Chafing and Blisters – A Runner’s Approach to Diagnosis, Treatment & Prevention

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Most runners will be sidelined over the course of their active years by a variety of ailments. Ask around your runners’ club, how many people sprained an ankle? A lot of hands will go in the air.  How many people have dealt with lower back pain? Once again a lot of hands will go in the air.  How many of you have suffered from tendonitis in the knee? Same thing, a lot of hands will go in the air for that one as well.  Ask the question of how many of you have dealt with chafing and blisters? This time all the hands go in the air.

Chafing and blisters are like the termites of running injuries.

Coming down with chafing and blisters is just an inevitable scenario any athlete or runner must deal with as a result of their physical activity. For many, it is a constant pain that comes and goes, but is always a threat.  Nobody wants to be derailed by an injury. That is why something as so small and seemingly preventable as chafing and blisters is such an annoying issue that runners must constantly monitor.  Add side stitches into this conversation about small but painful impediments to your running as well.  The following information will help runners become more acquainted with chafing and blisters, their symptoms, treatments, and preventive measures.

What is Chafing?

Just like the cavemen of thousands of years ago learned fire could be created by vigorously rubbing sticks together, the same concept is occurring on your body. Chafing is an irritation of the skin caused by friction.

The friction itself can happen skin on skin, or skin rubbing against clothing. Either way, it is painful and causes skin discomfort and a lasting burning sensation.  Chafing can take place anywhere on the body where multiple skin locations come together or where skin comes into contact with clothing.

Since friction on the body can happen to anyone, anyplace and anytime, chafing is an issue nobody is immune to dealing with over the course of time. However, there are often two main groups (athletes and overweight people) who regularly deal with chafing. Athletes are prime candidates for chafing since their activity can create heat and friction on the body. Also, quick and repetitive movements create an optimal reason for the skin to create friction with clothing. Add in sweat for more hyperactivity.

As for overweight people, they need to sweat a lot, and have rolls of skin that create friction with one another. Overweight people also tend to have issues with their clothing not fitting correctly (either too tight or loose) which will lead to skin on cloth friction.  No matter your gender, activity level or size, the prime areas of chafing on the body are the groin, thigs, armpits and nipples.  There are many runners, including myself, who just felt a jolt of pain after seeing the words chafing and nipples together in the same sentence. How can something so small be so painful?

What are Blisters?

Blisters are another issue that often results from friction. In the case of a blister, the irritated skin becomes separated then raised and as a result fills up with fluid.  Medical professionals sometimes refer to the common blister as a vesicle. Blisters are like a level above chafing since the bumps that form on the skin contain fluid and then look irritated bubbles.

The same areas of the body that are likely locations for chafing can become blistered, but for many, the prime spot for blisters are on the feet and heels.  Also, hands and fingers are other common locations for blisters.

What are Blood Blisters?

A blood blister is the same as a traditional blister (raised skin that fills up with fluid) that has trapped blood beneath the skin’s surface.  The blood within the blister is usually a result of heavy pressure placed upon the impacted area. The pressure creates an injury at a deeper level that then creates problems for the blood vessels.

The broken blood vessels force blood to join with blister fluid within the raised bubbled area of the skin.

Blood blisters tend to form near bony areas and joints such as the heel, fingers, and the palms/base of the hands.  Runners can come down with multiple cases of blood blisters like anybody else.  Since there is pressure involved with the skin irritation, those getting blood blisters tend to be laborers and construction workers who use heavy machinery and tools on a constant, pounding basis.

What are Side Stitches?

Although it is technically not an injury, side stitches are very painful and can hinder running and exercise. To be precise, a side stitch is an exercise related transient abdominal pain, known as an ETAP. It is so common for runners to deal with side stitches that one research report pegged a population of 70% of regular runners suffering from them within the past year.

Overall though, it tends to be inexperienced or beginner runners and athletes that suffer the most from them.  The pain associated with side stitches is a stabbing and intense around the ribcage and abdomen. Both sides of the abdomen can be vulnerable to this pain. Interestingly though, some researchers have  found it occurring most often on the right side.

A side stitch tends to feel and act like a muscle spasm.

What tends to trigger side stitches is exercise and strenuous physical activity that features up and down movements. Think of runners and horseback riders being in this position quite often.

Symptoms of Chafing

The onset of chafing will usually begin with a burning or scratching feeling on the skin’s top layer. The impacted area will look red, like a very slight burn, and possible swelling. The level of redness and swelling can vary significantly based on the amount of chafing that has already occurred.  Besides the feeling of a burn, the affected region can feel like a sting from a bug. To the touch, the chafed area will feel rough, have some disturbed skin and very likely be moist or sweaty.  If the chafing is taking place in the groin or thighs, walking, and certainly running, can create more discomfort.

Breakdown of symptoms:
* Burning feeling on compact region of skin
* Skin will be red and possibly swollen
* Likely to happen in the groin or thighs

Symptoms of Blisters

A blister will look like a bubble perched upon the skin. Inside the bubble will be clear fluid – see below the difference between a blister and a blood blister.  Blisters tend to range in size from a small pinpoint to over an inch in diameter. The skin around the bubble will be itchy, red and painful. As with skin chafing, these aforementioned characteristics will vary on the severity of the blister.

Breakdown of symptoms:
* Circular bubble appears on skin
* Fluid will appear inside the bubble
* Area near fluid filled bubble will be red and painful to pressure

Symptoms of Blood Blisters

A blood blister will have the same symptoms and initial appearance as any other blister. The difference between the two is the fluid that fills up the bubble. A blood blister will have blood inside so the circular raised area on the skin will look red.  Over a short period of time, the blood inside the blister will coagulate so it will change color to either purple or black.

Usually blisters will appear on the feet and heels. Especially for runners, this location will make any type of walking or running and painful. It will usually force those suffering from blisters to take their shoes off or change sneakers.

Breakdown of symptoms:
* Circular bubble appears on skin
* Red fluid (blood) will appear inside the bubble
* Area near fluid filled bubble will be red and painful to pressure
* Fluid inside the bubble will change in color to purple or black

Symptoms of Side Stitches

A sharp pain will appear near the abdomen and rib cage area. A side stitch is an internal pain that comes on with no apparent external irritation to the region. The pain (usually on the right side) is felt after exercise or activity that features a lot of quick up and down movements.  Side stitches might appear early in a workout that followed a lot of eating and drinking or was not begun properly with stretching.  A key indicator of side stitches is the pain will subside, almost at the same moment, the person stops the physical activity.

Breakdown of symptoms:
* Sharp pain near abdomen or lower rib cage area
* Pain will usually be on the right side
* No apparent external injury to the area in pain
* Pain immediately goes away once the person stops running or physical activity

Causes of Chafing

Chafing occurs because of friction taking place on the body. The friction is caused by either the rubbing of skin on skin or skin and clothing. This friction then creates irritation and burning to the skin.  Chafing most often comes during physical activity so body heat is raised and there is increased amount sweat and moisture on the body.  The chafing is exacerbated when moisture is included into the friction.  For those overweight people who suffer from chafing, the cause is usually the density and amount of skin that is constantly rubbing against various spots on the body. The same chafing problems arise when loose fitting clothing enables too much skin on skin. Or skin creating unwanted friction with tight fitting clothing.

For athletes, too much sweat and body heat creates a ripe situation of friction. This is most evident and common in the groin and thigh areas. It doesn’t even have to be running, it can be brisk jogs or walking a golf course that then can lead to a painful case of chafing.  Certainly doing physical activity in hot and humid temperatures increases the chances of someone dealing with chafing.  In a way, if you are an athlete or runner, the causes of chafing are almost always present during your workouts.

Causes of Blisters

Blisters, like chafing are caused by friction that irritates the skin.  For many runners, wearing new sneakers is often the cause of blisters on the feet. The new sneakers are more rigid, give less to movements, and therefore rub against the skin to create blisters. The more the sneakers are loosened by pounding and become more flexible, the less they are likely to rub up against the skin. Also, the skin becomes accustomed to feeling the pressure from the new sneakers.

Blisters can form on the hands when doing activities like yard work with tools, swinging a golf club, squeezing a barbell, etc… Blisters are so common because over the course of the day, our hands come into contact with so many objects.  Besides the friction from sneakers and overusing hands without the use of gloves, there are other causes for blisters. Those causes include exposure to electricity and heat, exposure to severe cold, chemicals, pesticides, some insect and spider bites, cold sores on the lips and mouth, chickenpox and shingles.

A person dealing with contact dermatitis – an irritation of the skin by an allergic reaction can also cause blisters. For example, someone may blister by touching poison ivy or coming into contact with something he or she is allergic to like latex.

Causes of Blood Blisters

Blood blisters form like other blisters, but there is usually more pressured involved with the friction.  The pressure creates a mild disturbance with the blood vessels located in the dermis skin layer. This causes blood to come forward to the epidermis layer.

Causes of Side Stitches

Just like the other ailments mentioned in this article, side stitches result for physical activity. Instead of being a problem of friction, they are more like muscle spasms.  There are a number of different ideas and theories as to what causes side stitches but there is no definitive medical rationale.  The best source material for the causes of side stitches is a 2005 article appearing in the Journal of Science and Medicine in Sport.  The article was a research project on Australian runners.

This article mentioned that 27% of walkers and runners complained of side stitches during their workouts.  Runners, likely because of the pounding and heavy breathing, are more likely to feel side stitches than walkers.  Interestingly, there were more cases reported from women than men and younger runners than older ones.  Not surprisingly, there were fewer cases among more seasoned runners than inexperienced ones.

Many researchers contend side stitches are caused by elongating the ligaments that reach from the liver to the diaphragm.  Those ligaments get stretched forcibly when runners are hitting their feet against the ground while at the same time breathing at a harder rate than normal.

The pumping of the legs and the added pressure of heavy breathing causes the diaphragm (a dome shaped muscle that rises and moves downward) to work at a heavy load. When the lungs fill up with air, it causes the diaphragm to move down while the legs can be moving upwards.

There are other researchers who feel side stitches are correlated with the intake of fatty foods prior to workouts that put the diaphragm and abdomen in a position of becoming over stressed.  Once again back to the research project cited in the Journal of Science and Medicine in Sport, the authors found that runners who ingested the most food two hours or less prior to their runs where likely candidates to feel the effects of side stitches.  Nearly half of the respondents reported feeling side stitches after they drank water or other liquids.

Diagnostic procedures

These issues are very common for runners and for the most part do not need to be addressed by a medical professional. The exception would be when there are signs of infection within the blistered region.

Infections of blisters are a possibility for those who are unable to stop scratching or touching the wounded area, or who incorrectly try a home remedy to rectify the problem.  If a cluster of blisters appear or if they were caused by an exposure to chemicals, then medical attention should be sought.  Excessive chaffing can lead to bleeding and swelling – if this is the case a doctor will need to see the wound.

Treatment

For the most part, dealing with chafing is addressing the source and cause of the friction. Sure it might not look or sound like a major issue but it does need to be treated.  First the affected area should be cleaned off to remove sweat and any debris. After the area dries, petroleum jelly will soothe the pain and the irritated skin. If the chafing area is bleeding, a medicated jelly or antibiotic prescribed by the doctor could be in order.

A common home remedy for skin chafing is to place cornstarch or talcum powder on the affected area. Cornstarch is sometimes better than powder since it does not contain any allergens.  Use any leftover diaper rash cream you have around the house.  One school of thought is to drink a lot of water. The idea is that water cools the body down which will then lower skin temperature to reduce current and future chafing issues. This is not a guaranteed treatment but whenever there is physical activity involved, plenty of hydration is always necessary.

Time off is another good treatment for chafing. Let the skin heal by avoiding situations that create friction – yes this could mean no running for a while.  Give your skin some time to heal from chafing before being active again. Continued friction will only make it worse and could lead to infection. If your skin chafing does not improve after trying these self-care measures, make an appointment to see your doctor. You may need an antibiotic ointment if the area becomes infected.

Treatment for Blisters and Blood Blisters

Basically if you leave the blister alone, it will heal on its own. That means do not break the skin or puncture the blister in order to empty it of its fluid.  Keeping the skin around the blister intact will create a natural defense to protect the area against infection.  Also give the blister some added protection by placing adhesive tape over it.

There are times the blister becomes too painful and needs to be drained. If possible that should be done by a doctor in a sterile environment.  If a doctor’s visit cannot be arranged in time to alleviate the pain and fluid pressure, here are some at-home tips to drain a blister. First, your hands and the blistered area need to be washed with warm water and soap.

Then find a sharp needle (safety pin is good) and sterilize it with rubbing alcohol or placing it under a flame for a brief period. Take a cotton swab of iodine and lightly dab the blister with it before using the needle.  With as little pressure as possible puncture the blister bubble with the needle point. Let the fluid drain out on its own pace. Keep the top layer of skin over the blister in place.  Place some Bacitracin Zinc ointment directly on the blister to help fight infections then cover it with a bandage.  Cleaning the blister off and changing the dressing should only need to be done for a few days after draining it.

 Treatment for Side Stitches

Since side stitches are muscle spasms, once the pain hits, there needs to be immediate rest. Someone suffering from side stitches should reduce the intensity of the activity – like go from running to walking. A brief respite of one to two minutes could be enough to eliminate side stitches.

After slowing the body down, work on slowing the breathing down as well. This will reduce the stress on the lungs and diaphragm. Go for fuller, slower deeper breaths from the nose and then breathe out deliberately from the mouth. Short and choppy breathes will do more harm than good.  A light self-massage over the area can also help reduce some of the pain.

Prevention

If your body is moving, there is always going to be a level of friction. In order to prevent chafing, first start by reducing the amount of moisture on the body.  This means using talcum powder on skin prior to workouts. The powder soothes the skin, lowers heat on the epidermis, and will absorb the sweat that will come from the run or the workout.

Any store bought talcum and alum powders will help reduce the chances of chafing.  To make your life easier, a container of Gold Bond powder should be a mainstay of your gym bag. Gold Bond makes a number of different powders, but the original Gold Bond body powder will work well, as will, Gold Bond Friction Defense.  The Friction Defense is a balm that is applied to the body like a roll-on deodorant.  Many runners now use anti-chafing lubes or balms as a necessity for their pre-workout routines.

Another quality product is Body Glide’s anti chafe balm. The Body Glide product is sometimes more expensive than the other brand options, but it is worth the cost.

There is also a wide array of petroleum jellies from Vaseline that will also work well.

Apply the powder, balm or lube on the main areas of the body that tend to chafe the most. Make sure to apply these products on the groin and thigh areas even if you don’t regularly chafe there.  These products can be applied to your nipples as well. Also to prevent nipple chafing, place a piece of adhesive tape or a Band-Aid over your nipples prior to a run.

Your clothing choices will also help keep your body dry. Look for clothes and brands (that use synthetic fibers) that wick away sweat.  As comfortable as 100% cotton feels on the body, it can promote chafing.

Men that suffer from groin chafing should wear synthetic boxer brief underwear to help avoid the problem. Bikers wear compression shorts for a reason; runners and other athletes should follow their lead. As for women, if you run, wear a sports bra. Both the material and fit will help you avoid chafing around the chest area.  No matter what clothing or brand you wear, if it becomes too wet from sweat or the environment, change out of it.

Prevention of Blisters

When discussing the prevention of blisters, the main focus is on the hands and feet.  As for the top portion, when working out lifting weights, golfing, playing baseball/softball or doing lawn work, make sure to wear gloves to protect the hands and fingers. Wear gloves especially if you do the activity infrequently and your hands have not built up any resistance.

The main sneaker manufacturers all make workout or lifting gloves – the name comes with a cost. The cheaper option will be just as good as the expensive ones.  Don’t let those workout gloves live in the bottom of your gym bag. Let them air dry in order to prevent damage to both them and your hands.

For runners the focus on blister prevention is what is worn on the feet – both socks and sneakers.  Cotton socks will keep moisture trapped on the foot –wetness will help breed blisters. Use synthetic socks and try to keep an extra pair handy when running during the rainy season. Keep those socks in your gym bag, trunk or at the office. Get wet socks off your feet as soon as possible to limit blisters.

Just like your mother used to warn you, new shoes and sneakers need to be “broken in.” Even if you just got the newest pair of Nikes, New Balance or Asics, they need to be worn casually first so your feet can acclimate themselves to the new surroundings before you hit the pavement.  Some sneaker brands like Nike and adidias tend to be narrow so if you blister a lot on your feet, you may want to avoid sneakers from these companies.  Once you feel the burning of a blister, don’t pop it, but cover it with a Band-Aid or moleskin. The outer layer of the blister protects it from infection.

Prevention of Side Stitches

The primary way to prevent the muscle spasms of side stitches is to make sure you properly stretch prior to a run or working out. The stretch time should be at least 10 minutes. If you horseback ride – you also need to stretch before that as well.  The main area to stretch is the lower back, core and abdominal region.  Once you start to stretch and begin the workout, focus on breathing calmly and in a rhythmic fashion. You want to avoid short and choppy breathes that place pressure on the lungs and diaphragm.

Do not eat at least an hour before your run – preferably two hours – so the body and can properly digest food. You don’t want your internal organs working harder than they need to when your legs are pumping. In particular, avoid  high fiber foods before a run since they are hard for the body to digest.  Limit the sugar in-take before a run if possible.

Conclusion

Chafing, blisters, blood blisters and side stitches are not serious injuries, but even though they are small, they carry some consequences. All of these will stop runners from working out and could keep them on the shelf longer than desired.  Keep your body and clothes dry to limit and prevent chafing. Also, use powder and balm to soothe hot areas. As for clothing, shirts, shorts and undergarments made of synthetic fibers (not cotton) will help wick away moisture from the body.

Be leery of drinking and eating too close to your run time to help avoid side stitches. If you do feel the sharp abdominal pain of side stitches, slow down for a minute or two and you should be back to normal.  With the information presented in this article, you should be able to identify the symptoms of chafing, blisters and side stitches, and prevent them all from slowing you down on the path or track.  Stay protected and keep on running!

Some of the Sources Used while Conducting our Research

These are the sources cited in this article with additional information on a chafing, blisters, blood blisters and side stitches. While these are reputable sources with information from medical professionals, you should not take the information in this article as professional medical advice. Consult a doctor before trying anything listed in this article.

 

Sources

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  2. Fetters, Aleisha, What Causes Side Stitches, Women's Health , May 26, 2017
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  4. Mayo Clinic Staff , Blisters: First Aid, Mayo Clinic, May 31, 2017
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  10. Staff Writer, Home Remedies, Jun 02, 2017