Side Stitches - LATC Member Feedback

This is long, so be patient. Thank you to all who helped create this entry.

NOTE:

From what I’ve gleaned from texts, journals, professional coaches, doctors, and triathletes, there is little consensus on the cause and prevention of side stitches. What follow is the collective wisdom of those people who contributed. All of the submissions here should be taken with that in mind – most of these are submissions based on personal experience, while some come from professional expertise. Where there is a submission by a doctor or professional coach, I’ve made note of it.

CAUSES OF SIDE STITCHES:

“side stitches are the result of ischemia which is defined as a deficiency in blood supply to a body part. When you run, you frequently use parts of your body that demand a higher blood circulation, meaning that this supply is sent to a location, other than your abdomen. The resultant decrease in perfusion causes pain because the tissue at the cellular level is hungry for oxygen rich blood.” (M.D. and triathlete)

“A side stitch is caused by stretching the ligaments that attach your liver to your diaphragm. Humans breathe out once for every two steps. More than 70 percent of humans breath out when their left foot hits the ground, while 30 percent breathe out when their right foot hits the ground. Those who breathe out when their right foot hits the ground are the ones most likely to suffer side stitches because the force of the right foot strike causes the liver to go down when their diaphragm goes up during breathing out. So the ligaments are stretched and hurt.” (local M.D.) “…researchers believe that the side stitch is caused by stretching the ligaments that extend from the diaphragm to the internal organs, particularly the liver. The jarring motion of running while breathing in and out stretches these ligaments. Exhaling when the right foot hits the ground causes greater forces on the liver (which is on the right side just below the rib cage). So just as the liver is dropping down the diaphragm raises for the exhalation. It is believed this repeated stretching leads to spasms in the diaphragm..” (periodical)

“Side stitches occur when the connective tissue that suspends our internal organs cramp. They are more likely to act up on the run because of the vertical bouncing but can also occur on the bike simply from the diaphragm’s activity. That connective tissue holds the liver, stomach and sections of the large and small intestine.” (professional coach) “I have heard that side stitches occur from a spasm of the diaphragm muscle (yes it is a muscle) and usually when we start out too fast at something and in oxygen debt. There are many debates on this.” TO PREVENT SIDE STITCHES: “First of all, make sure that you are hydrated, in advance. If you become dehydrated, your blood is more concentrated, thicker, making efficient flow more difficult and increasing the liklihood of poor flow to your abdominal vasculature. Secondly, make sure that you are practicing appropriate breathing as oxygen depletion at the cellular level is the root cause of the pain. As a consequence of the normal aging process, alveolar closing capacity begins to approach the same volume as normal tidal volume. You need to practice doing things while you run that keep your lungs inflated and all the little alveoli open as much as possible. A good example of this is singing or doing another maneuver that causes you to exhale against resistance such as pursed lips. Deep breathe periodically and cough as well. Lastly, there is some indication for the use of agents that help to keep your blood flowing smoothy, such as aspirin, ginko biloba or even ibuprofen. These, however should be your last resort after you have tried the other two suggestions (especially the hydration).” (M.D. and triathlete)

“Time your eating. Having food in your stomach during a race may contribute to cramping by creating more force on the ligaments. Try to avoid eating one to two hours before a race.” “This year I did a half and full Ironman for the first time and I took MANY thermolytes on the bike and run (2 every hour in the half and 2 every half hour in the full). I had NO cramping issues anywhere on my body. So, at Malibu this year (where I often get a side cramp), I took 4 thermolytes on the bike and had NO stitches. It was such a relief. Nobody ever talks about taking salt pills or anything in a sprint or even an olympic but they might have helped. I have no idea if they were the answer, but it can't hurt. It makes sense to me that a cramp would come from an eclectrolyte imbalance. If you aren't familiar with them, thermolytes are electrolyte pills that you can get at Triathlete Zombies. Endurolytes are similar but have 1/3 the amount of electrolytes in them, so you have to take 3 times more.”

“Stretch more. Stretching is a good additional way to prevent or relieve a cramp. To target this often overlooked muscle, raise your right arm straight up and bend your trunk toward the left. Hold for 30 seconds, release, then stretch the other side.” “not to eat or drink during the last few miles of the bike/t2/first mile or so of the run.” “Eat earlier and give the intestines longer to empty before racing.” “One thing I noticed I was doing, was while on the bike, sometimes when I went to "suck" on my water bottle I noticed just that, that I was sucking on it. So I figured I was taking in air, I have been much, much more careful drinking on the bike. Squeezing instead of sucking, and it has helped considerably. Hope this helps.”

“Often side stitches develop when you don't exhale deeply enough. Try to always exhale deeper and longer than you inhale when running, for example, 3 steps out and 2 in.”

“the best way is through brick workouts, conditioning your body to get used to bike to run stress”

“Do core exercises, especially focusing on your obliques.”

“Run with your hips and torso still and level. a)Don't bounce. b)Shorten your strides and increase your cadence (this usually helps decrease the hip tilting). c)keep your torso upright and still. d)Don't allow you hands to cross over in front of your torso. e)Feel like you have a plate on your head and a ceiling right above the plate. This doesn't mean you go slower.”

“Breathe rhythmically, on your steps, in-in-out-in-in-out, etc.”

“the key to avoiding side stitches (for me, anyway) is decreasing my fluid intake. I have found that the more I drink, the more likely I will develop a side stitch. In fact, I have had such problems over the years that I drink very little at all. Of course, I wouldn't recommend this for longer races in very hot conditions, but for sprint distance triathlons it seems to work for me. I can get away with drinking very little if I stay cool during the run. To ensure this, I pour water over myself at the start and have the water station people splash me along the way (they seem to enjoy this). You stay cool, sweat less, don't have to drink along the way and ultimately eliminate the dreaded side stitch.”

“My husband swears that doing sit ups before a run helps him.”

TO DEAL WITH SIDE STITCHES DURING A RACE:

“David Brennan, MEd, an exercise physiologist at Baylor College of Medicine recommends specific breathing techniques to relieve the pain and keep you running. The prescribed technique is to exhale with force with each stride. According to Brennan, "If the stitch is on the right side of the abdomen, push your breath out when your left foot hits the ground, and use the opposite approach if the pain is on the left side." He also suggests that runners develop the habit of using the abdominal muscles for breathing, contracting and extending them in and out with each breath. Brennan suggests building workout intensity gradually. Increasing abdominal strength, especially the obliques and the transverse abdominis, can also help stave off side stitches.”

“Pete Pfitzinger, of American Running's Editorial Board recommends the following technique to relieve side stitches: Push your fingers into the diaphragm just below the ribs and bend forward, exhaling forcefully against the pressure of the fingers. The maneuver releases the spasm and the runner can continue with a jog. Keep intensity low after the stitch since there is a tendency for it to return.”

“To stop a side stitch when running, stop running and place your hand into the right side of your belly and push up, lifting the liver slightly. Inhale and exhale evenly as you push up.”

“When you get a side stitch, stop running immediately, reach your fingers into the right side of your belly and push your liver up. And breathe out with you lips pursed at the same time. Then you can resume running without feeling any pain.”

“…suggested I grab the skin right where the stitch was and pull it hard. I did this and it about 90% went away and I was able to finish the race. I have also used another method in running races - slow down a bit and hold your arms up over your head until it goes away. I have heard it comes from drinking too much water at once. I try to just take small swigs as I go.”

“Hold your breath and press the area near the side stitch. Also, slightly bending your side of body (stretching it) can help. i.e., a basic yoga stretch that can be done in 20 seconds.”

“whenever they occur I start inhaling and exhaling very slowly & deeply, focusing on my breathing...takes awhile, but usually helps.”

“suggested breathing out all the way when the cramp happens and holding my breath out for a few seconds.”

“I would also raise my arm up in the air to try and stretch out the side. I think that it has something to do with the diaphragm, which is why a breathing technique should work.”

“Concentrate on deep, smooth breathing even before they start. I'm convinced they are breathing related. I found that I often get a stitch on a downhill -- and an ultra-runner friend said we have a tendency to hold our breath on downhills, so I'm extra cautious then. If I feel the slightest twinge of a stitch, I start a pattern or deep exhales (pushing the air out of the lungs). A good exhales, forces a good inhale. I also try to tighten my stomach muscles - almost as if doing a crunch without the movement (this has been my best trick yet). Lastly, my coach said to purse your lips together. This seems to trigger a tightening of the stomach.”

“…take even, deep breaths while running. Shallow breathing tends to increase the risk of cramping because the diaphragm is always slightly raised and never lowers far enough to allow the ligaments to relax. When this happens the diaphragm becomes stressed and a spasm or "stitch" is more likely.”

“Rub it away. Massage or press on the area where you feel pain. You may also want to bend forward slightly. This seems to stretch the diaphragm and ease the pain.”

“Breathe in sharply and quickly through your nose, then exhale hard and long through your mouth. This helps to eliminate the gas buildup that you're experiencing. In recent runs with two fellow triathletes -- two separate runs -- they were experiencing a stitch and I suggested the quick inhale, deep hard (loud) exhale, and it relieved the stitch for both of them within a few minutes.”

“If you are breathing with your mouth, it could be because you have too much air traveling into your system too quickly. When this happens, try to breath with your nose, deep steady breath. I know when you are racing it's kind of hard to breath with your nose, I know I never do, even when I'm just training.”

“Here is a trick I learned when I was in the track team. Breath with your tougue against the roof of your mouth, this acts like a filter for the air that travels into your mouth. It works for me every time. But try to do this before it start to hurt, to prevent it from happening.”

“My way of dealing with them was through breathing. A good coach and friend in South Africa once told me to think about my breathing when they appeared and breath into your diagphram instead of into your top part of the lung. When breathing like this it should feel and look like you are breathing into your stomach. This is a good way to relieve the cramping feeling as it stretches the side muscles that cause it.”

“reduce the amount of fluid you drink on the ride”

“Once you have side stitches, you can try to completely exhale and hold it for 10 steps (I know it sounds like torture) before you inhale several times. Or if that still does not help, exhale, stop running, bend over forwards, exhale more, wait until the stitches go away.”

“I find if you raise both your arms above your shoulders and take slow deep breaths it slowly goes away. You can also try raising the opposite arm of the side that you have cramps.”

“I used to run with an amazingly fast woman (she was kind enough to wait for me). I learned alot from her including where to find the best trails and how to get rid of side stitches. I haven't had a problem since. Anytime you get them, she says you are supposed to breathe out as much air as you can, while running, contracting your diaphragm really hard, then inhale and do it again. You repeat this process each time you exhale, contracting the diaphragm by pressing down and closing the space in your rib cage. Works for me. She learned it from Pat Cunningham, I think.”