Catching My Breath

After my first full week off running in I don’t know how long, I very happily hit the road again on Saturday.  I had to fill my time somehow (other than catching up on laundry and  putting some effort into cooking again), so during my down time I started reading Budd Coates’ Running on Air.  The Amazon’s description promises that the book will “help runners at all experience levels improve their performance, prevent injury, and experience the joy of running” through rhythmic breathing.  Breath control has long been one of those facets of distance running that I relegated to the “Only Useful for Fast People” category and have thus ignored.  In general my M.O. has just been to belly-breathe as deeply and slowly as possible for any given pace. I’ve struggled with pretty major side stitches several times this season though, and I’ve been starting to think that maybe I’m doing something wrong.

There is also little science available on the causes or treatment of side stitches.  I’ve tried all of the usual recommendations–exhaling like I’m blowing up a balloon, running bent over, running with my arm stretched over my head, applying pressure to the spot–all to no avail.    Given that they don’t constitute an injury and seem to come and go mysteriously, it’s understandable that there is not much solid research, but you’d think some triathlete PhD candidate in need of a thesis topic would like a good mystery…   In any case, the severity and recurrence of mine lately has compelled me to learn as much as I could on the subject and figure something out.

The general theory of side stitches seems to be that they are caused by a spasm in the diaphragm muscle.  At their worst, I have experienced a few that felt like a full-on cramp, which would be consistent with that model.  They most often occur on the right side of the body, and there are several conjectures as to why that is.  One is that since the larger portion of the liver sits to the right of the midline, the weight of the organ pulls more on that side and causes a strain in the muscle.  Another theory is that right-handed runners are more likely to exhale on their right foot consistently, again creating a greater strain on that side.

Running on Air takes a more comprehensive view of the breath and running and, while it is not expressly concerned with side stitches, I found Coates’ description of the mechanics of breathing quite helpful in (perhaps) identifying my problem.  When we breath, the diaphragm essentially operates the bellows of our lungs.  On the inhale, the diaphragm goes into its “working” mode, contracting downward to fill the lungs with air.  On the exhale, it relaxes and rises to the neutral position (or past it) to force the air back out.  According to Coates, significant core stability is lost on the exhale as a result of the muscle relaxation, and the footstrikes that occur during this phase produce the greatest impact and potential for injury.

I have always used a very long exhale when I run, thinking that this would help keep my heart rate down.  When I get side stitches, I tend to try to draw it out even longer.  If Running on Air is correct, however, my approach is probably exacerbating the problem by subjecting a cramping muscle to even more tension and stress.  This was certainly borne out in Baltimore, when running downhill with the side stitch became nearly excruciating at times.  Coates’ method favors a longer inhale and short, strong exhale synchronized with footfalls.  This rhythm reduces the amount of time that the core is unstable and also ensures that the exhale begins on alternating feet.

I’ve been using Coates’ method for all of my runs this week, and the results have been interesting.  This pattern is comfortable, but MUCH faster than the breath I’m used to, and I’m curious to see how that translates on harder efforts.  I’m on my second week of marathon recovery and only starting to return to real workouts, so I only have one tempo run and some fairly brisk Central Park hills for data at the moment.  Still, the only time I’ve felt the side stitch start to pull has been when I’ve lost my breath rhythm.  In every case, as soon as I’ve gotten back in sync it has quickly subsided.  I find the 5-count somewhat difficult to internalize (maybe it’s all those years of marching band), so I have to consciously count to myself to maintain the rhythm.  (You can forget listening to music, too.)  I do find that tying my breath directly to my footfalls has made me much more aware of my pace and level of effort, and also makes me feel more fluid as I run.  I’m curious to see if that awareness continues once the breathing patterns becomes more automatic and ingrained (assuming that happens).  I also suspect that with time the faster breathing rhythm may actually strengthen my diaphragm and intercostal muscles.  Overall, I’m very encouraged.


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