could be exactly reproduced in 8 out of 17 people assessed, and the site of pain corresponded to the nerve root being pressed.

Other cases of stitch-like symptoms where the nervous system is implicated include slipping rib syndrome which results in trauma to the adjacent nerve, abdominal wall nerve entrapment, and spinal tumours and facet joint cysts which cause compression of the nerves of the muscles between the ribs (intercostal nerves).

Intercostal nerves can also be vulnerable to compression as a result in the reduction of the height of the discs between the vertebrae – something that can happen with the dynamic and repetitive movements of the torso in running.

Irritation of the Parietal Peritoneum

Stay with me on this one.

The parietal peritoneum is a layer of tissue that adheres to the abdominal wall.

The visceral peritoneum are layers of tissue lining the abdominal organs.

The peritoneal cavity is the potential space that separates the abdominal organs and parietal peritoneum. The cavity is filled with fluid to prevent friction between the 2 layers

Increased friction between the two might be a cause of the stitch. This increased friction could be caused by the distension of the stomach post-meal. Also, changes in the thickness and quantity of the fluid in the peritoneal cavity during exercise could cause an increase in friction.

Poor Functional Core Stability

A 2013 study of 50 runners found that those runners who did not experience stitches had stronger transversus abdominis muscles, than those who reported experiencing stitches either weekly or yearly (though interestingly, not than those who experienced stitches monthly). The transversus abdominis muscle is a deep muscle important for stabilising the lumbar spine and pelvis. Those who did not experience stitches had significantly thicker resting transversus abdominis muscles. Better core strength and activation of the muscles of the abdomen could lead to the lessening of symptoms of a stitch.

How to Prevent Side Stitches Whilst Running

Eating and Drinking

Don’t have foods and drinks before your run that are likely to stay in your stomach for a long time. Avoid highly sugary drinks (greater than 10% carbs) and avoid foods high in fat and fibre. If you’re taking gels or other energy boosters, make sure you are taking in water, to reduce the concentration of sugar.

Strength Training

Core strength and conditioning is important for everything we do, so even if it doesn’t stop you from getting a stitch, you should be trying to improve it! But, it does seem that improving your core strength, and improving your posture with stretching and strengthening exercises can help if you are a chronic stitch sufferer.

Improve Your Fitness

The frequency of stitches reduces with higher fitness levels, so getting fitter could help to mitigate the problem.

Get Older

The prevalence of stitches reduces with age, so you could just sit back and wait!!!

Immediate Treatment For Stitches

Unfortunately, the best way to stop as stitch is to stop doing whatever activity is causing it. That is rarely practical.

The most common techniques to get rid of a stitch reported by sufferers in a large study off 600:

The most common techniques to get rid off a stitch reported by sufferers in a large study off 600,:
Deep breathing – reported by 40% of suffers
Pushing on the affected area (31%)
Stretching the affected side (22%)
Bending over forwards (8%)

Other techniques include:

Breathing shallowly
Forcing out and sucking in between clenched teeth
Bracing the abdominal muscles – my personal favourite. It does seem to stop you from feeling the stitch whilst you’re bracing, but once you stop, it has a tendency to come back.

References

Morton DP, Callister R. Characteristics and etiology of exercise-related transient abdominal pain. Med Sci Sports Exerc. 2000;32(2):432–438. doi: 10.1097/00005768-200002000-00026.

2. Morton DP, Richards D, Callister R. Epidemlology of exercise-related transient abdominal pain at the Sydney City to Surf community run. J Sci Med Sport. 2005;8(2):152–162. doi: 10.1016/S1440-2440(05)80006-4.

3. Morton DP, Richards D, Callister R. Exercise-Related Transient Abdominal Pain (ETAP) Sports Med 2015; 23–35.Published online 2014 Sep 3

Knee pain Running Downhill: ITB Exercises

ITB Syndrome is worse on the downhill (1)

When running downhill becomes a pain in the ITB

To a runner suffering from ITB Syndrome, nothing says “hello knee pain” more than a good stretch of downhill terrain. For the uninitiated, ITB stands for Iliotibial Band. Whilst ITB Syndrome is an overuse injury, it can strike anyone, anytime, without warning. It is more often found in runners than in the rest of the population, but it’s not the exclusive domain of runners.

What is an ITB?

Your iliotibial band is a band of fascia which starts off near the outside of your hip. It then runs down the side of your leg and attaches into the kneecap and the two shin bones. The purpose of the ITB is to stabilise both your pelvis and your knee.

How does the ITB cause pain?

ITB pain can sometimes be felt in the hip, where it’s thought the ITB causes friction over the bursa that sits between your hip joint and the ITB. The bursa is a little sac of fluid that adds cushioning to the joint. Bursae can be found in joints all over the body.

It is far more common for the ITB to cause pain on the outside of your knee. What is actually happening to cause the pain is still up for debate.

For quite a while, it was thought that the pain was caused by the ITB rubbing backwards and forwards on the bone underneath it. The condition was known as ITBFS – Iliotibial Band Friction Syndrome.

Then new research showed that actually, the ITB is attached to the bottom of the thigh bone -meaning there couldn’t be any forward and backwards movement, leading to the conclusion that ITBFS, was in fact just ITBS – (that is, the F for FRICTION is taken out of the acronym, as no friction is created if the ITB is not moving). It was then posited that the pain in ITB Syndrome is caused by compression of fat structures, inflammation of bursae, or possibly due to structural changes in the ITB.

Fast forward a few years, and new research has shown that in fact the ITB does move, so could it be that the pain is caused by friction after all?

Pretty much, no-one’s quite sure exactly what is going on down there.

Read enough? Jump down to some strength training videos

Why does your knee hurt more when you run downhill if you have ITB Syndrome?

Ankle Stiffness

When you’re running on any type of terrain, the shin moves forward and downwards towards the foot and it should also rotate and twist inwards a small amount. So you need good mobility (enough but not too much) in your ankle joint. If your ankle is a little stiff and can’t move properly in these different directions, excess forces are likely to move up to the knee. The knee might be forced to bend or rotate more than it should, resulting in the tissues around the knee having to bear more load than they should. When you’re running downhill, this is exacerbated. Your foot hits the ground and stops, but the rest of your body continues in not only a forward motion, but also a downward motion, requiring greater ankle flexion.

Knee Flexion at 30 degrees

The ITB rubs against the bony bit at the side of your knee (the lateral epicondyle) just after your foot hits the ground. This rubbing happens when your knee is at or slightly less than 30 degrees of knee flexion. With downhill running, your knee is a bit straighter when your foot hits the ground than it is when you’re running on other terrain. Your foot also hits the ground with greater impact than in level or uphill running. You’ll find your ITB is far less likely to be painful if you’re running up hill, as your knee stays more bent whilst your foot is on the ground.

At least at first. If you bury your head in the sand and don’t seek treatment, you’re likely to end up with pain 24/7.

Risk factors and causes of ITB Syndrome

Weak Hip Abductors?

No-one really knows for sure what causes the ITB to give you pain. Some research shows ITB pain goes hand in hand with weak hip abductor muscles (they’re the muscles that take your leg out to the side and help to stabilise your pelvis). Whether the weak abductors are actually the cause of the ITB pain or the result of the ITB probem is uncertain.

One often cited study showed that of the 24 runners in their study with ITB issues all showed hip abductor weakness in their bad leg. The group then did 6 weeks 6 weeks of strengthening of their hip abductors and at the end of that six weeks 22 of them were pain free and could return to running.

But here’s the thing – they also took anti inflammatory drugs, undertook massage and stretching to loosen off and normalise the tissue in their legs, and stopped running. The researchers really had no idea whether the strength training “cured” the ITB issues. Nor did they know if the weakness in the subjects’ abductor muscles was the cause of the ITB pain, or in fact the ITB problems caused the weakness in their abductor muscles.

Other risk factors

runners with ITBS versus a non injured control group were less experienced, were doing greater weekly mileage, and had a greater percentage of their training on the track
Weakness in knee flexion and knee extension (bending and straightening of the knee) in people with ITB issues
Training on cambered roads might cause ITB problems
Bow legs
Thickened IT bands
Muscle imbalance or weakness in the gluteus medius leading to early firing, overactivation, and tightness of the tensor fascia lata and iliotibial band

Prevention

1: Avoid over training

The one thing that is certain is that ITB Syndrome is caused by overuse. So to prevent it, you need to be sure you are not doing more running than your body can handle. To avoid over training, you need to be careful not to increase your training load too quickly.

Build recovery into your training plan
Include recovery sessions, rest days, and recovery weeks
Don’t add massive amounts of mileage from week to week
Avoid increasing mileage and intensity at the same time
Add variety to your program
Train on different types of terrains and surfaces
Get enough sleep

2: Get Strong

There isn’t any definitive research that shows that strength training will prevent ITB issues, but that doesn’t mean it won’t help. It makes sense to include a good all over strengthening regime in your training. It is likely it will help in injury prevention, and it’ll also make you run faster, so why not do it? Strength training for running will never be a waste of time.

Treatment

Get onto the problem straight away. Don’t think it will go away on its own, as it is most unlikely to
Eliminate the pain – this may be by ice, anti-inflammatories and/or ceasing activities which cause pain (in our case, running).
Massage and/or use a foam roller on the outside of the leg to normalise the soft tissue, which is likely to be tight and help the hip abductors. Do not massage directly over the focal point of the pain.
Undergo a strength training protocol which strengthens the hip abductor muscles
Improve flexibility in your ankles through calf stretching and regularly rotating your foot through it’s full range of movement

NOTE: anti inflammatory drugs should only be taking to help reduce the inflammation, which will then make the injury easier to treat. You should not take anti inflammatories to mask the pain so that you can continue running on an injury!

If you do not see significant improvement in symptoms after a few days of self management (and this means coming off any pain killers so that you’ll know if there is an improvement) you should definitely seek advice from a physiotherapist.

Strength training exercises for ITB Syndrome prevention and treatment

Hip Hitch

Clam and Side Leg Raise

Case Study- My ITB Experience

In my own experience, massage was VERY effective in getting rid of my ITB problems. However, I got onto the issue straight away, AND it was not caused by running. I was hardly doing any running at the times – (so much so that when I told my husband I thought I had ITB problems he laughed right in my face). My ITB issues were caused by sitting at my desk too long with my legs crossed. I was sitting down one day, stood up and bang, pain in the knee. Not crippling, but bad enough for me not to want to walk too much. And sure enough, it was worse for going down stairs and down hills. I made a quick trip to my physio to confirm my diagnosis and check there were no structural issues. She massaged me to within an inch of my life, and I continued for a few days with self massage. Didn’t even have to jump on a foam roller. I did stop crossing my legs, and I didn’t run till the pain was gone.

Anti-Inflammatories and Running

Why does inflammation get such a bad wrap?

Inflammation. At its worst, it can stop you in your tracks. But if your tendency is to reach for the Voltaren at the first slight twinge or sign of inflammation, you might like to consider what purpose inflammation actually serves…

And you also might like to consider that Volaren, Ibiprofen and other Non Steroidal Anti-Inflammatory Drugs (NSAIDs) can limit the benefits you gain from training!!

Sometimes it’s tempting for runners with a niggling injury to take anti-inflammatories to get them through their key long runs leading up to a race, but studies have shown that this can be counter-productive.

What Role Does Inflammation Play?

Inflammation is a protective mechanism your body uses to remove harmful stimuli and start the healing process. After a hard workout, specific cells are activated to increase blood flow to the muscles used in the workout. This increased blood flow also occurs in the initial stages of an acute injury. It produces swelling and stimulates the nerves that cause pain.

Inflammation is the beginning of the healing process, and it’s super important for recovering not only from injury, but from normal bouts of training as well. Without inflammation, your recovery from each bout of exercise (or from injury) would be much slower.

But what about R.I.C.E? Isn’t the idea to reduce inflammation?

Good point. The standard procedure for injuries which provoke the inflammatory response, such as a sprained ankle, is Rest, Ice Compression and Elevation. The R.I.C.E protocol is designed to REDUCE inflammation, so if inflammation isn’t bad, and it’s the body’s natural response to injury, why do we want to reduce it?

Firstly, we need to understand that the inflammatory response is non-specific. Incredible as our bodies are, we don’t seem to have evolved to be able to differentiate between the response needed to cope with a potentially deadly pathogen such as a bacteria or virus entering the body, and the response needed to help a sprained ankle to heal. The overriding function of the body is to keep itself alive. This takes precedence over all else. If a massive inflammatory response is required to neutralise potentially deadly pathogens, from the point of view of survival, it’s of little consequence that your ankle might lose some functionality due to inflammatory overkill after injury. Better to have slight loss of function of the ankle, than be dead.

One of the things inflammation does is put up a barrier around the area of infection or injury– whether that is around a sprained ankle, or around an area where a pathogen has set up house inside the body. This slows the passage of pathogens or toxic products into the surrounding healthy tissue. In the case of a sprained ankle, too much inflammation can actually inhibit the repair of the tissue. Too much swelling in the injured area might make it difficult for blood to diffuse into the cells, resulting in a lack of oxygen and further damage, so reducing the inflammation makes sense. One of the other things ice will do is slow the metabolic rate of the cells in the area, which temporarily decreases the cell’s requirements for oxygen.

Why exercise produces inflammation

When you run (or perform any other form of exercise) you create small micro tears in your muscles. The higher the intensity of the workout, the more forcefully you are contracting your muscles, and therefore the more damage you cause.

The micro-tears cause your body to set up an inflammatory response. Substances such as blood, oxygen and nutrients are shunted to the damaged area for the healing process to begin. This micro damage is not enough for the body to over-do the inflammatory response, but it can be enough to cause pain and discomfort.

When you should NOT take anti-inflammatories, and why.

If you’re interested in getting your body into the best shape possible, you shouldn’t take NSAIDs in the following circumstances:

To reduce the pain of a current injury to get you through a long run
During a race
Prophylactically – that is to prevent the anticipated pain of a sporting endeavour, or to prevent injury

NSAIDs can reduce the training effect

If you’ve got a niggling ITB, or a bout of bursitis for example, something that’s not too bad, but there all the same, it’s very tempting to pop a pill to get you through your scheduled long runs. You fear not getting in the mileage you’d intended will affect you poorly on race day. And it might…

But washing down a couple of anti-inflammatories with your pre-run hydration isnt’ the answer. A 2010 study by Japanese scientists showed that whilst anti-inflammatory drugs will indeed facilitate a longer distance run, the taking of the drug cancelled out the training effect that could be achieved from the longer distance. If you run with NSAIDs coursing through your veins, the training adaptation you could expect from that run will be diminished.

In other words, by taking the drug to enable you to run further, your body is not able to make use of the longer distance you run. You’re wasting your time. You’d be better off running within your pain threshold and gaining the training benefits from that. A longer run on NSAIDs will not see you get as fit as if you were running without NSAIDs, so you may as well run for less time and enjoy the training benefit.

Taking NSAIDS for long periods of time can have adverse effects on your gastrointestinal and cardiovascular system. These adverse effects become more pronounced with longer duration of use. Taking NSAIDS before physical activity can mask pain and cause an injury to get worse, or mask the pain of a developing injury. Anti-inflammatories may also impede the synthesis of collagen, that gives strength to tissue. Some of the chemical substances naturally occurring in the body which NSAIDS inhibit are important in the response and adaptation of muscles and other connective tissue to loads placed upon them. Taking NSAIDS can reduce the strength gains from training.

Taking NSAIDs may not reduce your perception of pain

Using NSAIDS prior to a race to prevent the pain of racing has been shown to be ineffective. This study on athletes competing in a 160k endurance run showed the ibuprofen use did not alter muscle damage or soreness. That’s right, taking anti-inflammatory drugs before the race made no difference to the athlete’s perception of pain. The perceived exertion of ibuprofen users and non-users was very similar. On the Borg scale, the control group rated their exertion slightly lower than the anti-inflammatory group (14.5 vs 14.6), and interestingly, and interestingly, Ibiprofen use was related to increased endotoxemia and inflammation.

When is it good to take anti-inflammatory drugs?

During the initial stages of an acute injury (like a muscle strain, sprained ankle, or sudden onset of an inflammatory conditions such as tendonitis or bursitis), NSAIDS are likely to facilitate healing. Taking NSAIDS for the first 2-3 days is appropriate, but after that, you may be better off letting the body’s own natural healing take over.

There are of course other circumstances when NSAIDs are necessary, but that’s best left up to your medical practitioner to decide

To Cool Down or Not To Cool Down?

Should you cool down after running? That is a very good question…and one which has not been satisfactorily answered to date!

Traditionally, the cool down has included some two to twenty minutes of running (or run/walking) at an intensity much lower than the main part of the workout, as well as some stretching of the main muscles groups used.

It’s an established “fact” that the cool down is an important part of your training session. Cooling down, the narrative goes, will help you to recover quickly and get your body ready for your next bout of exercise.

But…

It turns out, there’s not a great deal of evidence to support this. In fact, there’s been very little scientific research done on the topic at all.

What a traditional cool down after running will do for you.

Speed up the rate at which lactate is cleared from the bloodstream. (Note it is lactate which is produced during exercise, not lactic acid)
Reduce the risk of dizziness and fainting
Help to prevent that post-exercise chill
Give you a feel-good factor whilst you’re stretching – it always feels kinds of nice to stretch those muscles
Put a mental punctuation mark at the end of your session, separating it from the rest of your day, and mentally signal you’re ready to get back to the daily grind!

What a traditional cool down most likely won’t do for you

Relieve muscle tightness
Relieve muscle soreness
Improve your performance in a subsequent bout over the next few days, unless it is on the same day.

Let me explain…

Lactate Clearance

Cool downs have been proven to clear lactate from the bloodstream more quickly than stopping moving completely after a run. This has, until fairly recently, been assumed to be a good thing, as lactate (or more commonly incorrectly referred to as lactic acid) has been blamed for the muscle burn you feel when you’re fatigued, as well as the post exercise soreness you might feel a day or two later. It’s now known that it’s not lactate, but hydrogen ions which cause that dreadful muscle pain and weakness whilst you’re exercising at a high intensity.

Whilst a cool down might clear blood lactate more quickly, that’s not going to have an impact on how you feel. It’s also only going to speed the process up by 30 minutes or so. Lactate will clear from your bloodstream within about an hour post exercise anyway. There’s also no evidence to suggest that clearing lactate more quickly after a run will aid in recovery or performance except in specific circumstances (more on that later).

Muscle trauma is the real cause of post exercise pain

Post exercise soreness is not caused by lactate. It is more likely due to the micro tears to your muscles which are caused by working out. These microtears are not something you should be alarmed about. They are how your body adapts and rebuilds to become stronger.

And there’s doubt as to whether a cool down and stretch actually relieves muscle tightness. Studies amongst soccer players found that cooling down after training had no impact on their performance, flexibility or muscles soreness the next day after training.

If you’re looking at reducing delayed onset muscles soreness, a good warm up is the way to go. A study published in the Australian Journal of Physiotherapy showed that you can decreased delayed onset muscle soreness by warming up, but not by cooling down.

Cooling Down can help you perform better in a subsequent same-day exercise bout

One study amongst cyclists did show that using a cool down after a 30 minute time trial gave a performance advantage in a subsequent time trial on the same day over the control group who did no cool down. It seems if you’re planning on competing twice in one day, or doing two quality workouts in one day, then cooling down might be useful.

Preventing Dizziness

One thing a post run cool down will do for you is help to prevent blood pooling in your legs. When you exercise, a lot of oxygen rich blood is shunted to the working muscles to transport oxygen and other nutrients needed for energy production and muscle contraction and relaxation. If you stop still after you finish running, you run the risk of blood pooling in your lower legs, and possible dizziness or even fainting.

If you’re a particularly fit athlete, this could be more of a problem. Your heart rate will return to normal pretty quickly once you’re at rest, meaning it will be pumping less blood back up out of your legs.

Exercising for several minutes at a very low intensity at the end of your workout will mean your heart rate will remain elevated for longer, hence deoxygenated blood will be pumped out of your legs and back to the heart more quicly. The muscular contractions in your legs will also help to get that excess blood back out of your legs to where it should be.

It’s unusual for anyone to stop completely still after a run or a race. Most race finishes are set up so that you keep shuffling through the drinks stations etc for a couple of minutes. You might have a little sit-down after that, but then there’s finding your friends, getting home, going for coffee, so you’re really still moving at a low intensity for quite some time after a race. Same with finishing a run. How often do you have the luxury of putting your feet up and flicking through a magazine when you finish a run? Me… pretty much never. I’m often straight in from a run, getting dinner ready, doing the washing, getting kids out the door…

Post Run Chill

During a race the body is working hard to cool itself. This built in cooling system keeps up for some time after the race, even though you’ve stopped running and are not generating extra heat any more. The more gradual drop in body temperature a cool down encourages will help to prevent the chills.

Not cooling down might help to replenish glycogen stores

Lactate is used by the body in a number of different ways, one of which is to fuel your working muscles. Through a series of biochemical processes, lactate is converted to glycogen, which is one of the main sources of energy for muscles. When you finish a workout, particularly one which will have depleted your muscle glycogen stores, you should be trying to refuel your muscles as quickly as possible. One study amongst cyclists came to the conclusion that when the cyclists simply stopped exercising, lactate was turned back into glycogen and stored in the muscles, but when they cooled down, some of the glycogen was used up by the working muscles. It’s possible, that from the point of view of recovery and readiness for the next bout of exercise, cooling down might be detrimental. Of course, you could counteract this by fuelling well after exercise with a good carbohydrate and protein feed. *********link this to the milkshake thing if indeed there is one on our website -might be in a recovery thing

Why a 10 minute run and a bit of a stretch might still be a good idea

Even though there’s no evidence to show that a traditional cool down actually does all that it’s supposed to do, there might be a couple of good reasons to cool down with a lower intensity run. These reasons have far more to do with training adaptations than recovery or preventing muscles soreness.

In a high intensity workout, the body will produce a lot of lactate. At some point, it will be producing more than it can readily use. By running after the main part of your session is over, when you have a high level of lactate in your bloodstream, you’ll likely be teaching your body to use lactate more efficient.

Likewise, you could use a slow 15 minute run after a heavy workout to practice maintaining good form when you’re tired. You’ll teach yourself to run more efficiently when you’re tired, so don’t slump and shuffle through your next cool down. Be mindful of what you are doing.

Confused?

So the good news is, if you really hate cooling down, you’re probably not going to be doing yourself too much harm if you don’t do it, but it’s a very individual thing. If you’re one of those people who swear their muscles ache if they don’t cool down after a run, then keep doing it. It’s not likely to do you any harm.

cool down Recovery running

Running and Electrical Storms Don’t Mix

Lightning can contain 100 million to one billion volts. That should be enough to make you wary of running in an electrical storm (or doing any other outdoor activity for that matter).

Here are some of the non lethal effects of being struck by lightning, just in case you need further convincing.

Short term Effects

Impaired eyesight or blindness
Ringing in the ears
Ruptured ear drums
Hearing loss
Unconsciousness
Seizures
Paralysis
Burns to the skin
Burning to internal organs

Long term effects

Memory problems
Problems with sleeping
Headaches
Irritability
Fatigue
Balance problems affecting gait
Joint stiffness
Muscles spasms

The three second rule

Count the number of seconds between seeing a flash of lightning and hearing thunder. For every three seconds, the lightning is one kilometre away. And just because you don’t see lightning, don’t assume it’s not around. Apparently, you can’t have thunder without lightning (but you can have lightning without thunder)

What to do if you’re caught outside in a thunderstorm

You should always check the weather forecast and the weather radar before you head out for a run, even if it’s a bright sunny day. If you’re planning a long run, much can change in a couple of hours. If you do get caught out in a storm there are some precautions you can take.

Seek shelter, not under a tree or other tall pole-like structure. Lightning has a tendency to strike taller structures within reason, and if you’re next to a tree when lightning strikes you can either be injured by the falling tree, or be felled by the electricity conducted through the earth.
Pop into a shop or a service station until the storm has well and truly passed. A bus stop, porch, verandah or other non-enclosed structure won’t cut it. It’s recommended you wait till half an hour after the last lightning flash before you venture out again. More than half of lightning deaths occur after the storm has passed.
If you’re close to your car, you can take shelter in it, but be careful to stay away from the sides of the car. Sit in the back seat, or on the floor in the back. Keep the windows and doors closed, and make sure you are not parked under a tree!
If you can’t get under shelter, crouch over into a ball with your chin tucked in. Have two feet on the ground, as close together as possible. This makes you a single point of contact. Don’t lie on the ground.
If you’re in a group, stay several metres from each other.
Keep out of puddles, as water conducts electricity
Don’t put up an umbrella. And if you have an umbrella with you when you’re running, you have other issues!

Some other points about electrical storms

Lightning does, and often strikes twice.
Someone who has been struck by lightning will not contain a residual charge from the lightning, and you can safely perform first aid on them
If you’re inside, stay away from concrete walls or floors which may have metal bars inside them
Do not have contact with anything that can conduct electricity (e.g., electrical equipment or cords, plumbing fixtures, corded phones)

Running in wet weather

If you’re sure there is no electrical activity about, there’s no reason you shouldn’t get out and run in the rain. Here are some tips for wet weather running.

References

http://www.lightningsafety.noaa.gov/resources/OSHA_FS-3863_Lightning_Safety_05-2016.pdf

https://www.australiawidefirstaid.com.au/lightning-strikes/

http://www.abc.net.au/news/2016-12-07/how-to-protect-yourself-from-lightning-strikes/8099570

Do Ice Baths Really Work for Recovery?

Ice baths can help recovery under certain conditions

When my kids were playing in a soccer tournament earlier this winter, they were due to play at least one game a day on 4 consecutive days, and sometimes two. Luckily for them there was a very-cold-unheated-outdoor-in-the-middle-of-a-Canberra-winter pool available for them to use!!

I wasn’t convinced of the value of this cold water immersion, compared to the stress placed on the immune system by running outside half naked in 5 degree temperature to get to the pool, then running back again dripping wet and still half naked. (Apparently it’s illegal to wear trackies and a warm top when you’re meeting your team mates pool side).

I did a little digging around on cold water immersion (CWI), more commonly known as “Ice Baths”, and found some interesting research. Here’s a quick summary.

What is an Ice Bath?

Ice baths come under the umbrella of cold water immersion. They are not actually baths chock full of only ice. That would definitely burn. They are a mix of water and ice, in any kind of vessel big enough to hold a human body, or part thereof. Generally the temperature is around 10 degrees C, although some research suggests that this is not cold enough, and favours a 6 degree submersion.

Why Would You Even Want to Jump Into an Ice Bath?

High intensity sport, or large volumes of low intensity sport, can cause fatigue which can reduce your performance. It can also reduce your ability to train well the next day. The more quickly you can recover from a bout of exercise, the better your next day performance will be, whether that’s in competition or in training.

It’s believed that immersing yourself in cold water post exercise bouts aids in recovery. That’s why you or I might think CWI is a good idea. Our kids…well, they tend to think it’s a good idea when their mates tell them it is.

Using Cold Water Immersion to Reduce Muscle Soreness.

Playing sport hard, long runs, high intensity interval training sessions, or sometimes even a reasonably moderate session of an exercise that is new to you, can leave you with what’s known as delayed onset muscle soreness (DOMS) aka “sore muscles”

Potentially, CWI can reduce this muscle soreness. The benefits include reduced pain at rest, reduced pain when stretching, and an increase in the active range of motion.

There are several mechanisms which might be at play here:

Reduced nerve activity due to the cold temperature, which results in increased pain tolerance (1)
A reduction in swelling due to the blood vessel constriction due to the low temperature (2)
Reduced swelling due to the hydrostatic pressure of water (3)

One study has shown that it’s most likely not the actual immersion in water itself that has the benefit, rather the temperature of the water in which you immerse yourself. Immersion in 6 degree C water was more effective than 10 degrees, and more effective than contrast immersion alternating between 10 degree and 38 degrees C.(4).

Wouldn’t you just know the coldest option would be the most effective?

Does Cold Water Immersion Always Work?

Not necessarily. It appears the benefit of using cold water immersion in reducing muscle soreness only exists in trained athletes, so unless you’re well trained, you can keep the ice firmly in the freezer where it belongs.

CWI is also ineffective in recovering from a new training regime. So if you’re a well-trained runner who does 10k on the rowing machine in the gym, chances are an ice bath won’t help to stop the inevitable muscle soreness you’ll experience.

Will it Improve Your Performance?

There is not a huge amount of research on cold water immersion, despite its popularity as a recovery strategy. Whilst it might reduce muscle soreness, this may not necessarily translate to improved performance.

I took a quick look at eleven different studies which looked at the effect of CWI as a strategy to improve performance. Six of the eleven studies showed the CWI improved performance, but 5 showed either no improvement or reduced performance.

This was of course a small sample of studies, but there aren’t too many studies going around. And that’s the thing. There really isn’t enough research on the strategy to come down on one side or the other.

Patterns in the Research on Effectiveness of Ice Baths

Studies which have looked at how well cold water immersion can prepare you for a second bout of exercise on the same day found either no effect or a negative effect on performance. This is probably due to a reduction in nerve velocity and the restriction of blood flow to the muscles.
Studies testing the effect on performance 1 to 2 days after the cold water immersion had a tendency to find a more positive result.

Long Term Effects of Ice Baths

Research on the long term use of ice baths suggest that long term, chilling yourself in this manner too frequently could have a negative impact on the way you adapt to exercise.

CWI increases the release of the stress hormones cortisol and norepinephrine for up to 60 minutes after you jump out of the bath. These hormones act to break down the muscles, so this would reduce the body’s ability to adapt to training. And adapting to training is really the whole point of doing it. You stress your body repeatedly, it says “bloody hell, if she’s going to keep doing this to me I’d better get stronger”, and diligently goes about doing just that, getting stronger. But, if your cold water immersion bout is releasing hormones which break down muscle tissue, long term, you’re not going to be seeing the adaptation that you’re training for.

The release of stress hormones could also impair your ability to get a good night’s sleep, and sleep is THE most critical factor in recovering well.

The reduction in swelling which is brought about by ice baths could also have a long term detrimental effect on your fitness. Post-exercise swelling is part of the process that leads to muscle repair and strengthening.

It’s All in the Timing

Whilst there’s still a lot more research needed on cold water immersion and ice baths, a few things are apparent.

CWI can reduce muscle soreness in trained athletes
CWI might improve performance in subsequent exercise bouts which are 1 to 2 days post immersion
CWI is likely to have no impact or could reduce performance on same day subsequent bouts of exercise
Long term use of ice baths and cold water immersion as a recovery strategy is likely to have a detrimental effect on the body’s ability to adapt to training
If you use cold water immersion as a recovery strategy, you should limit its use to times when you really need to recovery quickly for your next tough training session, or for an important event, but you should not use it as a matter of course.

References
1. Algafly, A.A., & George, K.P. (2007). The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. British Journal of Sport Medicine, 41, 365-369.
2. Cochrane, D.J. (2004). Alternating hot and cold water immersion for athlete recovery: A review. Physical Therapy in Sport, 5, 26-32.
3. Wilcock, I.M., Cronin, J.B., & Hing, W.A. (2006). Physiological response to water immersion: A method for recovery? Sports Medicine, 36, 747-765
4. Cold water immersion in the management of delayed-onset muscle soreness: Is dose important? A randomised controlled trial. Philip D. Glasgow, Roisin Ferris, Chris M. Bleakley

Cold Water Immersion Ice Bath Ice Bath for Recovery