Why side stitches occur in runners and other athletes and how to avoid them
Runners and other athletes are familiar with stitches, that pain that occurs while running in the abdomen by your diaphragm. Often, they appear as a cramp which in some instances gradually worsens. Sometimes, you may be able to work through or breathe through the cramp yet, at other times; it will stop someone in their activity until the pain from the stitch passes.
Where are stitches and where do they come from?
One source has described stitches as follows:
“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.”
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Another source that is rarely spoken about is the effect of body mechanics that eventually create the problem in the first place. Our regular readers have heard about the idea of how body asymmetry and foot overpronation affects running gait, with over and under striding and it affects the core as it torques. Side stitches are a side effect of this mechanism. As the myofascia surrounding the core muscles causes distortion of the pelvis, it also torques the rib cage, which affects breathing. It also affects the function of the diaphragm. The reason it is more likely to occur with people who are built asymmetrically is that asymmetry will cause the distortion of the pelvis, the tightening of the legs, the shortening of the stride and the improper recruitment of the oblique and rectus abdominus muscles as they fire when they are not supposed to. During running, the abdominals are more supportive, unless you are a sprinter. Since running hard will cause these muscles to fire and tighten abnormally, they will have fascial adhesions at the diaphragm causing the spasm we know as side stitches.
Relieving Side Stitches
Often, you can stop breathe and stretch out the spasm so you can continue. Rather than changing your routine, perhaps we need to be proactive rather than reactive which is what to do when the stitch occurs.
Since body mechanics plays a larger role than most authors on the World Wide Web offer in their explanations, there are things you can do that are effective in reducing pelvic distortion and improving your running form.
- Wear either off the shelf or custom insoles – You need to address the asymmetry. Asymmetry is easily helped with the right insert.
- Use foam rollers to reduce the tightness in the core and legs – this helps improve core function and the firing patterns that occur in muscle groups when you run. (visit our YouTube channel for video’s on this geared toward running.)
- See a health care provider who specializes in runners if you are having other running injuries. It is very difficult to be objective about your own body, and sometimes an outside source can be quite helpful. If you resolve the mechanism causing stitches, chances are you will prevent some future injuries while also resolving current running issues.
- See a specialist in myofascial release. Spasms of the diaphragm may be relieved using myofascial release to reduce adhesions from the abdominal region muscle insertions and the diaphragm.
Dr. William Charschan is the medical director of USATF NJ and the author of Cheating Mother Nature, what you need to know to beat chronic pain available through Amazon.com. He practices in Scotch Plains and North Brunswick NJ.