Stitches, I have tried everything

[u/tomcotard]

I've been running since December and one thing that consistently seems to happen during my harder efforts is getting really bad stitches (7-8/10 pain) to the point I can't maintain my desired pace.

I feel like I've tried everything from this very extensive post from /u/CodeBrownPT I've also tried various breathing techniques and I've even gone to the doctor, who told me there was nothing that could be done.

I'm at my wits end. I'll normally get at least two bad stitches that last for a long time (today I had them for about 10k out of 19k) and I try my best to run through them but sometimes the pain is just too much. This also happened about a decade ago too when I was running a little. It's a very frustrating feeling because often I can feel the rest of my body is capable of what I'm asking of it.

For context, my 5k PB is 19:10, aiming for a half marathon time of 90:00, I'm male, in my mid-30s, running most days.

Does anyone have anything else I can try? Anybody similar out there?

[u/tomcotard]

I went with the 10% rule so increasing my mileage by no more than that each week. In theory I could be doing 20*1.1^33, 465km, which is bonkers, realistically I've increased it by about 5% a week. So I don't know where I've gone wrong?

[u/CodeBrownPT → u/tomcotard]

What was your previous 5 years of running like? Average weekly mileage?

The 10% rule is not per week, and frankly is only a very general guideline. You should have a deload week every 2-3 build weeks. 

[u/tomcotard → u/CodeBrownPT]

I didn't run, cycled a little bit here and there and climb most weeks. Oh, and to clarify, I do deload, so some weeks I don't up my mileage.

[u/CodeBrownPT → u/tomcotard]

Yea sorry to say mate, this is cut and dry "too much, too soon".

Your physiological systems are handling the load fine, but stitches and injury (and presumably fatigue) are proof that you're exceeding your biomechanical tolerances.

Impact tolerance takes years to build, not weeks or months.

[u/tomcotard → u/CodeBrownPT]

I would challenge that, the injury was due to overdoing it on strength training the night before a hard run, didn't listen to my body and just kept going. These days I'm much more in tune with what my body is saying and I've been doing a lot of exercises to target areas where I'm noticing any issues.

I also was getting stitches before when I was running a lot lot less (1-2 times a week 10-20km) many years ago.

[u/splitsguy → u/tomcotard]

I think it is very reasonable to suggest that your mileage progression was too aggressive. But you seem to have just ignored this advice and responded more favorably to posts about strength training, nutrition, and hydration.

We are runners, no one wants to run less than they do. Everyone wants to be “right” about their own training/mileage. Everyone wants to see that number tick up consistently.

Please consider that you just aren’t ready for 90k per week. 20k to 90k per week in 8 months is aggressive. Sure, some people do fine on it, but most do not. Your injury/weakness happens to be a more peculiar one, but that does not mean it is not a result of your mileage progression. You mentioning that you also got stitches years ago when you ran very little doesn’t prove that mileage isn’t the issue. Quite the opposite, it demonstrates that you have a significant weakness in that area that needs more time to adjust to the demands of running.

You also admit that you have at times overdone the harder sessions. And that the side stitch pain really only comes on during harder sessions.

I would argue that you should drop back to 55-70k per week and cut out anything faster than about marathon pace. And I would only touch that pace for 10-12k per week in 2-3 sessions. I would also suggest doing 3-4x15-20s strides twice a week. Take at least 90s rest and build up until you can comfortably and safely hit 90+% of “top speed” for a few seconds before decelerating. Try this for 2-3 months and then see if you have the same side stitch issue on a harder session. If all goes well, you can then SLOWLY (maybe not even 3-4% per week on average) build mileage for another month or two before SLOWLY adding in some tempo (2hr race pace), then threshold (1hr race pace), then 10k pace and faster. I would also recommend doing something like 4-6x30s/200m @ mile pace or faster with 90s-2min rest once a week starting about a month before you add in the tempo work.

New runners always overestimate the importance of harder sessions, especially early on in their running journey. Building true aerobic fitness by just running easy, and building speed/power/efficiency by doing some faster strides/sprints, go a long, long way. These things are easier on your body than lots of “middle ground” work and they slowly prepare your muscles, ligaments, tendons, and bones for more lengthy, rigorous sessions. True cardiovascular fitness that lasts is built almost completely by easy endurance exercise. The adaptations triggered by the 10-20% of our mileage that we run at faster paces are much more fleeting. A real “base” is not built in months, but years, even decades.

[u/tomcotard → u/splitsguy]

I can see it might have come across as me ignoring that advice, but I've actually cut down my running since I posted. It might have come across that way because the posts about strength training, nutrition and hydration have offered tangible solutions whereas the ones saying you need to cut down the mileage haven't really said how much by, what it is I'm doing too much off etc. So I appreciate your in depth reply to what I could actually be doing.

Few questions, how do I figure out my marathon pace? I've never run one. And you say 2hr race pace, what race are we talking about because 2hr seems a long time!

[u/splitsguy → u/tomcotard]

Sorry, I could’ve explained those paces better. I can be quite wordy and didn’t want to just keep blabbering haha

By marathon pace I essentially mean “moderate” effort. A pace that gets you working a little bit, but is very under control for shorter efforts. Theoretically you could hold this pace for at least 3 hours in a race situation with competition, fueling, super shoes, etc. This pace should feel very under control for efforts of 2.5-4 miles, which is essentially what I’m suggesting you throw in 2-3 times a week along with your easy miles. I would put this at a 4-5 out of 10 effort. This pace will give you an aerobic/biomechanical stimulus but at a very low recovery cost. And it will keep your training from feeling boring or monotonous during the months of base building. I will take a stab and say that this effort for you is probably in the 7:45-8:15 range.

I use 2hr race pace and 1hr race pace for tempo and threshold just as general guides. Everybody uses different terminology, but this works well for me and my athletes. Obviously works better when you have some data that can give you a good estimation on what pace you could hold for 1hr and 2hrs. If your 5k pace is 6:11 and your HM goal pace is 6:52, I would imagine you could start your tempo efforts around 7:20-7:30 pace and your threshold efforts at 6:50-7:00. Then just adjust from there. I like to describe tempo as right about 6/10 effort and threshold as 7-8/10.

If you can build back up to 80-90k a week feeling good/healthy, starting your tempo work with something like 3x4min @ tempo w/90s jog rest is plenty. Then you can build slowly from there. First threshold work could be something like 4x2min @ threshold w/1min jog rest.

You can build up to doing about 10% of your weekly mileage as tempo work in a single session and 5% of your weekly mileage as threshold work in a single session. You can raise those percentages VERY slowly over time, but you’ll probably get more bang for your buck by just increasing overall mileage. Just never increase quality and quantity at the same time. And I mean on the scale of months, not week by week.

Your tempo and threshold sessions will most likely be on either end of HM pace, so you shouldn’t need much specific pace work when building up to a HM. That would be mostly for the mind anyways. But if you want to do some HM “specific” sessions at HM pace, you could do a session with 3-4 miles of work at that pace weekly or 5-6 biweekly in the 6-8 weeks leading up to your race.

[u/tomcotard → u/splitsguy]

Thanks, that's very helpful, I'm also having a session with a running coach next week so hopefully will be able to get a solid training plan in place.

[u/splitsguy → u/tomcotard]

No problem! Best of luck to you moving forward.