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Side Stitches

Running was never my thing in elementary or middle school.  In fact, I got caught once cutting across the field so I wouldn’t have to do the entire last lap of the mile.  It’s not like I was super slow.  I would just get the dreaded side stitch and it would hurt too much to want to continue.  That dang side stitch… I was talking with a family member last night, and she has been having problems with side stitches for a while.  She has been running quite a bit since January, but is still getting that nagging pain after months of running.  Why is this still happening to her? I told her I would look into this for a blog entry, so that is what brings me here today.

We are all susceptible to the annoying side stitch and I still get one every so often.  Therefore, today I ask…

What is a side stitch?  What causes it and what do you do once you have one?

A side stitch, or “exercise-related transient abdominal pain” (ETAP), is a stabbing pain that occurs right under the rib cage.  It is believed that this pain is caused by a cramp in the diaphragm, although no one is exactly sure why this happens.  There are several theories I read about including eating, bouncing organs, and too much air pushing on the diaphragm.  Allow me to explain in a little more detail…

Some believe that the consumption of food too close to exercise can cause ETAP.  One study has suggested that consuming fruit juices and beverages high in carbohydrates, either just before or during exercise, triggered the onset of a stitch.  Consuming wheat or dairy products too close to exercise is also believed by some to trigger a side stitch.  It is recommended to eat no later than one hour before exercise to avoid a possible ETAP.

Another side stitch theory is that the two ligaments, which connect the diaphragm to the liver, are being stretched from the bouncing of the running motion.  This happens by a person exhaling (when the diaphragm is at its highest and tightest position) at the same time the right foot is landing.  The liver is pulling down while the diaphragm, which assists in breathing, is pulling up. This tugging, some believe, is what causes the diaphragm to spasm.

Other theories about side stitches include decreased blood flow to the diaphragm because of increased exercise, resulting in spasms.  Or perhaps air is getting into the lungs much easier than it is leaving. Therefore, the increased buildup of air can cause pushing of the diaphragm from underneath.  Another theory suggests that ETAP can happen when gas is trapped in the large intestine.  As exercise increases intestinal contractions and pushes gas towards the end of the colon, if the intestine is blocked, cramping can occur.

Now imagine, for whichever reason it may be, that you do get a side stitch while running.  What can you do? Here are some suggestions I found:

1) Breathe deep and from the belly, making sure to expand the upper chest
2) Grunt.  Yes, grunt.  As you exhale, try to make a grunting sound.  This is thought to get the diaphragm out of its taught “exhale” position
3) Slow down until the pain stops.
4) Stop running
5) Gently massage the area with your hands.  This will relax the muscles and increase blood flow to the area.
6) Poke and Blow.  Or in other words, push your fingers deeply into your belly and then purse your lips tightly and blow out as hard as you can.

Some tips for preventing side stitches are to avoid shallow breathing, avoid eating too close to exercise, and periodically purse your lips and blow out hard while running.  Also, be sure to warm up before exercise and try exhaling when your left foot hits the ground (this keeps the ligaments between the liver and diaphragm from stretching as much).

Side stitches are never any fun and yet we have all suffered from the pain.  None of us want to run with the pain of a side stitch or be forced to stop running because the pain is too much.  Hopefully by knowing and understanding a little more about ETAP, we can prevent and successfully deal with the pain.  I just hope if I get one and decide to try the grunting remedy, nobody is around to hear me. That would be embarrassing.

I hope everyone is enjoying this beautiful Sunday!

Happy Trails and Happy Running,

2 Comments Post a comment
  1. EJD #

    Great article! I pin-pointed my stitches from eating too close to my runs. I won’t eat 2 hours prior to a run… easy sailing from there! Water doesn’t bother me!

    June 10, 2012
  2. Thanks for this blog, Tracie. Side stitches have been my nemesis in a couple road race events. For the severe ones, I have found that momentarily stopping (yes, as much as we ALL hate that nasty ‘S’ word), and crunching over, elbows to knees, really helps. Also, without stopping, slightly rounding the torso through a slower pace has also been effective. Hope these additions will also be helpful! (:

    June 11, 2012

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