The Side Stitch

Just about every runner has, at one time or another, experienced a side stitch. It’s that feeling you get when you’re running along just fine, and suddenly an intense stabbing pain materializes under your rib cage, as if an invisible knife is being driven underneath your ribs with each and every breath you take. It hurts and it can ruin a great run in a matter of seconds.

Nobody knows for sure what causes side stitches. They are thought to be spasms in the diaphragm muscle. This sheet-like muscle extends along the bottom of the ribcage. It separates the thoracic cavity, containing the heart and lungs, from the abdominal cavity which contains the stomach, intestines and liver. During inhalation, the diaphragm contracts downward, causing the thoracic cavity to enlarge. This creates a suction that draws air into the lungs. Upon exhalation, the diaphragm relaxes and air is expelled from the lungs as their elasticity causes them to recoil to their original size and shape.

Spasms in the diaphragm are thought to be influenced by a few factors:

1) Dehydration
2) The weight of abdominal organs jostling around during activity
3) Weak and/or tight abdominal muscles
4) Shallow breathing

Preventing a side stitch

First, make sure you’re properly hydrated. Do not drink a bunch of water right before running. Instead, hydrate all day by taking small drinks every 10 minutes or so. Keep a glass of water or a water bottle by your side at all times. Stop drinking about 2 hours before you run. During those two hours, you’ll urinate out any excess and that will keep you from making a bunch of pit stops during your run. Grab a small swallow of water just before heading out.

Don’t eat a lot before running. Give yourself plenty of time to digest large meals before you go out for a run. When you eat, your body diverts blood to the digestive system in order to process the food. That’s why you often feel sleepy after a big meal. Your body wants you to take it easy while it deals with the feast. In addition, excess food in your digestive system increases the weight of your abdominal organs. If you’re hungry before a run, grab a small snack like a granola bar or a banana, then have a healthy meal shortly after you workout.

Strengthen your core. The stronger your abdomen and lower back are, the less your organs will bounce around when you run. A strong core is important for proper running posture and it will help prevent many overuse injuries anyway. So, find a good core strengthening routine and do it on non-consecutive days at least 3 times per week.

Breathe deeply. Expand your belly to draw your diaphragm down and use your full lung capacity. You’ll suck in more air with each breath and your breathing will slow down, reducing the stress of rapid contraction and relaxation on the diaphragm. Yoga is a great way to practice your belly breathing and you can incorporate the technique into walks and easy runs to get used to it.

Getting rid of a side stitch
An ounce of prevention is worth a pound of cure, but there are a few things you can do if you feel a side stitch coming on. The first is to focus on your breathing. If you find that you’ve been breathing rapidly, then adjust your pace and focus on deep belly breaths. Extend your belly outward as you run, then breathe hard out, focusing your energy on the spot where you feel the pain. Sometimes it helps to lean into the stitch as you exhale and extend away from it as you inhale.

Another technique is to speed up. It seems counterproductive, but the stitch may be the result of poor posture. Speeding up often forces you into a more efficient running posture, which may help the stitch to disappear. If all else fails, it’s best to walk and raise your arms over your head. Focus on slow deep breaths and the stitch will eventually go away.