Side Stitches : Cause and Cure
by J. Johnson
Strength & Conditioning Specialist / Sports Nutrition Consultant
Performance Fitness & Nutrition
The following information will shed some light on "side stitches".
More importantly, this will help you prevent this physiological
malady from occurring and thus enjoy your running even more.
WHAT CAUSES A SIDE STITCH?
Side stitches are a muscle spasm of the "diaphragm".
The diaphragm is a dome shaped muscle that separates the chest
cavity from the abdominal cavity. In essence, it provides a boundary
between the organs of the abdomen and the chest cavity where the
heart and lungs are located.
The diaphragm assists in breathing. When we inhale, taking air
into the lungs, the diaphragm moves down. When we exhale, the
diaphragm moves up. (This detail, it becomes important later.)
Spasms of the diaphragm occur because of the movement of the internal
organs as they jounce up and down while running, thus pulling
down and straining the diaphragm as it moves up while exhaling.
The liver in particular is usually the cause of this. It is attached
to the diaphragm by two ligaments. The liver is the largest organ
in the abdominal cavity and is situated in the upper right abdomen.
Hence most people experience stitches on their right side, immediately
below the ribs. A stomach full of food may cause this as well.
In addition, most runners are "footed". They begin and
end a respiratory cycle on the same foot while running, usually
in a stride to breathing ratio of 4:1 while jogging and 2:1 while
running very fast. As the runner's breathing then becomes synchronized
with his/her stride, exhalation consistently occurs on the same
leg. If one repeatedly exhales (causing the diaphragm to move
up) when the right foot hits the ground (forcing the organs on
the right side of the body to move down), a side stitch may develop.
HOW CAN I PREVENT A SIDE STITCH?
The most effective way to prevent a side stitch is to avoid "shallow"
breathing. Shallow breathing can be defined as taking in a small
volume of air with each breath, using only a small portion of
the total lung capacity. When this occurs while 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 spasm or "stitch" results.
Instead, one should breathe "deeply", also known as
"belly breathing" while running. This allows the diaphragm
to fully lower and reduce the stress on it.
Here's an exercise to try. Lie down on the floor, place a hand
on your belly and breathe deeply. You are belly breathing correctly
if you feel your hand raise slightly. If only your chest moves
up, you are not breathing deep enough.
A technique that is very successful in preventing side stitches
while running, is to periodically "purse" the lips while
exhaling, as if blowing out the candles on a birthday cake. Again,
deep breathing is required to be effective. (This works best for
me as well as most of the runner's I work with.)
Another technique that helps, is to exhale as the left foot strikes
the ground, instead of the right foot. The organs attached to
the diaphragm on the left side of the body aren't as big as those
on the right side, so there is less strain on the diaphragm.
Running downhill exacerbates side stitches since it increases
the forces exerted on the entire body with each foot plant. Novice
runners should walk down hills until breathing techniques are
Don't eat within one hour of running and only eat lightly within
three hours of running. DO DRINK FLUIDS!!! The stomach drains
fluids rather quickly. Dehydration is one of the most common causes
of fatigue and should be avoided.
Preventing a side stitch using the above techniques is preferred.
If you get a stitch while running try the "purse" method
(blowing out the birthday candles). If the stitch continues, it
is best to stop running and instead walk while concentrating on
deep breathing. Continue running after the stitch goes away.
Give this a try on your next run. Let us know if it helps. Good
luck to all and have fun!
© 1996 J. Johnson and Aerosoftware. All Rights Reserved.