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40 Side Stitches


This article is from the Running FAQ, by Ozzie Gontang with numerous contributions by others.

40 Side Stitches

(Jack Berkery berkery@emmax5crd.ge.com)

The Latest Word on Stitches

In the May-June 1992 issue of Running Research News there is an article by
Dr. Gordon Quick about the causes of and cures for stitches. To summarize:

1) Stitches are a muscle spasm of the diaphragm. The cause of the spasm is
that the organs below it are jouncing up and down and pulling down as it
wants to pull up. The liver being the largest organ is the biggest culprit
which is why most stitches are on the right side. A stomach full of food
may also contribute to the problem for the same reason. Stitches also occur
more often when running downhill or in cold weather.

2) The cure seems almost too simple. Breathe out when your left foot
strikes the ground instead of when the right foot strikes so that the
organs on the right side of the abdomen are jouncing up when the diaphragm
is going up. The organs attached to the bottom of the diaphragm on the left
aren't as big, so exert less downward pulling strain. If this is not enough
to get rid of it, stop and raise you arms above your head until the pain
goes away and when you resume, be a left foot breather. (Conversely, if
your stitch occurs on the left side, switch your breathing to exhale on the
right foot.)

3) Do not eat anything for an hour before running if you are prone to
stitches, BUT PLEASE DO DRINK WATER. Water empties from the stomach faster
than solids and the risk of complications from dehydration far exceed the
problems one may have with a stitch.

4) In the long term, exercises to strengthen the abdominal muscles will
help prevent stitches because tighter abs will allow less movement of those
internal organs. Practice belly breathing instead of chest breathing as
recommended by Noakes. For the most part, stitches diminish over time.
While they are not strictly a novice runner's problem (about 1/3 of all
runners get them from time to time) they usually will go away after a few
weeks of conditioning.


By Tim Noakes Oxford Uni. Press, 1985. Quoted from "Lore of Running"

Proper breathing prevents the development of the `stitch'. The stitch is a
condition that occurs only during exercise and which causes severe pain
usually on the right side of the abdomen, immediately below the rib margin.
Frequently the pain is also perceived in the right shoulder joint, where it
feels as if an ice-pick were being driven into the joint. The pain is
exacerbated by down-hill running and by fast, sustained running as in a
short road race or time trial. For various complex anatomical reasons, the
fact that the stitch causes pain to be felt in the shoulder joint suggests
that the diaphragm is the source of the pain.

It has been suggested that when breathing with the chest too much air is
drawn into the lungs, and not all is exhaled. This causes a gradual and
progressive accumulation of air in the lungs, causing them to expand which
in turn causes the diaphragm to be stretched and to encroach on the
abdominal contents below it. During running, the over-stretched diaphragm
becomes sandwiched between an over-expanded chest above, and a jolting
intestine pounding it from below. It revolts by going into spasm, and the
pain of this spasm is recognized as the stitch.

Although there is really not a shred of scientific evidence for this
belief, I have found that diaphragm spasm is almost certainly involved in
the stitch and that belly-breathing can frequently relieve the pain.

The runner who wishes to learn how to belly-breath should lie on the floor
and place one or more large books on his stomach. He should concentrate on
making the books rise when he breathes in and fall when he exhales. As it
takes about two months to learn to do the movement whilst running fast, it
is important to start practicing well before an important race.

A change in breathing pattern may help relieve the stitch. Within a short
period of starting running, breathing becomes synchronized with footfall.
Thus one automatically breaths in on one leg and out when landing either on
the same leg - that is 2, 3 or 4 full strides later - or on the opposite
leg - that is 1 1/2, 2 1/2, or 3 1/2 strides later. Thus the ratio of
stride to breathing may be 2:1, 3:1, 4:1; or 1.5:1, 2.5:1, 3.5:1.

This phenomenon was first reported by Bramble and Carrier (1983). Of
particular interest was their finding that most runners are `footed', that
is the beginning and end of a respiratory cycle occurs on the same foot,
usually in a stride to breathing ratio of either 4:1 whilst jogging or 2:1
whilst running faster. Runners then become habituated to breathing out on
the same let, day after day. This produces asymmetrical stresses on the
body and could be a factor in both the stitch and in certain running
injuries. I am `left-footed' and have also suffered my major running
injuries only on my left side. If changes in breathing patterns do not
prevent the stitch then the last step is to increase abdominal muscle
strength. The correct way to strengthen the abdominal muscles is to do
bent-knee sit ups with the feet unsupported.


EDITORS NOTE: Readers response to "Belly Breathing" definition above.
"Belly Breathing" (Lamont Granquist lamontg@u.washington.edu)

While I wasn't breathing with my chest, I wasn't really "Belly Breathing".
When I exhaled, what I was doing was pulling my stomach muscles in. I found
out that this is *not* the way to "Belly Breathe". The idea is to throw
your gut out as much as possible -- try and look as fat & ugly as you can
when you run. For the suggestion in the FAQ of lying on your back and
lifting a book, it should probably be noted that when exhaling you want to
try to keep the book lifted up (of course naturally, you don't want to try
to do this all so hard that it becomes difficult to exhale -- the idea is
that breathing this way should be comfortable).

1. Since it is a cramp, I try not to drink or eat too soon before my runs,
and I try to limit my intake during runs.

2. I stretch my abs extensively before a run. Putting my arm over my head
and leaning to the opposite side until I'm pulling on the side of my
abdominals works well.

3. I regulate my breathing by breathing in through my nose, and out through
my mouth. This sounds like zen-crap, but believe me, it works amazingly
well in eliminating all types of cramping. When you first do it, it'll feel
like you're not getting enough oxygen, but if you persist the technique
will become very comfortable.

4. I run with my back fairly straight, even up hills. This keeps the lungs
from bending over in my body, and makes it much easier to breathe.

5. If none of these work, I keep going anyway. After about 3 miles, it
usually goes away . . . if you're lucky.


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