New article in NY Times talks about new theories about side stiches

New article in NY Times talks about new theories about side stiches

If you have ever ran and had a side stitch, the pain at the base of the diaphragm, the pain has stopped many an athlete from running, having them breath and walk it off (  I have had them too.

The above article suggests that side stitches are due to posture and that people who have slouched posture tend to be more prone to having the problem.  I would tend to agree however, the findings of the studies that are talked about in the article are looking at a symptom.  Poor posture is a symptom of something Brian Rothbardt DPM spoke about called bio implosion (  I too have written about this using the basic pronation accommodation pattern ( which describes the soft tissue changes that occur from foot flare and overpronation, when the feet flare out.

Putting it all together, simply explained, foot flare causes bio implosion, where the shoulders roll in as the core muscles (obliques, rectus abdominus) shorten and tighten.  As the core muscles torque, the pelvis loses leverage, the legs tighten, the running stride shortens and you begin to recruit into the rectus abdominus and oblique muscles with every running steps.  The eventual overuse of the obliques and the rectus abdominus causes shortening at the insertions of these muscles at the diaphragm, thus creating the stitch as the muscle shortens and goes into a state of rigor, or sustained tightness.  The result is the pain from the stitch, which stops the runner in their tracks.

Ways to prevent stitches
1. Foot orthotics to improve the firing pattern of the legs and reduce recruitment into the rectus abdominus and obliques.
2. Myofascial release in the abdominal regions which will improve the stability in the pelvis, and keep the legs looser.  This can be done with foam rollers before a run.
3. Core stability exercises such as Wii fit, Pilates, or roman chair or exercise ball proprioceptive activities.

What do you think?  You can email suggestions or questions to