Stop those Side Stitches
By Dr. Trish Kana, PT, DPT
Picture this: You're halfway through your big race, crushing your game plan and hitting your goal pace perfectly when all of a sudden - a sharp stabbing pain under your ribs has you coming to a grinding halt.
These incredibly annoying and unpredictable side stitches or cramps are common - regardless of running level or experience.
The experts refer to side stitches as exercise-related transient abdominal pain (ETAP) and theories abound as to why they hit us at the most inconvenient of times.
Keep reading for a breakdown on what causes side stitches and how to manage them if they come knocking during your next run!
What causes them?
Despite being so common, limited research exists around ETAP apart from case studies and anecdotal evidence. The following theories have emerged trying to explain what's contributing to that pain in your side:
irritation or spasm of the diaphragm
phrenic nerve irritation (the nerve that innervates your diaphragm)- this is more related to right side stiches
The common thread: your diaphragm is being over-stimulated!
How you can prevent them:
Don't skip your warm-up! For runners, making sure you're getting a full warm-up in before racing so that you body has been able to ease into the activity. Going from 0 to 100 when racing for long periods means you're breathing harder and putting excessive stress on the diaphragm, your body's primary muscle for respiration.
Just like any muscle can be prone to overuse injuries, think of a side stitch as a diaphragm overuse injury. You haven't made this muscle have to work this hard, and it's politely telling you to back off!
Make sure to time your meals and fluid intake accordingly. Keep your pre-run meal primarily carbohydrates with a little bit of fat. These are easier to digest macros than protein. If your body is still working on digesting when you run, your heart has to keep pumping blood to your extremities while running and less oxygen is available to the diaphragm, which could contribute to the side stitch.
Research has shown that beverages high in sugar/salt (hypertonic) can contribute to higher rates of side stitch incidents while running. If you are prone to side stitches, train your body to take in these types of fluids during your slower/shorter training runs and keep the volume low!
Practice your breathing during your training runs. Finding a pattern and rhythm that works for you is crucial - but not just when the run is easy and flat. Try the same rhythm running uphill and downhill.
Because muscles to have to work harder going uphill, your breathing rate naturally increases. But when you get to the top and are about to enjoy that downhill- don't forget to continue the breathing pattern. It's common for runners to forget this since running downhill doesn't necessarily require more oxygen or naturally increase your breathing rate.
How to handle them once they start:
Slow down! Continue to focus on your breathing. Emphasize expansions through your rib cage in 360 degrees as you inhale and let your ribcage collapse in as you exhale.
One expert on the issue and neuroscientist, Dr. Andrew Huberman,- suggests that runners try the physiological sigh next time they experience side stitches on a run. You can perform this technique while still running!
Physiological sigh: 2 inhales followed by a longer exhale (check out this video for a demonstration).
This should stimulate changes in the firing of the phrenic nerve which could lead to an alleviation of the pain from the right side stitch.
Side stitches are your diaphragm’s way of asking for a little respect — train your breath like you train your legs, and your next race will thank you!