Ask the Fit Professionals: Side Stitches

Dear Fit Professionals, 
    
Help! I'm trying to be faithful to my New Year's resolution, but every time I run, I get a painful, stabbing feeling just below my ribcage. I've heard this is called a "side stitch." What exactly is a side stitch? Will it ever go away? How can I prevent it? I want to run, but this is driving me crazy. 
   
Sincerely, 
Quit Stitchin' 
   
Dear Quit Stitchin'
     
We* feel your pain. The dreaded side stitch is the bane of new runners (and swimmers, incidentally). Most often a sharp, piercing sensation in the lower abdomen, a side stitch can be enough to halt even a strong runner in his tracks.  
  
So what is a side stitch? There are quite a few theories floating around regarding the cause of side stitches. The fancy name for a side stitch is "exercise-related transient abdominal pain" (ETAP). ETAP is commonly a muscle spasm of the diaphragm, the muscle that separates the chest cavity (where the heart and lungs are located) from the abdominal cavity (and the organs therein). The diaphragm moves as you breath, moving down when you inhale and take air into the lungs, and moving up when you exhale. When the diaphragm or the muscles and tendons surrounding the diaphragm are overstressed, they can spasm, causing a "side stitch." 
   
What stresses the diaphragm? Well, a few things. When you run, the internal organs bounce around a bit (kinda gross, but true), pulling on and straining the diaphragm as it moves up and down. The liver is an especially guilty offender. It is the largest organ in the abdominal cavity, and it is attached to the diaphragm by two ligaments. (Ever wonder why side stitches seem to favor the right side? Yep.) 
    
Shallow breathing also stresses the diaphragm. When you take quick, short breaths, only a small portion of your lung capacity is used. This means the diaphragm remains in a consistently high position, never lowering enough to let the connective ligaments of the liver relax (which freaks them out). Newer runners who are still adjusting to the high exertion level of sustained running are especially susceptible to side stitches caused by shallow breathing. This also explains why runners sometimes experience side stitches when they talk and run. 
    
Also, many runners involuntarily synchronize their breathing and stride, beginning and ending the respiratory cycle on the same foot (i.e., inhaling while the left foot is on the ground and exhaling while the right foot is on the ground). If the organs on one side of the body are repeatedly pulling the diaphragm down while the diaphragm is trying to move up (for exhalation), the muscle can become strained, and a side stitch can occur. 
      
Another cause of side stitches is drinking too much liquid or drinking the wrong liquid immediately before your run. (Notice the key words too much and before. Side stitches are NOTcaused by drinking while you run. In fact, insufficient pre- and mid-run hydration can cause side stitches, so be careful to hydrate wisely before, during, and after your run.) Carbonated and very sugary drinks have been known to increase the risk of side stitches. So avoid downing a Big Gulp in the minutes leading up to your workout. 
     
The good news is that you're not doomed to live with side stitches. They will become less frequent (and even disappear) with experience. As you continue to run, breathing will become easier, the muscles around your diaphragm will strengthen, and side stitches will be a thing of the past. (Woop!) In the meantime, here are some things you can do to alleviate and prevent painful side stitches. 
    
Breathe deeply. Throughout your run, remind yourself to breathe deeply from the belly, not the chest. One nifty little technique to ensure you are taking deep breaths is to occasionally purse your lips while you exhale, as if you are trying to blow out candles on a birthday cake. You can also try making a grunting noise as you exhale (think Monica Seles). 
      

Stop and massage the area of pain.
 When a side stitch is threatening your run, it's best to stop and take care of the issue before it becomes unbearable. Gently press your fingers on the area of pain, being mindful to inhale and exhale forcibly as you massage the muscles. Once the pain subsides, begin running again, slowly and gradually returning to pace. 
   
Avoid carbonated or super-sugary drinks immediately before your run. Just say "no" to the Big Gulp. However, be certain to drink sufficient liquids (such as water, GU Brew, or NUUN) pre-run, mid-run, and post-run. Hydration is key! 
    
Warm up before running fast, especially in cold weather.Make sure your body-lungs, muscles, and all-is ready for high exertion by warming up with an easy jog before you pull out all the stops. 
     
Practice running fast. Breathing while running fast is an acquired skill. Give your body some practice by inserting strides, sprints, or intervals into your running routine once or twice a week. It will strengthen the muscles around the diaphragm, making them less likely to spasm at increased speeds. 
     
Exhale while the left foot is on the ground. Obviously, you don't have to exhale every time the left foot hits the ground, but if you think you're falling into a "right foot" pattern, trying switching things up. The organs on the left side of the abdominal cavity are smaller than those on the right and tend to stress the diaphragm less. 
     
Increase your intensity slowly. If you're new to running or just hitting the roads after a long hiatus, take your time. Your intensity will increase naturally as your conditioning improves. 
      
Maintain good posture while running. Try not to hunch over when you run. Posture is especially important at the end of your run, when fatigue sabotages good running form. 
      
Walk the downhills if you're a newer runner. Running downhill increases the jarring forces on the entire body. If you are new to running and are frequently experiencing side stitches, trying walking on steep descents.
     
*NOTE: While we are the best darn Fit Professionals around, we are NOT doctors nor should this article be considered medical advice. Always consult your physician with any health questions. If you are experiencing pain while running, you should see your physician to ensure you do not have a more serious condition.

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