Stitch-like rib pain when (road) running

Question

I’ve been running fairly consistently for a couple of months recently, mainly because I move around a lot and this makes maintaining gym memberships etc quite difficult.

Prior to this I would road bike and weightlift fairly frequently.

Once I started running in earnest I rightly expected the first couple of weeks to be fairly miserable, so I took it fairly easy so as not to injure myself. Mainly doing up to 5k at a light pace. Over that period most of the initial aches and pains disappeared (foot and shin pain mostly, I’m quite a broad guy - 5’11” and about 100kgs).

However the only ‘ache I can’t shake’ is a recurring pain in my right hand side around my ribs. It feels like a stitch, a kind of stabbing pain, but its further up and sometimes radiates around to my back slightly. It starts about a kilometre in to the run. I’ve never really had this before in the gym no matter how heavy I’ve lifted, nor really when I run on the treadmill or cycle, even fairly extended distances.

I stretch before, during and after the run, and it will abate once I’ve stopped but it reoccurs every time I go running without fail. I’m now wondering if I should be more concerned about this? Has anyone had a similar experience?

Could it be my running form? I’m dominant right handed/footed. It’s annoying as it’s hampering my ability to improve my speed and distance.

Answer 1

Side stitches are quite common while running. It's typically a cramp in the diaphragm which is a muscle just underneath the ribs and below the lungs. People don't actually know what causes side-stitches, but there are theories.

1. Breathing. Commonly people will have very erratic breathing while running. They do very quick, short huffs. Ideally, you should be taking in big, slow, deep breaths. Use the full capacity of your lungs. A common tactic is to time your breathing with your pace. Three (or more) steps inhale, and one step exhale. Some people slow their breathing by inhaling through the nose, and exhale through the mouth. I personally don't like this method because it gets harder the faster you go, but it is a common tactic.
2. Eat salt and potassium. You lose a lot of salt while running through sweat. You need those and the lack of both can contribute to cramps (or so it's theorized).
3. Hydrate. Goes without saying. I'm not saying you should drink a gallon before every run, but if your pee is the color of apple juice you should have a glass. Interestingly though, over-hydration can lower your sodium, so you may need to increase sodium levels as well.

Answer 2

The answers that listed breathing as being important have probably almost nailed it, with one clarification/improvement needed:

Yes, controlling your breathing is critical. However, the best way I've ever found is to ensure my breathing pattern takes up an ODD number of steps. So if its a nice easy run, and my inhale is three steps, my exhale will be two. If there's a hill or I speed up, and the inhale drops to two steps, then I'll make my exhale one step.

I found this by accident, but then after a year or two, saw an article on active.com or somewhere that talked about this technique. Sweet vindication! I forget what reasoning they applied, but my thought is this: When we run, we're shifting our weight back and forth, up and down, no matter how smoothly we try to run. That means all of our internal organs are moving inside our abdomen, too. Breathing with an EVEN number of steps means that EVERY inhale will be tied to everything shifting to the same side when the abs/diaphragm/intercostals are loosening up to draw air in, and shifting to the same side on every exhale, too. So the muscles on that side are all taking more of a beating than the muscles on the other side. As running is far more impactful in general than biking, this might never have been an issue on the bike for you.

By shifting to an odd number of steps per breathing cycle, that weight/impact is distributed to both sides AND the number of impacts per side is cut in half.

Answer 3

If you know what a stitch is, I’m going to assume you know enough about running pains and rule out anything extreme like appendicitis, which is typically lower anyhow.

There’s a few things I would do:

1. Eat carbs and salt half an hour before your run. A few chips/crisps would be decent.
2. Hydrate. Stitches are commonly accompanied when not enough water is consumed or a diarrhetic is consumed. Stay away from coffee, soda, or other carbonated drinks prior to a run
3. Do not over eat/drink prior to running. Your body needs time to digest and process the food. Exercising too close to a meal will cause pressure on your digestive organs, which have acids and other chemicals to break down your food.
4. Breathe. It’s important to have a mixture of short and long breaths when running. Two quick breaths through the nose, one long through the mouth.
5. Check your shoes. An imbalance could cause bad pressure and harmful pull on your back (and other muscles). Ensure your shoes have adequate tread and are not misaligned or too far worn.
6. Running style. Your arms should be going up and down / forward and back, almost like a steam train. They should not be going across the body. This is important, since that cross-body motion can pull on your muscles (core, back/abs/ribs) in ways your body is not accustomed to. The effects of an improper pose may be exacerbated the quicker you run, which might suggest why you never had issues on a treadmill.

There could be a number of other reasons. As stated, if questioning something serious, go see a doctor or sports physical therapist. Otherwise, you could get some feedback from your local running club (some clubs/stores perform running assessments).