If you have been a runner for a while, you have probably got a stitch or two while out on a run – that intense stabbing pain on the lower edge of your ribcage (and usually on your right side).
What Causes a Stitch?
The actual cause of a stitch is a medical mystery, but there are some theories, including:
• Pulling downward on the diaphragm: While this theory makes sense in the case of runners getting a stitch, it does not in the case of swimmers (who also get stiches). When running, the large internal organs move up and down. Many think this repeated downward force on the diaphragm causes it to spasm, hence the stabbing pain. However, this theory does not seem to hold true in the case of swimmers whose internal organs do not bounce up and down when swimming.
• A spasm of the diaphragm: A spasm could be caused by an electrolyte imbalance particularly of sodium, calcium or potassium. This is a known cause of other muscle spasms, such as in the hamstring – in the front of the leg, or calf – the large muscle in the back of the leg between the knee and ankle. Regularly eating foods high in potassium seems to keep spasms at bay. Drinking an electrolyte-infused sports drink before running may also help with spasms.
• Shallow breathing: Shallow breathing prevents the diaphragm from fully expanding or relaxing. Consequently, this puts it under constant stress or tension and like most muscles that are hyper-exerted, they can tend to spasm causing a stitch.
What Can I Do to Prevent Getting a Stitch?
The good news is for most people, the more they run, the less often they get a stitch. Other prevention tricks that seem to work include:
• eating smarter – try not to eat a least an hour before you run and make sure what you eat is mainly complex carbohydrates that are high in the important electrolytes: potassium, calcium and sodium.
• breathing deep and correctly – focus on inhaling deeply and exhaling fully.
• strengthening your abdominal core – improving your core muscles provides more support for your large internal organs thus lessening the bouncing action.
What Do I Do When It Happens?
Fortunately, there are three things you can do when hit with a stitch:
Slow down – as soon as you start to feel the cramping, slow down your pace. This allows you to breath deeper and ease the tension on your diaphragm.
Press your hand in where it hurts – using your fingers or the palm of your hand, press up and inward at the site of pain. This can stabilize your large organs, if they are bouncing up and down, and it passively massages your diaphragm, if it is over stressed from shallow breathing.
Change your breathing pattern – when you exhale could be causing your stitch. If you exhale on the side of the pain, change your breathing so that you exhale on the opposite side of your pain. For example, if your pain is on your right side, make sure you are exhaling when your left foot hits the ground. It really works!
Knowing the cause, prevention, and what to do when it happens will make your running activity more enjoyable and less painful.