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Advice for a Side Stitch When Running

A lot of runners may have experienced a side stitch at one time or another during workout. The sharp, localized twinge of pain below the rib cage usually occurs on the right lower abdomen. A side stitch is commonly experienced by runners and if this happens, they have to slow down to a walk until the pain subsides.


Today, researchers refer to this nagging abdominal pain by a scientific term—exercise-related transient abdominal pain (ETAP). No matter what you call it, this pain is usually enough to stop runners and swimmers in their tracks and hold their sides in agony.

What causes a side stitch?

Currently, there is no definitive explanation for the culprit for a side stitch, but there exist several convincing theories. A common belief shared by the majority of the researchers is that it has a lot to do with the foods we have before exercise.

Some studies reveal that ETAP is most commonly seen in running and swimming. This pain usually occurs in the right of left abdomen and it often interferes with athletes’ performance, but it is not associated with the athletes’ gender or body mass index (BMI). However, ETAP is far more common in younger athletes.

It is already known that the most important factor in developing ETAP appears to be the timing of pre-event meals. One study indicated that consuming reconstituted fruit juices and beverages high in carbohydrate and osmolality (a measure of concentration), either before or during workout, triggered the onset of a side stitch, especially in susceptible individuals. The symptom seems to be unrelated to the amount of food consumed.

There is a more complicated explanation: a side stitch is resulted from stretching the ligaments that extend from the diaphragm to the internal organs, especially the liver. The different breathing methods are the cause of this issue—the jarring motion of running during breathing in and out stretches the ligaments. Runners are prone to exhale every two or four steps. Generally, most people exhale as the left foot hits ground, however, some people exhale while the right foot hits the ground. Since liver is on the right side just below the rib cage, exhaling when the right foot hits the ground results in greater forces on it and the liver will drop down while the diaphragm raises for the exhalation. Such repeated stretching causes spasms in the diaphragm.


What to do for a side stitch?

If you have a side stitch during running, you should stop running immediately and place your hand into the right side of your belly and also push up while exhaling and inhaling evenly. When you are running or swimming, try to take deep, even breaths. The stretched ligament theory tends to believe that shallow breathing will increase the chance of a side stitch because the diaphragm is always raised slightly and never lowers far enough to allow the relaxation of the ligaments. When this happens, the stressed diaphragm is more likely to cause a stitch.

In addition to the above knowledge, we also would like to offer some advice to alleviate the pain of a side stitch:

  • Have a good meal plan and make sure the foods are digested prior to exercise—don’t exercise immediately after eating.
  • Avoid consuming reconstituted fruit juices and beverages that are high in carbohydrate and osmolality prior to and during workout.
  • Thoroughly stretching your body before exercise may relieve the pain of a stitch. You can do like this: raise your right arm straight up and lean toward the left. Hold the stance for 30 seconds, release, then stretch the other side.
  • If you are experiencing a side stitch, slow down your pace until the pain lessens.
  • Try to massage or press the area with pain. Bend your body forward to stretch the diaphragm and ease the pain.

Of course, most importantly, if you frequently experience the pain, please consult your doctor immediately.

Doctor and runner

Source: sportsmedicine.about.com