I just got this today from our training coach, hope it helps.
By Bob Roncker
Stitches that occur while running can be very frustrating and
debilitating. Here are a few points that may be of help.
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. It provides a
boundary or muscular "plate" 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.
Spasms of the diaphragm occur because of the movement of
the internal organs as they jounce up and down while
running. They pull down and strain the diaphragm as it
moves up while exhaling. These inner organs, liver, spleen,
stomach, small intestine and colon form a weight of several
pounds. They hang from several ligaments that are fixed to
the diaphragm. The impact of every step forces the inner
organs to move downwards. The continuous up and down
stress may cause a cramp, or stitch, in the diaphragm.
The liver, the largest organ in the abdominal cavity, is
usually the cause of this. It 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 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.
Tips For Preventing Stitches
Don't eat within one hour of running and only eat lightly
within three hours of running to allow it to digest prior to the
event. Carbohydrates digest more quickly than proteins or
Avoid drinking reconstituted fruit juices and beverages that
are concentrated and high in carbohydrate before and during
exercise. Do drink water or a lightly concentrated sport
drink. The stomach drains fluids rather quickly. Dehydration
is one of the most common causes of fatigue and should be
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 reduces the stress on it.
Try this exercise. Lie down on the floor, place a hand on
your belly and breathe deeply. You are belly breathing
correctly if you feel your hand rise slightly. If only your chest
moves up, you are not breathing deeply enough.
How Do I Get Rid Of A Stitch?
Should you suffer from stitch, the first (and best) cure is to
slow down or stop until the stitch is gone. If you do not want
to stop, you can try to press your hand onto the part of your
abdomen where the stitch is, and release the pressure on
expiration. Bend forward at the waist (45-90 degrees) to
stretch the diaphragm and ease the pain. Repeat this
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.
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
Stretching may relieve the pain of a stitch. Raise your right
arm straight up and lean toward the left. Hold for 30
seconds, release, and then stretch the other side.
Additional Thoughts On Stitches.
Running downhill exacerbates side stitches since it increases
the forces exerted on the entire body with each foot plant.
Novice runners might walk down hills until breathing
techniques are mastered.
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