Why Does My Liver Hurt When I Run?

Overview

Liver function is seemingly increased during hard exercise (such as running), thus episodic pain may be associated with an episode of extensive training due to increased stress exerted on the liver. However, persistent sharp pain under the breastbone which radiates to the right side of the back, which does not resolve after rest and is getting worse during the exercise can be a sign of liver injury or an advanced stage liver disease.

Liver pain 

The liver is a multi-functional organ which participates in more than 500 vital biological processes, essential for appropriate body function.³

The liver contributes to detoxification, production and release of biological molecules as well as the  conversion of sugar to energy.² Recently, the liver has been also shown to play an important role in redox status and inflammatory modulation during exercise.¹

As demands for energy increase during exercise, a substantial increase in liver function is observed correspondingly. Increased productivity allows our bodies to maintain an appropriate energy supply to the vital organs and muscles. One may experience distinct liver pain during intensive exercise (such as running), if their liver is injured or inflamed. 

Other causes abdominal pain caused by running 

Liver function is increased by default in exercise, despite the fact that it is not directly targeted by an exercise. Running can cause abdominal pain due to various reasons. For instance, runners often experience so-called “runners stomach”, which is abdominal cramping, along with nausea, and diarrhoea which happens during a run.⁹ This condition occurs as a result of a poorly balanced diet and inappropriate hydration. Another reason could be pulled or strained muscles of the abdomen, the associated pain usually subsides after rest.⁴

Symptoms of liver pain 

Unlike the liver pain that tends to persist in the form of a dull ache below the ribs that can extend to the back, or a stabbing pain right under the breastbone that extends to the right side. Liver-related painful sensation seems to increase during cardio exercise and can be accompanied with a feeling of extreme exhaustion, nausea, and in critical cases, jaundice (yellowing of the skin and eyes).⁸

Causes of liver pain 

Can running cause liver pain? 

Particularly, hard exercise can be the cause of liver pain, since exercise exerts stress on the liver in several ways, exactly like eating a heavy fatty meal or drinking alcohol does. It has been recently found that the liver has important adaptive functions, such as modulation of inflammation and its toxic by-products, such as reactive oxygen species (ROS).¹ Intensive exercise reportedly leads to increased oxidative damage by ROS and the creation of training-induced hepatic stress. The liver makes sure that certain adaptations are made to minimise such damage.¹ Interestingly, while acute exercise induces inflammation and elevation of reactive oxygen products, consistent regular exercise prevents oxidative damage and has a protective anti-inflammatory and antioxidant role. 

Why does my liver hurt when i run? 

Liver pain associated with running can be a sign of advanced stages of liver disease. Normal liver function is compromised and there is an inability to keep up with increased blood flow to the liver, thus individuals may experience pains in the upper-right abdomen following a workout. 

While there are numerous kinds of liver diseases.³ the commonly diagnosed ones are:

• Infection-induced diseases, such as hepatitis A, hepatitis B, and hepatitis C
• Substance-induced diseases, such as fatty liver disease and cirrhosis
• Cancers, for instance, hepatocellular carcinoma
• Genetic liver diseases, such as hemochromatosis and Wilson's disease

Exercise on the liver

Best forms of exercise 

Any type of exercise is important for the maintenance of overall fitness and has multiple advantageous health effects. Regular exercise helps maintain a healthy weight and stronger overall cardiovascular health, the health of bones and muscles. Interestingly, health improvements in distinct organs and body systems (such as cardiovascular systems) can be achieved by choosing forms of physical activities that are found to be particularly beneficial.  

For instance, aerobic exercise (also known as cardio exercise) increases the heart rate, thus increasing both cardiovascular system output and maximising blood oxygenation.⁶ Cardio exercise tends to involve high-intensity training in a short period of time (such as jumping jacks), the repetitive movements target work of large muscles, which causes an increase in the heartbeat and changes the breathing pattern. Cardio exercise is particularly efficient for weight loss, improved cardiovascular health, control of high blood sugars, increased stamina and maintenance of mental health (due to the release of endorphins).⁶

On the contrary, resistance training includes weight exercises, it is less efficient at increasing the heart rate, but it is very effective for improving bone and muscle strength. Maintaining bone strength is particularly important for postmenopausal women that are susceptible to osteoporosis.⁵  In addition, resistance training helps to increase lean body mass and overall metabolism. 

A healthy balance of both exercise types was found to maximise the health improvements.⁶

Benefits for the liver

Both aerobic and resistance training were found to have multiple benefits for liver function.

Aerobic exercise contributes to the strengthening of the heart muscle, which helps it to pump blood more efficiently and maximise oxygenated blood supply to the distal organs. This leads to improved and eased blood flow, therefore making the process of delivering blood to the liver and sending filtered purified blood from the liver much easier and faster.

Resistance training helps to build lean muscle mass, which can be very important to prevent severe muscle wasting seen in advanced stages of liver disease. Maintenance of healthy body fat percentage through both aerobic and weight training is also an important prophylactic measure against fatty liver disease and nonalcoholic steatohepatitis or NASH.¹⁰

When to seek medical attention

Early-stage liver damage signs are non-specific and can be often misinterpreted or mistaken for digestive health disease. Pain in the liver, or abdominal pain in the upper right side, on the other hand, is one of the first important signs of serious liver health problems. Cirrhosis-induced pain usually occurs just below the right ribs, it can be a recurring sharp, pulsing or stabbing painful sensation.[4] Persistent pain that increases during exercise is an important sign to seek medical attention as soon as possible something that needs to be looked at immediately. It could indicate liver failure. 

In particular, warning signs⁷ that indicate that emergency help is required include:

• Severe abdominal Pain 
• Abdominal Swelling 
• Persistent Vomiting
• Tiredness/weakness 
• Fever
• Jaundice 
• Mental Changes 

One way to ensure an accurate diagnosis is by performing a series of liver function tests, checking levels and function of metabolic proteins, liver check with an ultrasound or conducting a liver biopsy if necessary. 

The liver is a self-healing organ and a combination of appropriate therapeutic help with a change in lifestyle might be all that is needed to resolve liver pain.

Summary 

To summate, it is important to recognise that  persistent liver pain is unlikely to be caused simply by exercising. Experiencing non-resolving pain during and after the run can indicate serious health complications, particularly if accompanied by other signs of liver dysfunction. It is important to seek medical help immediately to timely diagnose liver disease and prevent critical health complications.