You are running and gradually, you begin to feel a cramp or tightness in the abdomen, usually off to one side or the other that worsens as you continue to run. In some runners, the cramp is also in the shoulder blade as you continue to run. Do you stop, stretch or run through it? It used to be thought that side stitches were due to a spasm of the diaphragm and linked to the bouncing of the internal organs, yet many runners never got them even after piling on many miles. Another theory was the idea of footing or timing of how you run. These old ideas have been disproven over time. A professional's opinion on what causes side stitches. I have always found that breathing through a stitch with slow deep breaths while you run helps relieve most stitches. Deep breathing improves oxygen uptake in the body while it also improves rib movement and as the diaphragm is important for upper core stabilization, it forces lose the tissues that are resulting in the cramp. Abdominal cramps or stitches are usually a result of how we adapted to our gait and how it affects our running style. If you are asymmetrically built, and your hips have torsion that results from it, it is likely you will also hunch your shoulders in compensation. This torsion resulting from under striding on the side of the foot overpronation and its effect on the abdominal superficial fascia will affect your running symmetry. The fascia inserts into the right and left upper abdominal quadrants and when those tissues tighten more due to poor running habits, the result is the cramp we feel in the side and in the shoulder blade. Other clues that this may be happening include lower back pain, plantar fasciitis, knee pain, and neck and shoulder tightness after a run. What you can do to prevent side stitches? While side stitches may come and go, preventing them altogether is the best idea. Try these ideas and see if you have fewer episodes of stitches. Off-the-shelf foot orthotics will level your hips when you run and result in more relaxed shoulders while reducing torsion of the hips as well. Arms should swing forward and back with the elbow and just less than 90 degrees. A common cause of stitches is torsion caused by having your arms cross your abdomen which stresses these areas and simply wastes energy. Many avid runners have this bad habit. Arms should swing back and forth. Proper breathing is essential. Slow deep breaths can help prevent cramps. A proper warmup prior to your run. I recommend planks, both side and standard, gluteal kicks, lateral leg raises, balancing 30 seconds on one leg and then the other, and foam rolling generally before the run to improve the way you move. Many of these ideas are demonstrated in the exercise section of our website. Properly fitted shoes. It is common for runners to have black toes due to high mileage and tight shoes which will affect your hips, knees, back, and yes, your diaphragm. Be sure to watch our videos on how to properly fit a running shoe. If you continue to experience this and other problems, visiting a sports-certified chiropractor can help. The doctor will evaluate your body mechanics, and a treadmill evaluation may be very helpful in your understanding of the problem and how to resolve it. We are now heading into warmer weather so have fun running and training for your next event. If you continue to experience stitches and would like a professional opinion, book online here to schedule an appointment.