Side Stitches and Running

Posted by:

Louisville Orthopaedic SurgeonYou’re just getting started with your running program and you’re making good progress.  You’re starting to feel really good about your training, and then one mile into your weekend run you begin to feel an intense, cramping pain just under the right side of your rib cage.  The pain becomes so severe that you are forced to break your stride and stop running for a moment.  Persistent as you are, you start running again when the pain goes away only to have it come back again within a few minutes.  You have just experienced the bane of runners everywhere, the side stitch.

What causes a side stitch?  Side stitches are caused by a muscle spasm of the diaphragm, the large sheet-like muscle that separates the chest cavity and lungs from the abdomen and is one of the major muscles that controls breathing.  Side stitches are a common occurrence with vigorous activity such as running, and are more frequent in beginners or in those who haven’t developed proper pacing or breathing techniques.  About a third of all runners will experience side stitches at some point.

When we inhale the diaphragm presses downward, increasing the size of the lungs and bringing air in.  When we exhale, the opposite occurs and the diaphragm moves upward forcing air out of the lungs.  There are abdominal organs attached to the diaphragm and during running they place additional strain on the muscle during this activity and can lead to spasm.  The organs on the right side, particularly the liver, are larger than those on the left and lead to more frequent right-sided stitches but they can occur on either side.   It is believed that shallow, quicker breathing makes side stitches more likely to occur. This is common when running in cold weather because taking in a big breath of frigid air is uncomfortable.  Other factors that can increase the likelihood of side stitches are exercising too soon after eating, running downhill, or starting exercise too vigorously without a proper warmup.

How do you get rid of a side stitch?  In general, the immediate treatment for a muscle cramp is to slowly stretch the cramping muscle.  Stretching the diaphragm may not be as intuitive as stretching a cramping calf muscle, but it can still be done.  One method is to run as upright as possible and stretch your arms over your head if a side stitch occurs.  Altering your breathing pattern can be helpful to combat side stitches.  Try taking in a deep breath quickly and hold it for a few seconds and then exhale against pursed lips to increase the resistance.  You may have to stop and walk for a few seconds and focus on your breathing pattern, and then resume running when the stitch goes away.  If you get a side stitch in the middle of a race, try to mix up your breathing pattern.  If you get into a rhythm of always exhaling when the right foot strikes the ground, try exhaling on the left instead.  Relaxation techniques can also help get rid of side stitches as they promote deep, calm breathing.

In summary, if you are plagued by side stitches that are limiting your ability to run or train, remember the following:

  • Warm up before you run
  • Avoid extreme cold weather running
  • Run more slowly downhill
  • Take deeper, longer breaths
  • Don’t eat within 1 hour of running
  • Don’t always exhale on right foot strike
  • Relax!