The stabbing pains of stitches can instantly limit your triathlon race performance. Here’s how to avoid these uncomfortable side pains so you can reach your swim, bike and run potential.

Stitches – also called exercise-related transient abdominal pain (ETAP) – are characterised by sharp pains in your side when exercising, each breath bringing a stabbing sensation. As with cramping, there’s no real explanation as to what causes stitches, but they’re common in triathlon – especially during the run – and can totally ruin your race.

You might hear stitches referred to as ‘rookie side pains’ and while those new to the world of swim, bike, run do seem more susceptible, they can affect anyone. Just look at five-time ITU world champion and all-round triathlon legend Javier Gomez of Spain, whose challenge for the 2018 Ironman 70.3 World Championships was stifled by stitches.

Anecdotal evidence suggests that side stitches are most likely to occur while running soon after eating. What you eat is an important factor with foods high in fat and fibre taking longer for the body to digest –and more likely to cause problems. Studies have also shown that high-carb drinks (6-7% in concentration) can trigger stitches during exercises.

Tips to avoid stitches

Strengthen your core

Stitches usually strike your core muscles, so strengthening these can help ensure core weakness isn’t contributing to their occurrence. Working on the abdominals, obliques and lower back can help in reducing the incidence of stitches and will also serve you well in all triathlon disciplines, especially in longer races.

Check your bike fit

Triathletes who have just added tri-bars to their road bikes often suffer from stitches on the run. This could be down to not adapting your road cycling position to suit triathlon. When on the tri-bars, elbows should be just wider than 90-degrees so that your skeleton – rather than your torso – is doing the work to support you on the bike. Another rule of thumb is to have your ear over the crook of your elbow, moving your saddle forward to accommodate this fit.

Warm up

Stitches usually occur when heart and breathing rates are elevated. Going from resting right into high-intensity exercise can cause your heart rate to rocket as well as irregular breathing patterns that make stitches more likely. Warm up gradually into each session to avoid putting your body under extra stress and stave off stitches.

Find a regular breathing pattern

Once you’re warmed up, think about controlling your breathing to fit your pace, creating a regular rhythm in time with your running action. This doesn’t necessarily mean breathing on every step – depending on intensity, you could be breathing in for three strides and then out for the same or breathing every two if you’re running harder. The key is to keep the pattern consistent for each intensity, focusing on ensuring each breath is in synchronisation with your running form rather than the two being unconnected.

Some runners also swear that timing exhalations with the foot landing on the opposite side to the stitch can actually alleviate stitches if they appear. Again, not on every stride, but just in sync with the opposite foot landing. The theory is that contraction of the diaphragm from breathing out along with the impact of the footfall on the other side of the body causes interference with the spasm causing the stitch.

Take a break after eating

Many athletes struggle with stitches when doing a workout right after eating. How long you have to wait between eating and exercising without stitches affecting you can differ depending on the discipline, with running usually causing the biggest issues. What you eat and drink can have an effect – avoid high-carb drinks and foods high in fat or fibre to reduce chances of cramps.

Train your stomach

Not eating during a race, especially in longer events, isn’t really an option – but you can gradually build up your tolerance to food during training. Try eating small amounts before exercise and gradually shortening the time between eating and training to get your body used to working hard while digesting in a controlled way. Experiment with different types of food, keeping a food log and noting down what works for you as well as timings between eating and training.

When it comes to eating during exercising, the relative stability and generally lower heart rate of cycling makes digestion a little easier – so start by eating small amounts on the bike before moving on to the run.

Back off

If you feel a stitch coming on during a race, back off your pace a bit, relax and breathe deeply. If the pain is particularly severe, you may find some respite from stopping and stretching. Side and backbends can help ease the pain and could be less of a time penalty in a race than ploughing through the discomfort with poor technique and efficiency.

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Triathlon Vibe is the home of triathlon training advice for beginner to expert triathletes. From sprint to Ironman, we share how to swim, bike and run stronger and faster.