Avoiding the Marathon ER

There are two things that will throw a big, ugly, wrench into your marathon training works - running related injuries and running related illnesses. Missing a workout here and there isn’t going to destroy your marathon plans, but if you’re out of commission for an extended period of time you may need to postpone your marathon running goal.

Injuries, accidents and illnesses can happen to any runner no matter how careful or diligent you are. There just isn’t anything you can do to completely eliminate all chances of suffering from an injury. What you can do is stack the odds in your favor. How do you do that? Simple - just follow a few safety and injury management guidelines.

Running Safety Guidelines

Running is actually a relatively safe activity. Your speed is never excessive, if you stumble you don’t have far to fall, and no one is going to try to tackle you. But there are still situations that you should pay special attention to in order to avoid possible injuries.

Road Running Safety

Nearly every runner does at least a portion of their running on the public roads. While the roads themselves present little danger there are inherent hazards with road running. All of the following hazards may not pertain to your specific situation, but be on the lookout for any of the following.

Automobile Traffic - Traffic is the most serious danger associated with running on public roads. When you are crossing intersections always advance with caution. Do not assume that the automobile will yield to you. I guarantee that you will lose in a contest with a 2,500 pound piece of steel. Be especially cautious of cars making right hand turns. Many times these drivers are not looking for pedestrians at the intersections.

Air Pollution - An unseen danger, but one that you can certainly smell is automobile exhaust and other forms of air pollution. The pollution from cars can cause or worsen a number of physical conditions. Try to run during low traffic times to avoid the pollution. Air pollution can pose a risk no matter where you run. If air pollution is a problem in your area, try to do most of your running in the early morning hours when pollution is at its lowest levels. If there is a high pollution warning in your town, consider running indoors on a treadmill or indoor track.

Night Running - Many marathon runners must do some of their training at night due to work scheduling. If must run at night, try to stay on side streets with low traffic volume. Wear light colored clothing that will reflect in car headlights. You can purchase reflective tape or vests to wear that will increase your visibility. Don’t wear dark colored clothing. Drivers will have a hard time seeing you at a safe distance. Try not run alone at night. Running with a friend or even better, a group of three or more will discourage any would be attackers. Try to run in well-lighted areas and well-populated areas.

Park and Urban Trail Safety

Parks and trails are great places to run. You usually won’t need to worry about automobile traffic, but there is another kind of traffic you should watch out for. Other users of the park or trail include bicyclists and roller bladers. Bicyclists and roller bladers are usually traveling at a high rate of speed and a collision can cause serious injury. Everyone needs to share the park equally, so just watch out for others and enjoy yourself. Some urban trails are located adjacent to or even within golf courses. If you use a golf course trail watch out for flying golf balls. Golf balls are small, but they pack quite a wallop if they hit you. Don’t run on the golf course fairways when they are in use. Not only is it dangerous, but the golfers pay a lot of money to play on the courses and they would not appreciate being held up by a runner.

Hot Weather Running

Running in hot weather can cause a number of conditions that range from mildly irritating to life threatening. Possible heat related problems include: dehydration, heat cramps, heat exhaustion, heat stroke, and hyponatremia. These dangerous conditions can rear their ugly head at any time, but are especially hazardous when racing and your effort level is high. Take steps to avoid these heat related illnesses and you will safely enjoy your running throughout the hot summer months. Below is a table that outlines the various stages of heat illness and their symptoms.

Avoiding Heat Illness

• The best way to treat heat illness is to avoid it completely. Here are some tips that will keep you from suffering from any type of heat illness:

• If high temperatures are expected, try to plan your workout for early in the morning when temperatures are at their lowest.

• When running in hot weather, drink a lot of fluid. Take in at least 6 to 12 oz. of fluid every 15 minutes. If your workout or race is going to last longer than 1 hour, drink a sports drink containing sodium and other electrolytes, instead of water.

• Wear a hat. A hat with a brim will keep much of the sun off of your head and face. Many runners make the mistake of wearing a hat with no ventilation. That type of hat will actually trap the heat next to your head and cause more problems that it prevents. Make sure your hat is ventilated or wear a bandana that will wick moisture away from your head.

• Wear sunscreen. Make sure you use a brand that is sweat proof. Be sure to apply sun block to all exposed areas of your skin. Exposure to the UV rays of the sun can cause premature aging of your skin and has been proven to cause skin cancer.

• Wear loose fitting, light colored clothing. Light colors will reflect some of the heat. There are a number of high-tech fabrics available that will wick the moisture away from your body and aid in cooling.

• Warm up, rest and cool down in the shade. Direct sunlight can cause a rise in body temperature.

• If you are planning a race in hot weather, try to get in at least two weeks of training in similar weather. This will help acclimate your body to the higher temperatures.

Dehydration

The initial, less serious and most common heat illness is dehydration. You can become dehydrated at anytime of the year, but it is most common during warm weather. You probably will not suffer from all or even most of the warning signs during the early phases of dehydration, but if you notice any symptoms, it is time to take the proper precautions.

The average person needs 8 to 12 - eight ounce cups of water per day. An athlete needs more. An active runner should be drinking at least 80 to 100 ounces of water per day. Runners need to drink fluids all day, not just during their workout or race.

It’s important to replace lost fluids immediately following your activity. Research has indicated that you should drink at least 20 to 24 ounces of fluid for every pound of body weight that was lost. Most of us won’t have a scale available, so as a rule of thumb, drink 16 to 24 ounces for every 30 minutes of your activity. Sports drinks are a better choice than water for after-exercise hydration. The sports drinks contain both carbohydrates and sodium, which will aid in your recovery and in restoring lost electrolytes.

If you ignore the symptoms of dehydration you run the risk of suffering from a much more serious heat illness. There are three primary heat related illnesses. They are, in order of seriousness: heat cramps, heat exhaustion and heat stroke.

Heat Cramps

The second phase of heat illness is heat cramps. Heat cramps indicate a more serious condition than dehydration but are not a life threatening illness. The symptoms are cramping muscles, usually in the calf muscles, but can occur in other muscles. By the time heat cramps occur, you are already dehydrated. You should not continue to run because you will not be able to re hydrate yourself during your run. Drink a lot of sports drinks immediately. Massage the cramping muscles. Try to find some cool water or cool towels to cool your body and move out of the sun to a shaded or air conditioned location.

Heat Exhaustion

Heat exhaustion, the third level of heat illness, is potentially very serious. Left untreated it could lead to heat stroke. As with dehydration, you could have all of these symptoms or only one. Do not take a chance. If you suspect heat exhaustion you must stop running and seek medical attention. Until medical help arrives, lie down in a cool and shaded spot with your feet elevated. Drink a lot of sports fluids. Try to cool your body with cold water or cold towels.

Heat Stroke

The fourth and most serious stage of heat illness is heat stroke. This is an extremely serious condition and can even be fatal. If the symptoms of heat exhaustion are ignored, heat stroke is very often the next step. This condition involves a breakdown of the system that regulates your body temperature. Symptoms include all of the symptoms of heat exhaustion plus:

• Disorientation

• Lack of consciousness

• Coma

• High body temperature

• Bizarre behavior

• Heavy sweating may be present, but usually heat stroke is accompanied by lack of sweating.

Heat stroke requires immediate medical attention. A runner suffering from heat stroke may be mentally incapacitated or unconscious, so many times, bystanders must assist the ill runner. A person suffering from heat stroke should be moved to a cool, shady spot and cooled with towels soaked in cold water or ice until medical help arrives. If the runner is conscious, large amounts of sports fluids should be consumed. Medical personnel will probably administer fluids intravenously.

Hyponatremia

Hyponatremia is not technically a heat illness. It is more related to what and how much you drink. Hyponatremia is literally water poisoning. Most runners are not aware that they can drink too much water. Not only can you drink too much water, but it can also cause a very serious condition and has even caused some fatalities. The symptoms of hyponatremia include:

• Nausea

• Muscle cramps

• Confusion

• Slurred speech

• Unsteady stride

• Disorientation

   

Because these symptoms mimic those of heat exhaustion, many runners make the mistake of increasing water consumption, which makes the condition even worse. To avoid this, drink only sports drinks during events lasting longer that 1 hour.

A low level of sodium in the blood causes hyponatremia. When you sweat you lose approximately 2.25 to 3.4 grams of sodium per liter of sweat. During a race, you will average around 1 liter of sweat loss per hour. If you drink only water during your race, you will dilute your blood even more, which can result in hyponatremia. This condition is usually only a problem in activities lasting more than one hour, but can occur in shorter activities.

Hyponatremia can be a serious condition. If you believe you may be suffering from this illness, seek medical attention. Drinking sports drinks and eating salty foods can treat minor symptoms.

Aspirin, ibuprofen and other anti-inflammatory drugs can contribute to the development of hyponatremia. Because of the popularity of these medications among runners, this condition is becoming more prevalent, especially in the longer distances such as marathons, ultra-marathons and triathlons. To avoid hyponatremia follow these suggestions.

• Drink sports drinks during events lasting longer than 1 hour.

• Avoid anti-inflammatory medications.

• Take in at least 1 gram of sodium per hour.

• Don’t ignore your thirst. Drink when you are thirsty and drink enough to quench your thirst.

• Increase your salt intake before your race.

Heat illnesses can rear their ugly head any time the weather is warm. Always be on the look out for signs of heat injury. Signs include disorientation, headache, dizziness, nausea, decrease in sweat rate, paleness or cold skin. If you experience any of these symptoms - STOP RUNNING. If there is an aid station available, ask for help. If you are running alone, stop running and find some shade. Drink water and pour some water over your head to cool yourself. Get help as soon as possible.

Cold Weather Running

Running in cold weather doesn’t present as big a threat as hot weather but there are still some dangers you should be aware of.

Hypothermia

We all learned at an early age that our normal body temperature is 98.6 degrees Fahrenheit. Your body has a built in thermostat that make every effort to maintain that body temperature. When your core temperature drops, your body will automatically compensate by diverting blood away from your extremities (exercising arms and legs) and sending it towards your core. That is why extreme cold will adversely affect your running performance.

Hypothermia occurs when your body is unable to maintain its normal core temperature. This condition usually only occurs in very cold temperature, but can happen even in relatively mild (above 40 degrees F) temperatures if you become chilled due to rain, water or sweat. There are three stages of hypothermia as outlined in the following table:

Hypothermia in runners can happen at any time, but you are most at risk when you stop running. When you are running the energy producing processes are generating heat, which helps keep your core warm. When you stop running you are producing less heat. Compounding the problem is the additional heat loss that is caused by the evaporation of body sweat. So be very careful to either move to a warmer environment or put on some dry, warm clothing as soon as you finish running in cold weather.

Frostbite

A cold weather injury that is closely related to hypothermia is frostbite. As I mentioned above, when your body is struggling to maintain its core temperature, it shunts blood away from your arms and legs and sends it to your body’s core to keep it warm. The reduced blood flow to your hands and feet can put them at risk of freezing or frostbite. Frostbite causes a loss of feeling and color. The most commonly affected areas are your fingers, toes, nose, cheeks and chin. There are four levels of frostbite. The first two levels, normal cold response and frost nip are not actual frostbite, but are a precursor or warning sign of impending frostbite.

Cold response and frost nip are full reversible and are not serious conditions. Actual frostbite is a serious condition and requires immediate attention.

Wind Chill Effect

As wind passes over your body it carries away some of your body heat. The faster the wind, the more heat it carries away. High wind conditions compound the effects of cold weather. For in depth information concerning wind chill factors including a complete wind chill chart go to: www.nws.noaa.gov/om/windchill.

Keep in mind that as runner, you are generating your own wind chill effect. If you are running at 6 MPH you are generating a wind of 6 MPH. This effect multiplies itself when you are running into a head wind. If you are running at 6 MPH into a 15 MPH wind you are actually suffering the effect of a 21 MPH wind. This can work in your favor in you are running with the wind. Using the same example, if you are running at 6 MPH with a 15 MPH tail wind, your wind factor is only 9 MPH (15 MPH tail wind minus 6 MPH running speed = 9 MPH tail wind)

Air Pollution

Running outdoors in an area of high or even moderate air pollution can be hazardous to your health. This is especially true if you have any type of respiratory condition. Air pollution can come from automobile traffic, industrial exhaust, wood or coal burning or even forest fires.

You should avoid running outdoors during times of high air pollution, especially if you suffer from asthma or any other respiratory problem. Check your local air quality index. If the readings are 100 or higher, outdoor running can be hazardous.

 If you live in an area that often has poor air quality, try to exercise early in the morning before the pollution levels reach its worst. During periods of high pollution, run indoors on a treadmill or indoor track where ventilation systems will filter out the pollutants.

Carry ID

One of the easiest and most effective ways to decrease personal risk when running is to carry some sort of identification. This is something that most runners do not even think about. Most of us just throw on our running shoes and head out the door. During the vast majority of our training runs, everything runs smoothly and safely. But, things can happen. What if you become ill or are involved in an unfortunate accident during your training run and you have no ID? Responding emergency personnel will not know who you are or who to contact. There are a number of products on the market that solve this problem. Most of them involve a Velcro strap that holds your ID. You can wrap the strap around your ankle or wrist.

Avoiding Injuries

You put a lot of stress on your joints and muscles during a marathon. A typical experienced runner takes around 180 strides each minute. During a 4 hour marathon you would take a whopping 43,200 strides! Each stride will place between 1.5 and 4 times your body weight on your feet, depending upon how efficiently you run and how fast you are going. Taking an average of 2 times body weight a 150 pound runner would place almost 13 million pounds of stress on their feet and legs during a 4 hour marathon! With that much stress being placed on your body it is difficult to avoid all running related aches and pains. But there are four steps you can take to reduce your chances of suffering from serious or chronic injury.

Train Smart - This could also be called train patiently. It is easy to get impatient with your training and try to do too much too soon. If you want to suffer from overuse injuries, that is the way to do it. Be patient with your training. Allow your body to gradually strengthen and gain in fitness. Once you have chosen a training strategy, stick with it. Make all increases in mileage and intensity gradually. It will pay off in the long run.

Strength Train - Strong muscles are injury resistant muscles. Think of your muscles as ropes. Just as a rope is made up of individual strands, your muscles are composed of individual fibers. Strength training builds more and larger fibers, so you have a stronger muscle that is more resistant to strains or tears. Strength training also builds up the strength of your connective tissues so you are less apt to suffer from sprains.

Proper Stretching - Your muscle need to be strong to become injury resistant, but not tight. A tight muscle has less range of motion and is less resilient. A properly designed flexibility program will increase the resilience of your muscles and your range of motion. Keep in mind that too much flexibility can be counter productive and will reduce your running performance. This is covered more in depth in the chapter titled Stretching 101.

Running Mechanics - If I had to choose one phase of running that causes the most injuries, it would be poor running mechanics. Incorrect running form will drastically increase the stress placed on your muscles and joints. Running with proper mechanics will give you a smoother, more efficient stride and minimize your chances of suffering a major running injury. The most common form flaw is over striding. If you are landing heel first you are over striding. That type of foot strike greatly increases the stress on your foot, ankle, knee, hip and lower back. Always try to land flat footed or ball of your foot first, directly under your center of gravity. There is more on running form later in the book.

Treating Injuries

Despite taking every precaution there is still a chance that you will suffer from a running injury. Don’t panic if you are injured. Running injuries are very common and usually very manageable. Here are some treatment tips for common injuries. This does not substitute for advice of a doctor. You should always consult with your sports physician when you become injured.

Rest

The first step in treating any injury is rest. You don’t necessarily need to stop running completely. The amount of rest needed depends upon the severity of your injury. Serious injuries obviously require more rest than milder injuries. Use the table below to determine the recommended amount of rest.

After recovering from a running injury it’s important to gradually build back up to your normal training level. Don’t jump right back into full training mode. Too much sudden stress could result in re-injury.

Ice

The main benefit of applying ice to your injury is to decrease swelling, bleeding and pain. You should apply ice to the injured area for approximately 20 minutes, 3 to 4 times a day. A good way to do this is to use a bag of frozen peas. Just keep them in your freezer and they are ready to go when you need them. The peas will form nicely around your knee, ankle, elbow and most any other injured body part. If you use a bag of ice, cover your injured area with a wet towel and apply the bag of ice over the towel. Continue this ice therapy until the swelling and pain are gone.

Compression

Compression is another way to reduce the swelling associated with some running injuries. Application of compression, usually through the use of an elastic wrap, will help reduce swelling by forcing fluid back into the circulatory system of the body. Wrap the injured area firmly, but not so tight as to cut off circulation. Start the wrap a couple of inches above the injury and continue a couple inches below the injured area.

Elevation

Gravity tends to pull fluids and blood towards your injury. This is one of the causes of swelling and pain. Elevation of the injured part of your body will assist in returning fluids to the system. Try to keep your injured area above the level of your heart.

Severe or Chronic Injuries

If you are suffering from a severe injury, a chronic injury or an injury that will not heal, you should see a physician. It is best to consult with a physician that specializes in sports medicine. If you can find one that is also a runner, it would be ideal. Sports doctors will have the specialized knowledge and experience necessary to properly deal with running injuries.

Many times a doctor that is not a sports specialist or is not active in sports, will tell you to quit running if you get injured. In the vast majority of cases, this is bad advice. Any injury that is caused by running has a cause that can be corrected. A sports specialist and fellow runner will understand this and will help you find a solution. The benefits that you gain from running, far outweigh the inconvenience of occasional injury. If your doctor tells you that you must quit running, get a second opinion from a sports specialist. Podiatrists (foot doctors), chiropractors and physical therapists are other sources of assistance with injuries.

Common Running Injuries

Here are some descriptions of common running injuries and some suggestions for self treatment. This information is provided for educational purposes only and is not a substitute for proper medical advise. Self-diagnosis of injuries is not recommended. See your doctor for diagnosis and treatment of all injuries.

Shin Splints

Shin splints have become a catchall phrase for an aching pain on the front of the lower leg. This generic term is used to describe several different conditions.   The most common is a sprain or tear of the posterior tibial muscle, which is located at the back of your lower leg bone. Other conditions include an inflammation of the covering of the bone, a stress fracture of the tibia and anterior compartment syndrome, which is a restriction of the blood flow to the muscles at the front of the lower leg. All of the conditions are caused by overuse or intense exercise before the muscles are properly conditioned. Strengthening and stretching of the muscles on the front of the lower leg will help prevent this injury.

A true shin splint, called medial tibial stress syndrome (MTSS) is a tearing of the muscle fiber where it attaches to the tibia. This causes a dull pain on the inside part of the front of the lower leg bone. Shin splints should be treated with rest, ice and an anti-inflammatory such as aspirin. This is a very common running injury. Running downhill or running on hard surfaces such as concrete will increase the chances of having this injury. Stretching the front of the lower leg by “sitting” on your feet, with your feet sole up and extended behind you and leaning backwards will help prevent shin splints. If you do this stretch, be sure your feet are directly under you legs, not out to the side.

Shin splints in runners are often caused by landing heavily on your heel. That is why downhill running contributes to the occurrence of this injury. When you land on your heel, the muscles on the front of your lower leg activate in an attempt to keep the front of your foot from “slapping” hard on the ground. That repeated stress can cause shin splints. Landing under your center of gravity on the ball of your foot or flat footed will help you avoid this injury.

Tibial Periostitis

Tibial periostitis or swelling of the covering of the bone is recognized by touch. The tender area will be just under the skin, above the bone on the front of the lower leg. The pain will begin about three inches above the ankle. This should be treated with rest, ice and an anti-inflammatory such as aspirin. If the pain does not subside in a few days, see your doctor.

Anterior Compartment Syndrome

This injury involves the muscles on the outside part of the front of your lower leg. These muscles are surrounded by a box of fascial covering. As the muscles are exercised they swell with blood. The surrounding box pushes back against the swelling and constricts the blood flow to the muscles, causing pain. Pain caused by this injury will be in the muscles on the outside part of the front of the lower leg. This condition should be treated with rest, ice and an anti-inflammatory. Severe and chronic cases may require minor surgery to relieve the pressure. You should see your doctor if you suspect this injury. If you feel any numbness in your foot or lower leg, see your doctor immediately. Severe swelling can cause circulation to be diminished, which can be a serious condition.

Tibial Stress Fracture

Tibial stress fracture is a small crack in the lower leg bone. The pain from a stress fracture will be dull and aching at first; and will be centered in one small spot. Later the pain will become severe and will not allow exercise. A sports physician should diagnose the stress fracture. It is difficult to self-diagnose a stress fracture. Treatment will require rest for four to six weeks. A cast is usually not required.

Runner’s Knee

Runner’s knee is the most common injury among runners. Surveys have shown that around 30 percent of the more than 15 million joggers in America suffer from runner’s knee. Runner’s knee is an overuse injury. The pain is located around the knee, usually on the outside part of the kneecap. Multiple areas of tearing in the sleeve surrounding the knee or a mis-tracking knee cap cause the pain.

The pain from runner’s knee usually begins with mild discomfort and progresses to a major ache or sharp stabbing pain. The pain is not localized and is hard to pinpoint. The cause of runner’s knee is usually inappropriate shoes or biomechanical inefficiency in the foot. It can also be caused by weak quadriceps muscles, which results in the knee cap tending to mis-track. You may need shoes that provide more stability or special orthotics. Consult with your sports physician, who will be able to analyze your stride and your shoes. Runner’s knee should be treated with rest, ice and anti-inflammatory medicines such as aspirin.

Chondromalacia

Chondromalacia is wear and tear on the back of the kneecap.   The pain caused by chondromalacia is located directly behind the kneecap. The pain may intensify with long periods of sitting. When you bend your knee while sitting you may hear a grinding sound or feel a grinding sensation. Chondromalacia is treated with rest and anti-inflammatory medicine. Strengthening of the quadriceps muscles on the front of the thigh may help this condition.

Plantar Fasciitis

Plantar fasciitis is a tear in the arch ligament on the bottom of the foot. This is the most common heel injury in runners. The pain experienced with this injury is located just under the front part of the heel bone. The pain is usually worse in the morning. Plantar fasciitis should be treated with rest, ice and anti-inflammatory medicine such as aspirin. If you have this injury you may need an orthotic in your shoe to support the arch. A good way to ice this injury is by freezing water in paper cups. You can roll the bottom of your foot over the iced cups.

Achilles Tendinitis

The Achilles tendon is the largest tendon in the body. It connects your calf muscles to the heel bone. This tendon is used constantly when running and jumping. Achilles tendinitis is an inflammation of this tendon. There is a sheath surrounding the tendon. The lining of this sheath becomes inflamed which restricts movement and causes pain. During the early stages of this injury the tendon will be painful when you squeeze it. You may not feel pain when you run in the early stages. By checking your Achilles tendon occasionally, you may be able to avoid a more severe Achilles injury.

In addition to the pain, you may hear or feel a grinding sensation when the tendon is moved. This injury should be treated with rest, ice and elevation. Rest for at least one week. Then begin a stretching and strengthening program. If the tendon responds positively to the treatment, you may slowly resume your running program. If the pain remains, you should consult your sports physician.

Blisters

Blisters are caused by friction. They most commonly occur on the feet and are caused by shoes that are too tight or skin that has not been toughened to the stresses of running. Running for an extended time in wet shoes or socks can also cause these annoying and painful injuries. Blisters will usually heal on their own. If you tend to get blisters, try covering the sensitive areas with mole skin or a similar product that will protect the area.

Side Stitch

A side stitch or side ache is not technically an injury. But it can be more disabling than many real injuries. Once, during an important cross-country competition, I suffered a side stitch so severe that I had to run doubled over. My coach appeared and reminded me that no one has ever died from a side stitch and told me to straighten up. After shooting him my most poisonous glare, I gamely continued on. Needless to say, his unappreciated advice did little to make me feel better. However, he was right. A side stitch is a painful condition, but is not medically dangerous unless it is a continuous problem. If you have a frequent or continuous pain in your side, see your doctor.

Side stitches have been a bit of a mystery. Researchers have not been able to pin down the exact cause of the cramps. The latest research has narrowed it down to two possible causes. One possible cause in centered around the ligaments that attach your stomach to your diaphragm. The movements of running causes a bouncing movement of your stomach which pulls on these ligaments. This causes a pain in your diaphragm. This would explain why stitches are more common when you run after eating or drinking a large amount. Another possible cause is related to blood flow in the trunk of your body. When you run, blood is diverted from the diaphragm to the working muscles of the legs. This results in the diaphragm being starved for oxygen, causing the cramp.

A 1999 study published in Medicine & Science in Sports and Medicine, investigated both of these theories. The study showed that the most likely cause is the ligament theory. With this in mind, the following tips should help you avoid future side stitches.

• Do not run until 3 hours after a large meal. You will want your stomach to be mostly emptied before you start to run.

• Drink small amounts of fluid frequently, rather than a large amount more infrequently.

• Perform abdominal crunches daily. The tighter and stronger abdominal muscles will help support the stomach and diaphragm.

• If you get a stitch, contract your abdominal muscles to support your stomach. Breath with your belly. You should feel your belly move in and out as you breath, this will also help stabilize your stomach. Place pressure directly on the point of the pain with your fingers or the heel of your palm.

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