Side Stitches : Cause and Cure

by J. Johnson

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.

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 mastered.

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!