Unknown Abdominal Pain Under Ribcage Caused By Impacts From Jogging

Hi everyone

So this is a question I'm asking on behalf of my friend. Please note that this will be quite a lengthy post as I want to give you all the details I have about her condition at this time. Please note also that I don't have all the info, but will gladly ask her if you need more background info!

She used to run a lot and used it as a release, but now she cant anymore cause she gets a sharp abdominal pain just below the right side of the rib cage and she is getting depressed because of it. It is certainly not side stitches as this was ruled out multiple times already in the past. She has been to top sport coaches and physios and none of them could identify the problem ( I have a theory tho that they didn't look deep enough into it as they are only used to top athletes as clients ). The condition started when she was about 13 years old and kept getting progressively worse as she grew older. Even when she was intensely fit, it persisted. It began as a pain in the lower obliques and grew progressively to just under the ribs. By the time she was 16 it was at it's peak and she could barely run anymore. She is currently 20 years old.

Also I want to disclaim that I am by no means a physiotherapist, but I do believe ill be able to give sufficient knowledge for you guys to help out.

I conducted a few tests on her where I gave her some exercises to test out and rule out possible theories I had. So let me start them

- 8 min trainer bike warm-up ( No pain was mentioned )

- Trainer Bike Intervals ( 1 min , 45 s , 30 s , 20 s with 2 min rest in between intervals )

- She mentioned no pain whatsoever, even when she was breathing heavily

- Abdominal Exercises ( Side lying oblique crunches, Lying leg raises ) ( I intended to put as much stress on the obliques and side abdominal to get a pain reaction )

- She had no pain whatsoever doing these exercises. I asked her to breathe heavy and deep after each set to try and also provoke a reaction to no success

- Jumping Squats ( Both Legs , Right leg only, Left Leg only ) ( I intended to simulate impacts that she would take when running )

- When using both legs, she had no pain reaction whatsoever

- When using the left leg only, She had an intense trigger of the pain!!
When doing the third set, she mentioned intense pain on the 17th rep

- When using right leg only, she mentioned no pain

- Jogging ( I gave her a 1.5 km run, cause she said it usually only triggers on those distances )

- She triggered the pain when running/jogging, but I noticed she twisted a lot and flailed her arms a lot when running to dampen the pain, so I told her to twist less and try and take the impacts when landing a bit harder, and it triggered the pain even more

- Post Testing

- She mentioned that a past physio noticed a knot near the area, so I went ahead and felt the muscles around the area where it was affected. I noticed that between where the upper right ab and the obliques meet that there is a intense tight muscle and proceeded to put pressure on it, to where she mentioned that it hurt a lot when I did that. I concluded that the muscle laid somewhere between under her right upper ab and in the insertion of the ab and the oblique.

Comments that she told me during testing that I noted:

- She feels it a bit when stretching her abs
- When pushing on her diaphragm, she mentioned that she get nauseous ( this is only when the pain is triggered )
- It is a very sharp pain
- It gets worse the longer she runs, and fades to controllable levels when standing still
- Pain gets activated only when impacts are applied vertically ( i.e when jumping and landing )
- She feels it when exhaling deeply
- The pain usually lasts a few days after, although it is described as more of a irritation than a sharp pain

I realize that this sound a lot like common side stitches, but she was diagnosed with this countless times by physios and it was worked on, but to no success. I dont know if this is applicable, but she doesnt have much of a hunger drive, as she only weights 52 kg and even though Ive mentioned it, she says that she just doesnt feel hungry all the time. She is healthy though, no form of anorexia present. She is also pretty fit body wise, and looks normal.

Please let me know if you need more information, I really want to help my friend :)