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Who am I

I started running about two months ago. Before that I occasionally played football/soccer so one can say that I was out of shape but not to a very high degree. As a teenager though I played football at least three times a week. My weight is 87kg/190lbs and I am 1.88m/6.1feet tall.

The stitch

During my running sessions I continuously get side stitches approximately after 4km/2.5miles and I recall, that I also used to get side stitches all the time in my youth.
Sometimes the side stitch is so painful, that it is not possible even to walk quickly.

What I do against the stitch

  • Breathing through the nose
  • Exhaling on the left/right foot, whichever is opposite to the stitch (this really helps, I did believe it at first)
  • Slowing down when the side stitch sets in

The question

  • Are there exercises that explicitly help to prevent side stitches to occur?
  • Does it get better, when I continue working out?
  • Is it advisable to go to a doctor to check it out?
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6 Answers

up vote 6 down vote accepted

Still no sure explanation has been found - it's a difficult field and "whys" are often only guesses or results from ones own experience that is been passed on.

Summery of the linked article:

Quote

While there is still no definitive explanation for the cause of a side stitch, there are several very convincing theories.

Quote

The most important factor in developing ETAP [aka side stitch] seems to be the timing of the pre-event meal. One study reported that consuming reconstituted fruit juices and beverages high in carbohydrate and osmolality (a measure of concentration), either just before or during exercise triggered the onset of a stitch[...]. The symptoms didn't seem to be related to the amount of food eaten (gastric volume).

And this might explane how some breathing control methods might help:

A more complicated explanation [...] is that a side stitch is caused by stretching the ligaments that extend from the diaphragm to the internal organs, particularly the liver. [...] Exhaling when the right foot hits the ground causes greater forces on the liver [...]. So just as the liver is dropping down the diaphragm raises for the exhalation. It is believed this repeated stretching leads to spasms in the diaphragm.

And

The stretched ligament theory would argue that shallow breathing tends to increase the risk of a stitch because the diaphragm is always slightly raised and never lowers far enough to allow the ligaments to relax. When this happens the diaphragm becomes stressed and a spasm or "stitch" is more likely.

Apart from this there are many good sources to read further on in the bottom of this article.

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Care to summarize the points mentioned in that link @Steeven? –  Ivo Flipse Aug 10 '11 at 9:29
    
No problem. Done. –  Steeven Aug 10 '11 at 9:45
    
Now you've gone from uninformative to probably the best answer here :-) –  Ivo Flipse Aug 10 '11 at 10:14
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I experienced quite bad stitch when I first started running, and after some casual research discovered my problem was coming from:

  • Running too soon after eating/drinking
  • Running too fast
  • A beer gut!

So the easiest way to immediately stop the stitch is to leave 1.5 - 2 hours after eating before running, and slow down to a speed where you don't get stitch. Usually it was the former though, and reducing how much I ate also helped (switching to a single pita, baked potato or cereal bar).

If you want to relieve it while running, bending over forward with your hands towards the floor helps to relieve it, although you do look a bit stupid running down the road doing this.

A simple breathing technique can help - breath in and hold your breath for 5 seconds, then as you exhale breath in as you're exhaling.

It definitely gets easier if the two reasons I gave are the cause of the stitch. If the eating timing doesn't make any difference then a trip to the doctor or physio would be best.

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If changing your breathing pattern helped, there is no reason to go to the doctor, as stitches from diaphragm compression are entirely normal. The reason you got these cramps less when playing sports is probably because you frequently stopped and started, which naturally gave you rest, and also broke up your breathing pattern. Your organs will get used to the constant rhythm of jogging over time, and varying your breathing as you describe will become more natural as well.

One thing you can do to increase the effectiveness of the breathing change is to belly breathe, as this extends your diaphragm down and reduces some of the bounce in your core.

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To ease/relief the stitch, I usually take the hand opposite of the stitch and press gently into the side while continuing to run (a little slower, of course) and focus on deep breathing. Helps every time within a minute.

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I have been running since high school, and still get stitches if I do not follow my coach's advice (and a few tips from running friends over the years):

  • Breathe 3 breaths out for every one breath in. As soon as I try to inhale deep, I always cramp
  • Breathe in through nose, out through mouth (still working on this one, but it helps, so I keep trying)
  • Like Chris S answered, run on an empty stomach, although eating 1/2 Powerbar an hour before has never hurt me
  • Form - keep your arms pumping up and down, always maintaining a space the width of your torso between hands (do not cross those arms inwards - straight lines), chest lifted. If you fail on this, you will cramp.

When the stitch does hit, slow down and exhale with much strength, and only inhale as little as needed, the fully exhale again. Keep arms moving, chest lifted, even if it hurts.

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To try answering the specific question:

Are there exercises that explicitly help to prevent side stitches to occur?

The deep and controlled breathing in on the right foot and out on the left foot is suggested to help. You have to be concentrated on this and train this while exercising to breath the right way without concentrating to much on this while performing.

According to the internal organs being tossed around, stretched and hammered or what else happens: Remember to always warm up properly and effectively before performing AND before exercising.

Strengthening the muscles in that area like the diaphragm as well as the core muscles like the lower back, the abdominals and the obliques is of course a direct treatment. Especially the core muscles improve your static and "bearing" parts, roughly spoken.

If you gradually increase exercise intensity the body will "warm up" while at it and will stretch out what hasn't already been.
Remember this during warm up, that you have to let the body experience the amount of pressure, you intend to put on it while performing, as well as getting your pulse as high, as you expect to get it - just over shorter periods.

See more here.

Does it get better, when I continue working out?

It is usually said just to continue will make it disappear. Especially by the coach. But as long as no real threat has been proven or documented (by some accident or injury actually happening) you might just keep up the good mood and use pure willpower to overcome the hard times.

It works for me to think about breathing with my belly instead of just the upper chest. It might touch some right places, but nevertheless it will activate the side stitch area and is worth a try.

Is it advisable to go to a doctor to check it out?

Well no, as there are no proven treatments and no proven actual danger. As far as to this days medical science, just continue running and exercising. It might disappear some day.

Another article with mere to read.

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