In the May-June 1992 issue of Running Research News, Dr. Gordon Quick discussed this very topic. A “side stitch” is a sharp, intense pain under the lower edge of the ribcage caused by a muscle spasm of the diaphragm. Such pain can occur during vigorous exercise, such as running, and seems to occur more commonly in novice exercisers who have not yet established proper pacing and who tend to breathe more quickly and shallow. However, about 30% of all runners will experience stitches at some point. What exactly causes them? On inhalation, we take air into the lungs, pressing the diaphragm downward. When we exhale, the diaphragm moves up. If the body has some trapped air/gas below the diaphragm, if we’ve eaten too close to exercise, or if we start exercising too vigorously, the diaphragm may cramp, causing pain under the rib cage on the right side.
How do you cure this problem?
How do you prevent this problem?
The most effective way to prevent a side stitch is to take deep, full “belly breaths” while running. This will allow the diaphragm to fully lower and reduces the stress on it. If you take a lot of shallow breaths when running, the diaphragm remains in a consistently high position and never lowers enough to allow the connective ligaments of the liver to relax. The diaphragm becomes stressed and a “stitch” may result. Another way to prevent stitches is to make sure you include a warm-up that helps you gradually increase your running speed. If you head out in an all-out dash from the front door, you’re more likely to take quick, short, shallow breaths, inducing a cramp.
- Running downhill increases the forces exerted on the entire body with each foot strike and may induce side stitches, especially if you are nervous (for whatever reason) about running downhill to begin with! Try walking or slowly jogging down any steep hills until you have mastered deep breathing techniques.
- If you tend to suffer from side stitches, try to avoid eating within 1 hour of running. Water or gatorade is fine within an hour — liquid empties from the stomach faster than solids and shouldn’t cause any problems.
- Running in extreme cold temperatures may induce side stitches, as it’s less comfortable to take in deep lungs full of frigid air until you’re thoroughly warmed up. Try doing some sort of warmup indoors first, before hitting the icy city streets.
- Strengthening the abdominal and lower back (core) muscles can help prevent stitches since tighter muscles in the mid-section will allow less movement of those internal organs.