Many runners and other athletes experience short, sharp pains that originate at a point just below the ribs. These often debilitating cramps are known as side stitches or, more formally, exercise-related transient abdominal pain (ETAP). Side stitches can literally bring an athlete to their knees, but the pain can be relieved through rest, self-massage of the diaphragm area, and careful stretching. Side stitches can also be largely prevented through proper warm-up techniques, dietary changes, and a change in running mechanics.
Side stitches are not caused by excessive gas buildup or a lack of oxygen in the chest muscles. Side stitches are primarily caused by a spasmodic diaphragm, the muscle that aids breathing and keeps internal organs separate from the chest cavity. When a person inhales, the diaphragm moves downward, an action that tends to stretch the ligaments attached to it. Normal exhalation 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 session.
The problem starts with gravity. A runner's internal organs are naturally pulled down by the force of gravity, but the diaphragm is mechanically pulled up during breathing. If a runner's foot hits 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 right side of the corridor where the liver is attached, can be very painful. The diaphragm can go into spasm, as its normal cycle was interrupted by the shock of the runner's foot. Pain generated by both the stretched ligaments and the spasmodic diaphragm constitute lateral points.
Treating lateral sutures after they develop is usually a matter of rest, self-massage, and stretching. If the runner can press several fingers under his ribcage, the stretched ligaments can often be manipulated back into a healthier state. By using deep breathing techniques, also known as abdominal breathing, the runner's diaphragm should also stop spasming after a few minutes. Experts suggest exhaling a strong breath through pursed lips, like blowing out candles on a birthday cake. Avoid taking shallow breaths, which tend to keep the diaphragm trapped in a state of limbo.
Preventing side stitches in the first place may involve some changes to your running routine. Drinking a sufficient amount of fluids before a race can keep your muscles hydrated and reduce the chance of cramping. There should also be at least a two to three hour window for eating before a race. 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 about 30% of all runners. Most runners have a preferred foot that corresponds with the exhale. Most runners exhale at the same time their left feet hit the ground. The internal organs on the left side of the body are generally smaller, which means that the chances of a stretched ligament causing lateral stitches or spasms are minimal. However, the liver is a fairly heavy organ located on the right side of the body. If a runner favors their right leg as they exhale, the impact of the foot strike and the position of the diaphragm can trigger side stitches.
The solution to avoiding side stitches may be to rethink your running style to avoid exhaling when your right foot hits the ground. By changing the preferred foot from right to left, a runner can avoid the kind of abdominal ligament strains that often cause side stitches.