Why do runners and other athletes experience a side stitch?
Runners and other athletes are familiar a running stitch, which are spasms that occur under the diaphragm or just under the rib cage. Wikipedia describes it as follows:
“A side stitch (also called a side ache, a side cramp, a side cramp, a side sticker, a muscle stitch, or simply the stitch) is an intense stabbing pain under the lower edge of the ribcage that occurs while exercising. It is also referred to as exercise-related transient abdominal pain (ETAP).”
There are many theories about what causes a side stitch including circulation, the liver, the spleen, the gut and the thoracic spine. A common chiropractic finding has to do with posture which is rarely listed as a popular theory. I have referred to it as a DNA shaped spine.
When I experience a side stitch during a run, I find it helpful to take deeper breaths while running and relax my shoulders. Often, the stitch will be relieved which builds the idea of a lack of oxygen being the cause of the cramp in the side. Some runners will try stretching it out, either by bending forward, or to the side or by stretching their quadriceps. These maneuvers may also relieve the side stitch.
On the other hand, having taken care of thousands of runners over the past 35 years, the most common finding is actually a torqued core or distorted pelvis. Patients who get stitches also report shoulder pain after runs, knee pain and even back pain.
If you are built asymmetrically, and overpronate on one side as we see in the diagram to the left, the knee will roll in and the hip will drop as shown on the left side. The other side will then tighten along the side of the leg and into the deep hip flexors. The myofascia, which is the connective tissue that surrounds it that controls the coordination of movement will distort your core, making it less effective and cause recruitment into the oblique muscles and the fascia surrounding it. Those oblique muscles begin from the lower hip on one side and end just below the diaphragm on the other.
Typically, a side stitch occurs with running as the fascia surrounding it tightens up and the upper body will have its motion affected as well. The most common compensation for a torqued core that has been seen on hundreds of treadmill videos is hunching of the shoulders when you run. Looking at the diagram again, you will notice that an unlevel pelvis will also create a compensatory unlevel upper body as well, held in place with tight fascia which gets tighter after running or athletic activity. This affects the way we run, our ground impact and how we feel after we fully cool down 5 hours later
Resolving a chronic stitch problem may also resolve many other complaints in the stomach, neck, shoulders, hips and knees as well. This is because the problem actually is caused by movement which is affected by tight fascia caused by poor adaptation of our body mechanics. As you can see on the right side, the spiral line in the anterior view coincides with the most common area of a stitch.
To fully understand the symptom of side stitches which can vary from person to person, we need to look at the person, getting a full history of other problems they may have as well. Looking at each symptom without understanding the connection to their other complaints is unhelpful, since we are only getting part of the story.
Sports chiropractors (primary spine provider or PSP) are holistic providers who are best trained to look at you, your symptoms and to find the reason behind the complaint before treatment is offered. A combined approach by a PSP using active evaluation, myofascial release, foot orthotics which can balance your hips and spinal adjustments to restore movement of the spine and extremities often resolves the stitch problem and other problems as well. Perhaps, this is why chiropractors have such a great reputation with athletes. Rather than the segmented care approach we typically see in healthcare where the patient goes from doctor to doctor and provider to provider, having a primary care for the musculoskeletal system is more effective because the approach will be coordinated by one provider. Understanding your unique mechanics does not require a village; it requires someone understanding and personalizing the care to you.
See a chiropractor first for side stiches and other athletic complaints. Find out why athletes depend on chiropractors for the best drug free care for painful conditions such as shoulder pain, knee pain, neck pain, hip pain, foot pain and back pain.