It’s been a good week! Let me break it down by workout!
Monday found me back in the gym for a pretty intense workout. I actually got so caught up in circuit training that I never made it to the pool. I can’t say I missed the smell of chlorine in my hair though. 😉 This is what I did:
- 30 minutes on the recumbent bike, interval training but no steep hills (per PT).
- Circuit 2 x:
- Double-leg-lift w/ crunch x 15 (wearing 5 lb ankle weights on each ankle)
- Side leg-lifts x 15 each side (wearing 5 lb ankle weights on each ankle)
- Standing single-leg deadlifts to kick-backs x 15 each side (wearing 5 lb ankle weights on each ankle and using 26.5 lb KB)
- TRX low rows x 10
- Bicep curls x 10 (using 12 lb weights)
- Bicep forearm curls (using 12 lb weights)
- Overhead tricep extensions on an exercise ball (using 15 lb weight)
- French presses on an exercise ball (using 15 lb weight)
- Weighted pilates sit-ups (using 15 lb weight)
- 15 mins stretching, including full leg stretch series with resistance band.
I felt great after this workout and I saw my PT later that morning. She says my quads are getting noticeably stronger and as my vastus medialis strengthens the tracking issue with my patella should resolve. The brace I bought is making a huge difference and the PT encouraged me to start trying short-duration squats, lunges and planks.
The BIG news is TUESDAY I CLIMBED!!! Woo-hoo!! That also means I’ve re-discovered muscles in my back that I forgot I had. 😀 I started by riding a bike at the rock gym for 15 minutes and then I hit the walls. Whoo, I forgot what a cardio workout climbing is, coming into it with a sweat from the bike was tough! I started by climbing all of the V0’s, and I was feeling really good. I even did a V0 that was all overhang and it felt good and smooth. The leg exercises that my PT has had me working on are very core/psoas oriented which was perfect prep for hitting the rock walls. I felt strong despite not climbing in over a month. I then hit some V1s and a V2- before I decided I had enough. That was only about 45 minutes of climbing, but it was a great start and again the knee brace made the tracking issue nonexistent.
Tuesday after work I took a trek to Mission Hill in Boston to check out a recumbent stationary bike I found on Craigslist. It was totally what I wanted and at a good price so it was worth the almost 2 hours of driving to get it. When I got it home I did 30 mins on it.
I’ll admit, after two days of pretty intense workouts my knee was a bit sore today at the distal tendon attachment. So this morning I just did pilates with a glute focus. I did play with squatting and lunging a bit in there. I’ve also found that planks are pretty comfortable with the knee brace so I’m excited to start doing more plank exercises. When I went to PT today I let her know I was sore, but much better than last week. She was happy with my progress and told me some sore is ok, but to monitor it. She thinks I’m on an upswing and that’s my hope and thought too.
CLIMBING AGAIN TOMORROW WOOHOO!!!!!
Recovery has its ups and downs. I was feeling great after my last post. The knee pain was under control and I could really feel the upswing of recovery. Unfortunately, I overdid it in Seattle and have been slowly getting back to where I was this past week.
For starters, we just couldn’t find rental bikes that were affordable (I’m talking $180/wk, the same as our rental car), which put a damper on my plans to bike. It also didn’t help that we stayed in Mapleleaf, which is a long haul to downtown Seattle so the feasibility of riding daily was greatly diminished. That said, I did manage to do my PT exercises five out of the seven days we were there, and I also did laps in a pool for one day and yoga on one day. Obviously, compared to my normal workout schedule that is a drop in the bucket.
The real thing that set me back was, unfortunately, the walking. I was told walking was ok, and even light hiking would be ok. Apparently, my knee did not agree with the hills in Seattle. A few days into the trip a group of us headed to the Locks and Discovery Park. It was a long walk, up and down many hills. I was doing ok for the first few hours, but the last stretch of the hike took us up several staircases in the park and that’s when my knee pain really came back with a vengeance. I made it to North Beach and sat for a bit. By then my partner could see I wasn’t doing alright and he started trying to figure out how to get me back to the car without hiking the whole way back. He knew I was stubborn enough to just walk back, but I’ll admit I was glad he stepped in. He and a friend ended up jogging the three miles back to the car and picked the rest of us up. Since a couple of his friends were beat by then, they were happy to stay behind with me, which made me feel like less like a cripple.
By then the damage was done, so for the rest of the trip walking hills was painful both in my distal quad tendon and under the kneecap. I ended up skipping the group hike at Rattlesnake Ridge and hung out at the lake there instead, which didn’t feel like a sacrifice at all; it’s gorgeous!
Tuesday I was back in PT and let my therapist know what was up. She found that the quad tendon is doing much better, with noticeable improvement to the scar tissue, but the big issue now is the tracking of my right patella. I’ve always had tracking issues with my knees, but apparently right now the right patella is trying to go too far laterally when I bend my knee so it’s grinding on the bursa and bone beneath it, causing the pain I’m experiencing. She did the usual ultrasound, TENS and massage and we tried some kinesiotape to see if that would help.
Wednesday I was back in the gym for a “normal” workout:
- 30 mins on the spin bike
- Circuit x 2:
- Double-leg-lift w/ crunch x 15 (wearing 5 lb ankle weights on each ankle)
- Side leg-lifts x 15 each side (wearing 5 lb ankle weights on each ankle)
- Superman arm/leg lifts x 15 (wearing 5 lb ankle weights on each ankle)
- 30 KB swings (26.5 lb KB)
- 10 KB Press each side (26.5 lb KB)
- 10 mins stretching, including full leg stretch series with resistance band
- 20 mins swimming
- 5 mins in the hot tub
Unfortunately, my knee actually hurt while biking, which was new. It seemed fine during the circuit but I felt the pain when I bent my knee swimming again. On Thursday I opted to just swim for 40 minutes, which was fine but kind of boring.
By the time I went to PT on Thursday I was not feeling great. My therapist spent a full hour with me, doing assessments and additional treatment. She decided the kinesiotape wasn’t enough and that I should try a thin knee brace for patella tracking. I have to say I felt great after her treatment. I picked up a knee brace that’s intended to be lightweight and is used for patella tracking. I used it for yoga last night and overall I have good things to say. It’s a bit thicker than what I’d ideally use for yoga, but I’m struggling to find a thinner product; the tape was really the ideal thickness. I did feel like the thickness compromised my flexibility since it bunches up a bit behind the knee. Per the PT’s advice, I did play around with bending my knee a bit, and it was a rigorous class and my knee didn’t hurt afterwards! I’m going to take the brace to the gym on Monday and see how I do. I was also told to not use spin bikes since the clips cause some shearing of the bone that my patella is coasting over, and the position one rides in uses more range of motion than I should use right now. So back to the normal bikes and we’ll see how it goes!
I’m so ready to be recovered. 🙂 Hoping to climb next week too!!
About two weeks ago I wrote a long post about how I injured my knee at the end of May and the many frustrations I’ve had seeking proper treatment for it. I thought it was my best entry ever, which meant, naturally, that the entire body of the post disappeared when I hit “publish”. After much ado, tech support let me know there was no hope in getting it back. I will hopefully wrangle up the hutzpah to re-write it at some point, but for now I’m just moving on.
So, quick facts on what’s up:
- The last week of May I banged my knee against the climbing walls while bouldering (not unlike me, I have very little grace in my legs when I climb) and bruised my distal quad tendon right at the top of the patella.
- The very next day I could barely move my knee and was in a ton of pain. Ice/rest/elevation and I was getting better.
- Feeling better, I went back to my normal workouts, which left me unable to walk for two days…crap.
- Spent a month modifying workouts and using ice when needed. No pain killers. Still struggling with pain so I saw my PCP, who sent me to an Orthopedist, who diagnosed me with a very small tear on the distal quad tendon and sent me to Physical Therapy.
- I haven’t been able to teach yoga since I can’t squat or lunge, I also can’t run/jump or do bodyweight exercises with significant quad engagement. Not easy, but I’ve been making it work.
- Just started PT yesterday, which already has made a difference. I have scar tissue in my quad so it will take 4-6wks to repair, as opposed to ~3 if I came in right away, but it WILL repair.
So I’m looking at about another month of recovery as long as I’m careful and keep my fitness up. Unfortunately, much of what I’ve been asked to do (swimming, cycling) I can’t do at home so my loving partner bought me a 1 month membership at our local
cattle-call gym. It’s one of those fancy Boston Sports Clubs and, frankly, I fucking hate it. That said, recovery is the most important thing. I’m a physical person, I have two physical jobs and I was preparing for a climbing comp in September, which I still have a chance for if I take care of myself. My leg will also, hopefully, be with me my entire life so I have to treat it right.
I’m posting today to start a log of my workouts. This may not be daily, but I thought this would both help me track what I’m doing and possibly help give others with knee injuries ideas on what they can do. The most common thing I see as a massage therapist is clients who get injured, get out of a normal exercise routine, lose fitness and struggle to get it back or give up entirely and become sedentary. I’ve personally seen this lead to chronic health issues including depression, chronic aches and pains, insomnia, and in extreme cases issues like heart conditions and diabetes due to weight gain. Let’s face it, we all know proper diet and exercise make a huge improvement to our quality of health, so the lack of exercise can lead to poorer health. This is one of the reasons I’m fighting to stay fit, while also ensuring I treat my knee right to prevent further injury. The Orthopedist said this is not a time to “play through the pain” unless I want to be back in 6 months with a completely torn tendon; at which point I would need surgery. No surgery, please!
On to the workouts…
First one is a circuit I’ve been doing at home. I start with a 5-10 min warmup and end with ~15 minutes of yoga for a cool down, ensuring that I’m not doing lunges, squats or two-legged planks on the right.
- One-Legged Wide-Arms Pushups x 10 (bad leg on top)
- Bicep and forearm curls x 20 each (10lbs)
- Tricep overhead and push x 20 each (10lbs)
- L side-crunch x 20
- R side-crunch x 20
- Chest push and flys x 20 each (10lbs)
- Kettlebell Seated Twists x 40 (26lbs)
- Weighted sit-ups x 10 (15lbs)
- Butt-lifts->legs straight full sit-ups x 10
- One-Legged Close-Arms Pushups x 10 (bad leg on top)
And here’s what I did for my first two days at the gym:
7/14/14 – Total time: 1:15
- 45 min spin class without standing
- 10 mins stretching
- 8 laps in olympic-sized pool, various strokes
- 10 mins sauna
Reaction: Spin class was SO BORING!! I really struggle with machines that use a lot of cardio but don’t go anywhere. I get the rat-in-a-cage syndrome. That said, I have to bike right now so…
7/15/14 – Total time: 1:15
- 30 mins cycling, using intervals for both speed and tension
- 5 mins upper-body stretching
- Circuit 2x of:
- Chest push and flys on ball x 10 each (12.5lbs)
- Bicep and forearm curls x 10 each (12.5lbs)
- Tricep overhead and push on ball x 10 each (12.5lbs)
- Leg lift series (per PT):
- Lying on back, lift one leg up, foot flexed, and lift upper body into a crunch x 10 each side.
- Side leg-lifts x 10 each side.
- Lying on stomach, lift one leg back, foot pointed x 10 each side.
- Side-crunches x 10 each side.
- 5 mins stretching
- Swam 5 laps, various strokes, one lap with kick board.
- Attempted to sit in steam room, it smelled like a pile of old socks.
Reaction: This was much more my style, even though I still wanted to gauge my eyes out during the cycling. It’s so boring. I have to find a way to make it more fun. The circuit was good, shorter than I’d like but it’s hard to fit everything in before work. As it is, ideally my PT would like me to do 40 mins on the bike and I’d like to have swam longer, but I really needed the circuit to make me feel good in my upper body and abs. I realize swimming is a full-body workout, but as someone who’s used to lifting weights, it’s not enough for my upper body.
Through this process I’m also tightening up my diet. I have been cheating on my food allergy diet off and on since moving back to MA; lots of temptations down here. It’s amazing that in just not eating the things I’m allergic to I drop weight immediately…like 7 lbs in a week. That’s just pure gut inflammation, and I was feeling it as my belly started protruding again. For the record, this is not a calorie-restrictive diet, it’s simply not eating the foods I was diagnosed as being allergic to. Huzzah science!
Speaking of which…after a workout like that a healthy breakfast is imperative! This is what I went for:
Eggs on a gluten-free millet bun with half an avocado with salt + pepper and a small handful of fresh fruit. I have my healthy fats, a good amount of protein, and some carbs to perk me up. Feeling great!!
Aside Posted on
The past month has been particularly busy, as Spring is finally here in full force and I’m happily spending as much time outdoors as possible while squeezing a ton of activity into each day. The sun stretching across so many more hours of the day means my energy is renewed and I’ve successfully sloughed off the winter urge to hibernate. I even got talked into competing in my first rock climbing comp, The Ring of Fire held by Central Rock Gym (my favorite Boston-area indoor rock gym).
It was a bit of a last-minute decision as I went in to climb the Monday before the comp and the woman working the front desk really encouraged me to sign up. I didn’t realize most comps have a Women’s Beginner’s division. I had already been planning on coming to watch the pros climb, so I figured why not give it a go. All-in-all I didn’t do terribly well (flashed the first wall, fell on the other two) but I had a lot of fun and learned a ton. I’d definitely do it again! I’m really not a competitive sports person so it was quite a surprise that I both did it and enjoyed it. Also, watching the pro finals that night was outstanding. Ashima Shirashi and Delaney Miller blew my mind, and I was seriously impressed by everyone who climbed.
The real reason I was drawn to blog today though is to address some information that’s making the rounds about Vibram Fivefingers. If you’ve been reading this blog for a while, then you may know I started blogging when I first did the Couch-2-5k program back in the Spring of 2010. I had always hated running and used the excuse of “bad knees” to get me out of even thinking about it. I was encouraged to try running with C25K and Fivefingers as I read there were benefits of running barefoot. The biggest benefits for me were that it encouraged using a more natural stride (mid-sole/fore-foot strike instead of heel strike, working on pushing up/being springier) and increased awareness of the environment (eyes learn to scan the terrain to avoid stepping on sharp objects). I personally experienced both of those pros and also found it was the first time in my life I could run without knee pain and shin splints. I also enjoyed running for the first time as it felt like playing when my feet could really feel the textures of mud, sand, gravel, etc. It was such a positive experience for me that I’ve bough three pair of Fivefingers in the past four years and I use them for running, hiking, paddling and swimming. I even just ran my first 5K in them last weekend (note, I just started walking at this point so that heel coming down is not my normal running stride):
While I’m obviously a fan of VFF, I also realize they’re not for everyone. Depending on your foot shape and bone structure they may not be for you. I’ve also seen quite a few people injure themselves due to switching to VFFs and not weaning into them properly. VFF shoes use muscles in the feet, ankles and calves that you may not be used to using on a regular basis. This isn’t true of just VFF shoes, it’s true of beginning any new physical activity or picking up an activity after months without it. For example, how many of us know people who have become injured after heading to the gym and doing the same weight routine they did four years ago when they haven’t touched a weight in months?
So to me, it was no surprise when this research study came out citing the potential for increased foot bone marrow edema in those transitioning to VFF shoes. The thing is, some people are seriously misinterpreting this study to mean VFFs are terrible and horrible and, as one post mentioned, “will fuck up your feet”. Whereas in reality the study clearly states: “CONCLUSION: Runners interested in transitioning to minimalist running shoes, such as Vibram FiveFingers, should transition very slowly and gradually to avoid potential stress injury in the foot.” Well, that makes sense.
But let’s take a moment to break down the study. It involved 36 experienced runners, 17 in the control group ran in their normal shoes, while 19 transitioned to Vibrams. The transition plan sounded reasonable. Runners continue their normal running routines (which are 16+ miles) and use Vibrams for 1-2 miles to start and gradually increase. The thing is, the study gets a little wishy-washy from there. “It should be noted that some subjects stopped logging their runs prior to the 10th week of training and 4 of the 19 Vibram subjects did not document their training at all, though they did participate in both pre- and post- testing and therefore, were included in the statistical analysis in this study. This lack of documentation presents a limitation to this study.” That’s kind of a big strike here. The people running the study also don’t note how runs were tracked. It’s alluded to that the runners all self-document, which leaves quite a bit of room for error. I was surprised they didn’t have them at least track their run with a smartphone app. Not that those are perfect, but it would be a bit more scientific than giving them a logbook and sending them on their way.
The study goes on to explain that they used a MRI before and after the study with each included participant to check for bone and soft tissue damage. There was a noticeable increase in edema and a small incidence of stress fractures with those using VFF shoes. Incidences were higher in women than in men. This is certainly concerning and not something to brush off. I do personally feel this warrants more study, since the control group was small and there were issues with the data collected, but their conclusion draws upon common sense.
“Although most runners will not know about the presence or degree of bone marrow edema, our results suggest that if a runner transitioning to VFF feels pain, they should modify their running regimen.” Yes, this. They also concluded that if you are a long-distance runner, it’s advisable to transition over a period of time greater than 10 weeks. I’m totally down with those conclusions. Not only do these rules apply to running with VFFs, but they’re common sense rules for exercise in general.
Rebecca’s Simple Rules to Avoiding Injury
- If you feel pain make modifications to your exercise.
- Transition slowly into new exercise routines.
- Properly warm up the body before engaging in physical activity.
- ALWAYS stretch and cool down after physical activity.
- Support your body with proper nutrition to fuel your workouts and support your recovery.
And lastly, since our society is so friggin’ litigious, Vibram Fivefingers was sued for making unsubstantiated claims about their footwear (basically saying it was a healthier way to run). So if you purchased VFFs after March 2009 you may be eligible to collect from this class action suit. So if that applies to you and you’d like to be a part of it, keep an eye on this page for updates on how to register. For the record, VFF still claim they did nothing wrong, so this is a settlement, not an official ruling.
As for me, I’m going to continue rocking my Vibram Fivefingers. And I’m especially excited to use them for paddling season!
Oh poor ignored blog! I apologize for my lack of regular entries. Due to some family complications my writing schedule has been a little off. Luckily, my running has been right on schedule!
I can’t believe how much I’ve improved in just four workouts. The past three runs have been 1.58 miles (I’m sticking to the same path) and I’m continuing to run quickly through the fields and slow down to a light jog or fast walk around the wooded areas. I’ve found this is both giving my foot a chance to heal and I haven’t had any breathing issues, despite sweating up a storm! My speed has already increased so much that I’ve cut more than four minutes off the workout! Woo-hoo! Eventually I’d like to reintroduce distance along with the speed, but right now I’m enjoying speeding up and having a steady recovery from my foot injury.
Under that little band-aid is a needle routed through a tiny magnet. It’s placed on the Liver Meridian, point #3 (LV3) which, aside from aiding my foot, is also a stress-reducer.
I do have a funny story to share. Yesterday, when I got to work my Vibram’s were still wet from some reservoir swimming I’d done the day before. Since it was a bright, sunny day I put them on the roof of my car. Well, around lunch time I headed into town for some grub and then to a client’s home for a consult. Naturally, I completely forgot the Vibram’s were on my roof. At the end of the day, I headed out to my car to grab my shoes and hit the trail. You should have seen the look on my face when I found one sad Vibram clinging to my roof rack, while it’s buddy was no where to be found. I was furious with myself (though, also amused by my stupidity). I decided to start driving down the road and fully expected that if I was lucky enough to find my shoe it would certainly have been run over by then. Needless to say I was pleasantly surprised to not only find the shoe, but I found it intact less than a mile away and near a turn around so it was even easy for me to park and pick it up. I believe that was the last time I dry my shoes on the roof of my car!
Lastly, I wrote up a synapsis of how technology has aided my running in this week’s Tech Tails newsletter. Here it is if you’re curious. Also, if you enjoy my babbling you’re welcome to subscribe to Tech Tails and get a dose of Mac bantering in your inbox every week.
It’s a twofer! The VT Biz Expo ate the middle of my week so while the running was still right on target, I didn’t quite find time for the blogging.
I had two very different runs for my last days of week 8. Both were 28 minutes but they took place in very different weather conditions. Day two was full of fail. It was Wednesday and the temperatures were predicted to be in the 90’s; this is Vermont, right?! I decided to be smart and run before work so I’d avoid the mid-day heat. Well, it was already in the mid-80’s by the time I headed out on the Mad River Path a little before 8am. The humidity was incredible. I had issues breathing deeply just during my pre-wamup-stretching. The sun on the East side of the path was also full and HOT. I expected the trees to shade me more, but there was no getting away from the unrelenting sun. I was hot, I was covered in beads of humidity, and I hadn’t even started running yet!
I tried. I swear I tried my hardest. I kept telling myself I could do it, but around 20 minutes I started getting terrible side-stitches on top of the not being able to breath and being beaten down by the sun. I continued to run in-between trying to relieve the cramp and at 25 minutes I made a b-line for the river and collapsed. I guess I’m glad I made it to 25 minutes, but it’s the first run that I didn’t complete and I felt a little defeated. I know I was only three minutes away from the goal, and some reading this might wonder why I didn’t just push myself a little harder, but I seriously pushed myself hard the whole time and that last three minutes would have been an eternity. Ok…maybe I’m being a little dramatic there, but let’s just say I was DONE. The river felt swell though. 😉
Day three was much more successful. While it was still warm, the temps were in the mid to high 70’s with much less humidity so it was totally do-able. I did the entire run on the West side of the Mad River Path and ended up on a part of the path I had never been to before. I find it’s much easier to run if I’m running somewhere new. I get distracted by looking around and exploring new places. Once I’m back to part of the path that I’m familiar with it’s easier for me to find landmarks of “time” so I think to myself, “Ok, don’t get excited yet, you’re only to that bench and that means you have a loooong way to go.” or “This is the last bend in the path, only about three more minutes!” Finding ways to take the focus off of the clock makes the runs more interesting for me and it seems less like exercise and more like brisk exploration. I need to work on this since it’s much easier to fall into the routine of taking the same route every time.
The session ended with another luxurious swim in the Mad River. Toby is getting used to my swimming with him now, but he was still surprised (and so was I) when I ran through the river and caught up with him, as he was taunting me with a freshly-caught stick. I can’t believe my thighs are strong enough to actually run through the river current now. It continues to be very exciting to see how my body is changing thanks to running!
I do have one potential injury that I’m a little worried about. Thursday, while I was at the Expo, I wore heels all day; this is something that I’m seriously not used to, especially since I’m about 6′ tall and really do not feel the need for heels often. My feet were very smooshed all day and they (and my lower back) were bothering me that night. When I ran on Friday, my gate was off. I tried to correct it but I could tell I was landing differently on my left foot. Sure enough, last night my left big toe was bothering me. After some palpation, I found the source of the pain is coming from higher up, following the path of the adductor hallucis and bugging some nearby muscles and fascia. I did some self-massage on the area (and whole foot) last night and iced it a bit.
Today, the area is still sore. I’m not thrilled by this. Foot pain can be serious if left alone and as a massage therapist, being off my feet means I can’t see clients. Not to mention, as an active person being off my feet is just NOT OK. My next run is planned for Monday, but I’m going to be RICEing my foot this weekend (so much for hiking today) and I’ll have to assess how it feels before the next run. That said, next week is MY LAST WEEK!!! I can’t believe it’s already been nine weeks. I’m still looking for fun suggestions on how to continue with running without getting bored. Please pass any ideas my way!
I’m happy to report that my blisters have quickly transitioned from painful to barely-there thanks to those Epsom Salt soaks and a local organic foot salve I picked up at Healthy Living. I’m not even wearing the Band-Aids anymore and am walking around pain-free! While I’m glad I don’t need to run in the bizarre snow-sun-shower we’re having today, I’m excited to get back out there tomorrow!
For today, let’s talk about Exercise related Transient Abdominal Pain (ETAP), aka “side-stitches” or “stomach cramps” during running. I would imagine I’m not the only one out there who was barked at by coaches while running that once-a-year-mandatory-mile to “raise your arms and run through it” when experiencing a side-stitch. It had been years since I experienced one of these evil ETAPs but the first time I did I put my arms over my head and didn’t get much relief. I ran through it, but the pain was much more terrible than I had remembered. Being an anatomy geek, I wanted to understand what was really happening when I had a side-stitch and I wanted to know what I could do to stop it.
To understand ETAPs, one needs to first understand two concepts: how the diaphragm works and how a muscle cramp works. Let’s start with the diaphragm. The diaphragm is a large muscle that lives within the thoracic cavity. As one breaths in, the diaphragm fills with air and swells, which expands the rib cage and shifts the organs that are near it. As one exhales, the diaphragm flattens, bringing the rib cage and the displaced organs with it. Check out this animation from the Stough Institute for a a good idea of how the diaphragm looks in action.
Sometimes, the diaphragm itself can cramp and that’s when we get hiccups. With hiccups, the diaphragm experiences spasms and we can coax it out of this state by taking deep long breaths, holding our breath, drinking water upside-down or doing any other technique to try to stabilize the diaphragm. During an ETAP, the diaphragm is involved, but it’s not actually the muscle that is cramping, the ligaments around the diaphragm are.
So, let’s talk about muscle cramps. When a muscle cramps up it’s staying in a contracted state; which can be very painful. Let’s take an example we can all relate to: the Charlie Horse. During a Charlie Horse, the gastrocnemius muscle (the large superficial muscle that makes up most of the “calf”) contracts, which causes a lot of pain. Sometimes, just applying static pressure or stretching the contracted muscle is enough to get it to release. In Sports Massage, I often use a technique called “Reciprocal Inhibition”.
Reciprocal Inhibition is a blog entry all on its own, but the long story short is it’s a technique that engages the opposing muscle group which often causes the contracted muscle to relax. For example, if the calf is cramping, I’ll have the client lie on their back and I’ll apply light resistance to their ankle while asking them to push against my hand which engages the anterior muscles of the legs. The brain is wired to stretch the muscles that oppose the engaged muscles so this technique often gets the cramped muscle to release. This idea is important when it comes to relieving a side-stitch.
Ok, so we now know how the diaphragm works and we understand some basic concepts of a muscle cramp. Now, let’s get visual! First, let’s look at the thoracic cavity so we can really get some perspective of how much is going on in there. Check out the picture on the right. It offers a great illustration of how jam-packed our body is. The diaphragm in this drawing is depicted as a thin layer beneath the lungs and above the liver. From the illustration above and the linked animation, we know that the diaphragm is actually quite large, as it wraps around the ribs, though it is also fairly thin. Recent research has shown that ETAPs are a result of ligaments that connect the diaphragm to the internal organs and other connective tissue cramping up, which offers an unpleasant resistance to the diaphragm as it contracts and releases.
Since the liver is the largest inferior organ that is connected to and displaced by the diaphragm, most side-stitches are felt on the right side (which is what I kept experiencing), and most have to do with the ligaments running from the diaphragm to the liver. Let’s look at that!
There are five ligaments that run between the diaphragm and the liver. Four of these are peritoneal folds: the falciform, the coronary, and the left and right triangular ligaments. There is also the round ligament which results from the umbilicus. To try to visualize this, check out the two pictures below from Gray’s Anatomy. They’re giant in the hopes that you can read them!
Just like with any muscle cramp, if one (or more) of these ligaments cramps up there are a few tricks to try. Our gym teachers weren’t all wrong by telling us to put our arms over our heads. When a muscle cramps one of the best first steps is to try to stretch it. By raising our hands above our heads we’re gently stretching those ligaments. However, there are better ways to get the job done. Give these techniques a try and let me know what works for you!
- Try taking deep slow breaths in and then exhale by blow out forcefully through your mouth; like blowing out candles on a birthday cake. This technique uses the diaphragm to stretch the ligaments. It’s also similar to Reciprocal Inhibition as when the diaphragm contracts the brain sends a signal to the ligaments around the liver to relax.
- Try side-stretches like the yoga posture “moon”. Bring your hands above your head, take a deep breath in and on the exhalation tilt to one side, hold for a few breaths. Take a deep breath in as you bring yourself back to center and on the next exhalation tilt to the opposite side, hold for a few breaths. Take another deep breath in as you bring yourself back to center and on the next exhalation bend backwards, really stretching out the abdomen.
- Manually stretch the ligaments by bending forward and pushing in with your fingers under the rib cage and gently pull downwards on the liver. Personally, I’ve found this method works the best for me. This can also be used while running by squeezing the right side (which helps stretch those ligaments) and taking deep breaths while continuing to run.
There are also some ideas on how to avoid an ETAP:
- Try not to eat within an hour before running, as a full belly can cause more stress on the ligaments. Drinking water is totally A-OK.
- Take even breaths in and out and try to breath deep into your belly. It’s thought that shallow breathing also creates more strain on the ligaments.
- Be sure to hydrate yourself before, after and during the run as needed.
- Incorporate side-stretches in your pre-workout stretching routine.
If you’d like to see the ETAP relieving techniques in action check out my video below! Please let me know if you find any inaccuracies in this post. Thanks for reading!
Some other sources for information on the causes of ETAP and how to relieve it: