The past 3 races I have run(olympic dist Tri, and 2 10Ks) I have developed severe deep side “cramps” at about 4 miles into the run…I have trouble believing it is muscle cramps- not typical side “stitch”…I have a good strong core…I am running 6:30 pace in the tri, sub-six in the 10k, but then just have to STOP because my middle is cramped…I am so frustrated…so, is there anything I can do to train so this doesn’t happen? Is it diet-some vitamin or mineral lacking? sodium? lactic acid? is it dehydration? Help! Thank you 
PS. Never get this on training runs…even when I push it… (I am 29 year old female, 5’4, 107lb)
I know you said you had a good core but my guess is that you need a better one. You should pay extra attention to your lats.
Another theory is that pain works down. So if your having pain in your core its because your chest/back/shoulders are weak. Just a thought. Good luck.
Thank you for the advice- I do lift weights 5x/wk, bench, lat pull-downs, free weights, abs, ball work…but maybe I need to change up my routine…make it more functional…I do full body work-out with 2 sets of each musc group mon through fri…maybe better to beat up one musc. group and then rest it? Like- back monday, chest tuesday…does this seem to work for you? A bit off topic, still want some more concrete info on the cramping…thanks again…
find the min you can drink and be ok (less in your stomach the less there is to bounce around), and try breathing through your nose more during the run,
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I like to stick to push ups pull ups and then some weights with high reps. Any core pain I have ever had has always been worked out with more core work. Another thought is if you are lifting 5x a week you probably (just a guess) aren’t running enough. The way I see it lifting needs to be done less than anything else. Are you running more than 5x a week or swimming or biking? I just do legs one day and upper body another.
You might want to try mixing up your core work also. 5x a week on your core would be more than enough but you have to hit it hard and make it hurt. Don’t forget your lower back.
I’ve had the same problem this year. I’m a bit relieved to know that I’m not alone on this one.
I raced an oly distance in March during which I had the inability to keep fluids down on the bike and SEVERE upper abdominal cramps during the run. The pain was so severe on the run run I thought I was giving birth. I vomitted 5-6 times. When I stopped running the pain gradually when away over minutes. I had a “normal” appetite immediately after the race. Two days later, I had bloody stools(red). Two days after that, no blood. I had lab work, “turn and cough”, rectal swab, and a CT scan. All negative.
I resumed training and racing. I performed at a very competitive level with mild to moderate ab pain (only on the run during racing only). No blood. No vomiting. The pain is sharp along/under the rib line on both sides. Worse in the beginning. Improves over the length of the race. One guy saw me in agony one race and he said to drink more. I had been doing the opposite. I tried drinking at least a “gulp” at each aid station. I’ve also paid closer attention to pre-race nutrition. I only do a liquid diet(protein shakes) the morning of the race about 3 hrs pre-race. It seems to help. Very unexpected. I still can’t explain it. Lack of “core strength” can’t explain it. Acid reflux can’t explain it. Doctors can’t explain it.
I’m anxious to hear what others have to say.
Thanks for the replies…It definitely does not feel like “stuff” in my stomach…It feels more related to breathing- diaphragm-like?? Or cramping due to dehydration? or something else- someone said low calcium- but I have a lot of dietary calcium… ???
it comes and goes with me also. during ironmans, sometimes when i switch to cola the stitch goes away. someone also told me to eat a banana and that it will go away. i think it still goes from racing harder than you train during the bike.
Obvious answer to that is to train harder! I’m not being facetious - especially if you’re racing Ironman distance, you should be able to do some bricks at similar or higher intensity to race day and experiment to find what works and what causes problems
I’ve had similar issues, although for me they occurred at shorter distances where the intensity was higher and I haven’t had a problem at IM distance. The solution for me was to drink more fluids of a lower concentration (particularly on hot days) and it also got better by trying to replicate race conditions in training to get my body used to it. Be very wary of minimising your fluid intake - if you get dehydrated it is almost impossible to rehydrate without slowing down to give your body a chance to recover. Lots of small sips can help the body absorb better than glugging half a bottle at a time as well.
Thanks for the replies…It definitely does not feel like “stuff” in my stomach…It feels more related to breathing- diaphragm-like?? Or cramping due to dehydration? or something else- someone said low calcium- but I have a lot of dietary calcium… ???
If it feels like diaphragm that it is probably a “typical side stitch”
- It took years for the medical community to finally learn what causes a side stitch. Suddenly a runner develops pain in the right upper part of the belly, just underneath the ribs in the front. With each step the pain worsens. Doctors proposed all sorts of explanations for side stitch and most were nonsense. A stitch is not caused by gas in the colon because it is not relived by passing gas. It is not caused by a liver swollen with blood during running, because the liver has a very distensible capsule and the liver does not enlarge that much during exercise. It is not caused by cramps in the belly muscles because the belly muscles are not held rigidly when you have a side stitch, and it does not hurt when you push on the belly muscles. Lack of oxygen to the diaphragm doesn’t cause them because blood flow to the diaphragm is not shut off by running. They are not caused by trapped gas in the lungs because gas does not get trapped in the lungs during exercise. *
Then along came Dr. Tim Noakes, a medical school professor from South Africa, who offered the first reasonable explanation and a successful treatment. Thick fibrous bands called ligaments extend downward from your diaphragm to hold your liver in place. When you run, your liver drops at the exact time that your diaphragm goes up, stretching the ligaments and causing pain. Humans have a fixed pattern of breathing when they run. They have a two to one breathing ratio, breathing once for each two strides. Most people breathe out when the right foot strikes the ground. When you breathe out, your diaphragm goes up, and at the same time, the force of your foot strike causes your liver to go down. This stretches the ligaments that attach the liver to your diaphragm, causing pain. So the cause of a side stitch during hard running is a stretching of the ligaments that hold the liver to the diaphragm and the cure is to relieve the stretching of the ligaments.
*When you get a stitch, stop running and press your hand deep into your liver to raise it up against your diaphragm. At the same time, purse your lips and blow out against the tightly held lips as hard as you can. Pushing the liver up stops stretching the ligaments. Breathing out hard empties your lungs. The pain is relieved immediately and you can resume running as soon as the pain disappears. The pain usually will not go away unless you stop running long enough to raise your liver. *
EDIT → Source - http://www.drmirkin.com/fitness/1611.html
I echo what jwu42 said. I read a similar article, and started breathing out when my LEFT foot hits the ground, assuming it would make no difference whatsoever. it did in fact help a lot. i don’t think cramps are all core strength, since there have been times when i have been doing and hour plus a day, and have bad cramps, and other times where i have done a lot less and have been fine. As long as you are hydrated but not overhydrated and are not lacking in sodium or something electrolyte related, cramps are usually a breathing thing. more fitness will help, but if you are already doing a lot of running, focus on your breathing - deep belly breaths that are even and not panting. i am actually now usually able to ward off cramps in races and training - when i feel them coming i instantly deepen my breathing and that usually subsides them before they are painful and force me to slow down. good luck!
I don’t want to hijack the thread from the original poster, but the diaphram/liver scenario sounds the most reasonable yet.
Thanks for the reply.