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Many runners and other athletes experience short, sharp pains originating from a point just below their rib cages. These often debilitating cramps are known as side stitches or, more formally, exercise-related transient abdominal pain (ETAP). They can literally bring an athlete to his or her knees, but the pain can be alleviated through rest, self-massage of the diaphragm area and careful stretching. They can also be largely prevented through proper warm up techniques, dietary changes and a change in running mechanics.
Stitches are not caused by excessive gas build-up or a lack of oxygen to the chest muscles. They are caused primarily by a spasming diaphragm, the muscle which aids in breathing and keeps the internal organs separated from the chest cavity. When a person inhales, the diaphragm moves downwards, an action which tends to stretch the ligaments attached to it. Normal exhaling causes the diaphragm to rise, and the internal organs attached to it, especially the liver, become more relaxed. This process is supposed to continue without fail throughout a runner's entire session.
The problem begins with gravity. A runner's internal organs are naturally pulled down by the force of gravity, but the diaphragm is pulled mechanically upwards during breathing. If a runner's foot strikes the ground at the wrong point in the breathing cycle, the diaphragm moves up as the ligaments attached to it move down. This stretching of the ligaments, especially on the runner's right side where the liver is attached, can be very painful. The diaphragm may go into a spasm, since its normal cycle was disrupted by the shock of the runner's foot. The pain generated by both the stretched ligaments and the spasmodic diaphragm constitute side stitches.
Treating side stitches after they develop is often a matter of resting, self-massage and stretching. If the runner can press several fingers under his or rib cage, the stretched ligaments can often be manipulated back into a healthier state. By using deep breathing techniques, also known as belly breathing, the runner's diaphragm should also quit spasming after a few minutes. Experts suggest blowing out a strong breath through pursed lips, as if blowing out the candles of a birthday cake. Avoid taking shallow breaths, which tend to keep the diaphragm trapped in a state of limbo.
Preventing stitches in the first place may involve some changes to one's running routine. Drinking a sufficient amount of fluids before a run can keep the muscles hydrated and reduce the chances of cramping. There should also be at least a two to three hour gap in eating before a run. Stretching exercises before a race should include some slow side-to-side movements to stretch the ligaments in the abdomen attached to the diaphragm.
Many side stitches are caused by a running technique used by approximately 30% of all runners. Most runners have a preferred foot which corresponds with exhaling. The majority of runners exhale at the same time their left feet strike the ground. The internal organs on the left side of the body are generally smaller, which means the chances of a stretched ligament causing side stitches or spasms are minimal. The liver, however, is a fairly heavy organ located on the right hand side of the body. If a runner favors his or her right leg while exhaling, the shock of the foot strike and the position of the diaphragm can trigger side stitches.
The solution to avoiding side stitches may be a matter of rethinking one's running style in order to avoid exhaling as the right foot strikes the ground. By changing the preferred foot from right to left, a runner can prevent the kind of stresses on the abdominal ligaments which often trigger side stitches.
Mutsy- I also exercise in the morning. I try to stretch before I run. This helps me from getting the side stitches that cause me to want to stop my run.
Running is difficult enough, so I make sure that I drink a glass of water about a half hour before I run, and stretch my entire body as well. I also keep a measured pace that I keep for my runs and with the treadmill; I can adjust the speed at whatever intervals I want.
I think that side stitches also develop when someone is exerting too much effort too soon. I also make sure that I breathe properly.
This method helps me finish my work out without any problems which is how to prevent side stitches.
SauteePan-I have had side stitches when running and it is usually due to either eating too heavy of a meal prior, or not pacing myself properly and starting to run too quickly too early in my run.
I now avoid the problem altogether by running early in the morning after I had my first cup of coffee.
This allows me to have a focused run and it is the best feeling in the world to finish your workout so early in the morning.
It actually allows you to burn more calories throughout the day because your metabolism remains elevated.
It also gives me a huge sense of accomplishment and I don’t have to worry about fitting in my workout for the day because I already completed it. I don't tend to have problems with side stitches when I run this way.
The best way to learn how to prevent side stitches while running is simple. First, try not to eat anything about an hour or two before you run. If you are feeling a little hungry you can drink a little bit of juice, but nothing more.
Running is a high impact exercise that if you are not careful you can actually develop nausea and vomit if you have had a full meal before a run, in addition to the side stitches.
The other thing to remember is that running requires controlled breathing. If you train your body to do deep control breathing then you will eliminate the side stitches when running.
Even if you start to develop slight side stitches when running, the pain will subside if you breathe correctly and push through it. This is what I do when the side stitches burn.
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