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.