There is actually quite a bit written about side cramps or stitches (these terms are used interchangeably). It is a cramping of the abdominal muscles – diaphragm. Most often it is on the right side but most definitely it can be on the left or both sides. You may even get a deferred pain in your shoulder due to nerve connections. (Note: I’m avoiding technical anatomical descriptions purposely.)
First, the huge consensus is that a more novice runner or an out of shape returning runner are by far the most likely to experience a stitch.
Second, stitches can often be traced to faulty breathing.
Third, and related to the first two, is running downhill (and occasionally uphill). Because we alter our body alignment or posture, we stress those abdominal and respiratory muscles differently. We are not in shape for this type of running.
Mostly, it is related most often to a newer runner or someone out of shape, or someone pushing themselves to higher levels (or on new terrain) than they have prepared for in training. In each case, your breathing becomes increasingly relied on to supply your body with oxygen due to the work load. The work load is relative so it makes sense in each case that these people are most susceptible to side cramping.
Prevention & Cures for Stitches
At the foundation of ridding yourself of stitches is progressively getting in better shape. As your diaphragm and intercostal muscles get more exercise they begin to accommodate to heavier breathing for longer periods of time. These muscles are in no different situation than your leg muscles for running; they have to be conditioned.
Here’s a breathing-specific training tool. Here is one option to isolate the respiratory system muscles - the Power-Breathe exerciser. (Nope, I have no financial gain in this referral unfortunately.) It is clinically used for asthmatics and sufferers of COPD and other respiratory diseases specifically to strenthen breathing muscles. They have athlete adapted apparatus as well. I have tried this contraption out. It’s simple, small & portable, under $75 and it indeed does give your breathing muscles a workout.
Learn to belly-breathe. Your stomach should move out as you inhale. If it moves in as your chest moves out, it puts added stretch on that diaphragm and can induce those stitches.
As for those hills as a cause, most basically simply get in shape for running hills. The stitch is most likely related to changing your running biomechanics – leaning back and breaking on the downhills. It can be countered by running more naturally, letting go a bit and not breaking so much (without going wild). Uphills refrain from leaning over too much from the waist – run more upright (but not straight as an arrow). In both cases, the best cure is prevention. Train on hilly terrain similar to what you will race on. Of course, you also have to run at similar paces or it will not get you ready for those uphills or downhills. Hard repeats on hills (up and/or down) is a good training element to introduce to your routine.
Though there is no solid research supporting this fI agree with conventional wisdom and strongly recommend that you do both abdominal strengthening and stretching as part of your workout routine. It will enhance strength and the range of motion of the muscles.
Correcting your breathing is the next focus. Some “experts” profess some magical formulas like 2:2 breathing (2 steps inhale, 2 steps exhale). They cite some research that found similar patterns in elite runners. This pattern is a result of being in condition and breathing at the rate which supplies enough oxygen to your body to move at a given pace. It is not: breathing at this pattern makes you faster and more efficient to run at the given pace and therefore have less stitches. These are Tail-wagging-the-dog theorists. They have taken correlational data and made it into a cause-and-effect – the wrong one at that! The reason elite athletes do not suffer very often from a side cramp is because they are in shape! It is not because of breathing some arbitrary pattern.
Once you get a stitch - slow slightly and purse your lips on exhaling and forcefully exhale. It provides an exaggerated exhalation and tension on those respiratory muscles which may relieve that stitch. Repeat this several times.
Another technique is to put your hands on your sides and apply pressure to the area of the stitch as you breath. Sometimes bending forward slightly with pressure from your fingers in the area will help relieve it as well.
Ancecdotally, when I workout and do sit-ups or abdominal crunches I have found a pattern of getting stitches the next time I run. I’m sure the connection is that it affected tightnessor fatigue in my diaphragm or ancillary respiratory muscles and so I got a cramp when I went out trying to breathe in that “running” way.
Sometimes curing a stitch is like stopping the hiccups – there are as many home solutions and cures as there are people. So, how about you, what have you found to be effective to stop getting stitches?
Filed under: Breathing, Running, The Critic, Training Effectiveness
Hey coach,
I seem to get them when I push really hard during a run (above target pace) and have found the best way to resolve them is to belly breathe or take a real hard, forceful inhale (greater than normal) or two. And definitely, as I have gotten in better shape, they have decreased in length and intensity. Great post!
[...] blog on running. I’ve been giving it a read through and looks interesting. The post on side stitches is what I’m going through at the moment. Based on my running history (zilch), I’m [...]
Been spending the last few months on a treadmill doing 3-5 miles at a time & obtaining my personal best 1 mile time. Ive been very competitive with myself. Today I ran outside on somewhat hilly terrain and was horrible! Cramping to the point of having to stop. I also experienced a tightening/cramping in my back (laterals) Have you ever heard of this. Great comprehensive post coach!
Ok,
Well you experienced what does indeed happen … if you change training terrain it can indeed cause cramping. I have had some runners with lower back cramping as well but usually with higher speed track work. The common element though is that you change body postures over varying terrains. That causes your muscles (not just abdominal or diaghragm) to work differently. Any muscles not used and developed can become overused in this scenario and cramp.
Gradually go from one terrain or surface to another. Sudden changes will precipitate cramping. Simulate hills on your treadmill… use varying inclines to help with the transition. If yo haven’t been working core muscle groups… you’ll want to do that also.
I think you’ll be fine… just make gradual transitions. My hat’s off to you that you’re donig lots of tread training… it’s mentally fatiguing. Keep up the good work!
Coach Dean
Thanks so much for the article…I have a question, I have been running 3-5x a week for 5 months now, and just recently I have been getting cramps under my entire ribcage. It usually lasts for my first mile, and a little down hill, but eventually goes away. I have tried regulating my breathing and I always try to “belly-breath” but the problem is still occurring. Could it also be caused by drinking too much water before my runs?
Thanks!
First – yes fluids or food on your stomach can indeed cause cramping. The excess expansion of your stomach (it doesn’t have to be much and it varies widely form person to person) causes your diaphragm to contract differently.
Second – downhill running can often causes cramping.
Third – if your pace downhill is slightly faster than usual and causing you to breath harder or differently than otherwise, it may be the cause of cramping.
Solutions: Well, first as you get in better condition over time hopefully they will subside. The fact that it goes away AFTER the downhill leads me to suspect the issue is more getting used to the downhill running. Don’t lean back too much going downhill. Let go a bit and let gravity take you more naturally down. Now the possible down side is that you will run slightly faster (instead of holding back) and that in itself may give you cramps. Definitely decrease fluids before your run… take some in 20-30 minutes before you run. Unless you are in very hot climates and run more than 30 minutes or so, you really don’t need to be tanking up on fluids before you run. Get them in you immediately afterwards instead. (I’m not saying abstain from drinking… just lay off in that 30-60 minutes before a run.)
Tell me how it goes.
Coach Dean
Ugh, I had this problem this morning. I run every day and normally don’t have a major problem with cramps. But this morning I only got to about two miles when I got cramps so bad in my right side that I couldn’t continue. I could have finished my run pressing into my side for the duration, but that seemed a nuisance. I’m not sure what I did wrong….I’m not out of shape, I was not running any exaggerated hills or too fast…..basically, I was just doing an “easy” run but “bam!!” The worst stitches I’ve had in months. I think you’re right about the abdominal exercises as my trainer had me do a new ab workout that left by obliques very sore. It must be related. Thanks for your article!!
Interesting that pressing into your side helped. That is often reported. When you put pressure on your side you are in effect stretching out that muscle… much like with massaging muscles.
You might try abdominal stretches after those hard ab workouts. That way, you leave them stretched out instead of contracted or tense from the exercising. I’d recommend using an exercise ball and lay your back on it and slowly roll backward stretching out your abs as you do.
Coach Dean
I have a question. I have been training for about 8 months now for a half marathon. I used to be a runner in high school, so my body is fairly used to running, but it’s been a while, so I’m taking my time getting into marathon shape. Anyway, I usually don’t get these stitches, but when I do they usually occur during a harder run and last for days. If I take a day off then it may heal in two days, but if I keep training, they won’t go away. I have had one now for four days and I’m beginning to get frustrated. I was running between 5-8 miles 4-6 days a week and was doing just fine, but now I’ve cut back to just 2 miles and I barely make it to a quarter mile before I get this pain. It’s on my right side, just beneath my rib cage. It helps to press on it, but it’s hard to run and hold my hand there the whole time. I try the belly breathing and when I exhale it feels good, but as soon as I take air in it hurts extremely bad and I have to stop after a mile or two. Today I only made it to a mile and couldn’t stand up straight. I tried stretching it out today before, but that didn’t seem to help. I do abs about three times a week, so maybe they are just too tight, but I’m afraid my body won’t let me get any faster or something. Anyway, just wondering if the problem is over exercise, or going to fast, or could it possibly be diet? Can taking in not enough calories, or not enough of a particular food make this happen? Does eating pasta help? I can’t think of anything else to do other than stop running, but I want to get better and faster.
Natalie,
You don’t say how long it’s been since those high school days but remember – DEtraining takes place pretty rapidly. So, if it’s been a few years – even if you’ve been pretty active – you’re in starting over mode.
Think of that side cramp as as cramping muscle. As stated before the #1 issue is conditioning. Be patient… for most runners… most of the time… they subside.
Ok, that doesn’t help today. So, I would recommend a good abdominal strengthening AND stretching program. It is obviously your “Achilles Heel”. The fact that holding your abs helps tells me that indeed you have a traditional side cramp. The #1 cause is conditioning.
I thoroughly doubt it is of diet origins… not that it is impossible, but unlikely. If it is due to diet., then ALL muscles or at least many different muscles may be getting similar symptoms.
Though I am an advocate of quality over quantity… in your case perhaps for now… slow down.. get runs done .. even if slower than usual. Overall you’ll get some progress. That is better than having so many days off that you lose conditioning.
Run until you feel a cramp coming on then STOP. WALK. Then run again. Each time you feel it coming… and yet BEFORE it really happens… stop and walk. Do this continuously. The goal is that you’ll gradually extend the distance and “condition” those breathing muscles.
One other tactic that I have known to help, but I have to admit I do not have research evidence to support it (which I am always bias to over anecdotal evidence); take a couple of aspirin/tylenol/ibuprofen 30 minutes or so before you run. It may help alleviate the discomfort and allow you to work through it better. (If you area susceptible to stomach upset these are not viable options.)
Hang in there… work through this… you can make it. Stay in touch and tell me how it goes.
Okay, thanks Dean for all your help! I will keep in touch and let you know how it goes. I know this will be hard because every time I have to slow my pace down I feel really slow and discouraged that I’m a slow runner. I graduated high school in 2003, and during that last year I was building back up after having been through kidney failure. I took time off running (during college aside from one year on the crew team) up until 8 months ago. In addition to running I’m doing weight lifting 4 days a week.
So, I have another question. Perhaps you may not know the answer… probably no one does. In high school I ran a 25 minute 5k (I know really slow), but I think I could have been faster because I wasn’t doing any strength training and had pretty poor nutrition that really took a toll on my running. My goal is to reach a 21 minute 5k, but I’m not even sure if that is in the cards for me. Do you think it’s possible, with the right training for me to get that fit, or fast? If not, how do I keep from getting discouraged about being a slow runner. I love running, but I’m very competitive, and feel defeated. Perhaps, I just need to let go of the dream of being a fast long distance runner. What do you think?
And also, do you know how long (approximately) it takes for someone to get back into shape? I know it probably depends on the person, but I’ve been weight lifting (which I had never done before) and running and I’m discouraged by how far I have come… I know I have made improvements, but I thought I would have met my 5k time by now. Does this kind of thing take years?
I’m not sure if I’ve made much sense, but I’m not sure who to ask these questions, and you seem to be patient and friendly!
Thanks!!!
Such a great question… check out a new blog article on this today or tomorrow!
Thanks
Hello Dean,
This website is very informative and helpful as I think I am starting to understand what is going on. I’m starting to push my running very heavily for cross country training and it seems I seem to get these “stiches/cramps” quite often halfway or 3/4 through the intense run. This only happens when I put myself hard and sometimes the stich spreads all throughout my right side, including chest and obliques. I was wondering if you had any other suggestsion besides what I read up top or possibly this could be another problem.
Thanks, Kyle
Kyle,
You have a more classic pattern that indicates a conditioning issue. Since you mention cross country, this also means some hills and varying terrain – which as mentioned contributes to side cramps. Since it is late in the run and at an intense pace I would try a couple things.
First, slow down BEFORE it occurs… when you just get that hint that it is coming on. Relax, recover a bit… then see if you can launch back into your intense pace. You’ll be training your muscles to work at that pace over a longer period of time – albeit not continuous. Gradually, with conditioning you should be able to decrease that “backing off” time and do it all as one continuous hard run.
Second, as I mention above to one post:
“One other tactic that I have known to help, but I have to admit I do not have research evidence to support it (which I am always bias to over anecdotal evidence); take a couple of aspirin/tylenol/ibuprofen 30 minutes or so before you run. It may help alleviate the discomfort and allow you to work through it better. (If you area susceptible to stomach upset these are not viable options.)”
The key will be to be proactive and stop the cramping before it occurs. Once it occurs it is always harder to get rid of.
Tell me how it goes.
Ah thank you for the advice, but I have to mention that during one of my races was around 6k (The whole race was flat terrain) at around half way I started the side cramping and I still pulled through the other half at a decent pace. As soon as I stopped running the cramping stopped. I would of thought it would stay since I was pushing it so hard for at least 3km.
Anyways I will try your advice and continue to also do some abdominal exercises/stretching in those areas to hopefully eliminate this problem.
What other factors contribute to getting side stitches? I recently began getting them every time I run (1.5 weeks) just a little after my first mile. I have not changed my route or intensity, I have tried breathing in more deeply, breathing out when my left foot hits the ground, drinking water 20 min before I run, not drinking water before I run, stretching my abdomen ……. The only thing that has changed is the temperature outside. Might the climate have something to do with my side stitches or could it be something else?
For a the relatively short distance of 1.5 miles, avoid fluids at all for even a longer period before you run. Dehydration is a non-existent issue at that distance.
I do not know of any weather related reasons for stitches.
I don’t know what condition you are in but my thoughts go more towards a conditioning issue if 1.5 miles is your average or long run. Extending your runs and doing faster runs will enhance your condition and decrease incidents of stitches.
If your stomach can handle it, try the couple aspirin or ibuprofen prior to running.
If you have changed any other training routine – new exercises, new stretches, etc. – that could be the cause also.
Hello Coach, I’m a 15 year boy who has had weight problems in the last few years. In the last 8-12 months ive lost approximately 63 pounds and have always wanted to do cross country. All of my friends are on the team and tell me how much fun it is and I really wanna do it to prove to myself that i have made a difference. When i run I get these stiches in my side after about a tenth of a mile, by the way my first tenth of a mile is a downhill angle of around 30-40 degrees and pretty steep. I have stopped drinking all carbination, I dont drink or eat anything before i run for at least an hour, and these stiches are really the only thing stopping me from running alot farther of distances.
First congratulations on losing weight and choosing a healthy direction… not easy to do but you’re doing it!
Two things are most likely at play here: that pesky downhill and general conditioning. You don’t say if the stitch stays with you or eventually goes away or if it only happens when running this one course with the downhill. So, it it is primarily on this course, the first thing to do is make sure you warm up well before running down. Second, how about just making that downhill a walk and part of your warm up? It’s only a tenth of a mile…
Second, if you can keep the stitches at bay so that you can get out and do more running without being impeded by the cramp, the faster you will get into shape.
Your friends are right about cross-country by the way. Unlike track I found it far more fun with just one “event” as the focus and everyone doing the same thing. And better yet… everyone can go out for cross country. I love the all-inclusive nature of the sport. And as far as individual efforts go, it’s something you can measure you progress all along the way. The only real limitation is the amount of personal effort you put into it.
Hang in there… over time those stitches should decrease. See some of the other general suggestions in this whole thread too.
Thanks for reading! Drop a line on your progress.
Coach,
Thanks for the site, very useful. I am a D1 tennis player, and obviously train very hard. I’m in the weight room every day, 2-3 hours of tennis everyday, and very high intensity conditioning 3 times a week (typically I burn about 350-400 calories in a 30 minute treadmill workout). Long distance running has never been my thing, unfortunately. I have ALWAYS had trouble with side cramps, but I know it’s not due to being out of shape. It’s typically only in long distance running that I have this problem, I have never run into it while doing sprints or while playing tennis. Anyways, it has really been bothering me the past couple of weeks, to the point where I can’t finish workouts. Some other things that come along with my side cramps are tightness of my chest ( I think it may be more of a very deep cramp down in my rib cage), as well as a very uncomfortable feeling (almost a cramp) in my upper back area, it feels like its behind my left shoulder blade. I was just wondering if you have ever heard of posture possibly affecting these types of cramps, or if you had any other thoughts? Thanks!!
[...] Posted on 11 December 2008 by Dean Hebert From Whitney a D-I Tennis player on stitches: Thanks for the site, very useful. I am a D1 tennis player, and obviously train very hard. I’m in the weight room every day, 2-3 [...]
I get stitches unpredictably even when I’m in shape after a seasons worth of running. I’m not convinced that I’m breathing incorrectly because they would occur more often.
Annie,
You may be right. So, the first thing to do is to look at all other patterns – eating, time of day, terrain, run effort, pace, hydration status, medicines/prescriptions, etc. You may find something that ties the unpredictability together. On the other hand, sometimes a single cause is not to be found. When it is not linked to something, somewhere, some how, it is very frustrating. I wish I had a better answer.
I’ve just starting training for a marathon, and I think I am experiencing the “deferred pain” in the right shoulder. I should mention that this is my first race ever, and I wasn’t ever a runner. Right now we’re just at 5 miles a day, and I do okay keeping up with it. We’re running through neighborhoods, and they get slightly hilly, but I notice the pain at various points of my run. The pain is like a jabbing but numbing pain and it seems like it travels through my tricep down towards my elbow. I’ve tried rubbing my shoulder and I try to keep it lose while running, and I even stretch/swing my arm around while mid-stride, but that one just hurts it more. The pain also comes and goes. About 5 minutes after my run my arm is totally fine, thank goodness.
Now that I’ve read from your site (and a few others) that it could be messed up nerve connections, and that the pain is actually my diaphragm, my question is do you have any suggestions on alleviating it in the short term? I completely understand that with training/conditioning my muscles should get used to this work, but I don’t have any cramp near my diaphragm to press on at the moment, and I don’t think I want to try the aspirin/advil route. Such a weird phenomenon, but I’m so glad to find out it’s sort of normal! Is there any term to describe it so that I can go read more technical details, just to satisfy my own curiosity =)
Thank you so much for your site, it’s so very appreciated!
Nicole,
I have to admit I have not heard of the pain moving down the arm. I’m glad it subsides after a few minutes. I am not one to jump to the ridiculous but I want to share one thought: you may want a stress test done by a cardiologist. Women experience heart related ailments differently than men, and I have personal experiences that bare this out.
Given that one thought, in the interim it would appear that conditioning is the most likely cause since you are just beginning. Since it does go away after warming up and moving along a bit I would try to do longer warm-ups that include both stretching and strengthening your diaphragm/abs/core. Side to side stretches, sit-ups or crunches, core (the plank) exercises might be things to work into that warm-up. The goal is to get all those muscles warmed up similarly to after the 5 minutes you usually find relief.
I don’t think I’ve ever come across a medical term for this deferred pain. Maybe we could coin a phrase for it!
Thanks!
I wouldn’t want to drop dead in the middle of a run, but I am only 25 and not overweight. Do you think at this age I might still need to see a cardiologist?
Of course I’m not a doctor. My most vivid experience is actually a blog post http://coachdeanhebert.wordpress.com/2007/12/06/shhh-listen-your-body-is-talking-to-you/
Claudia was in her early 40s; 5-4 115 pounds soaking wet; no risk factors; no history of heart disease in her family; a highly competitive runner since high school – almost 30 years running experience; represented the US in the World Duathlon championships only 10 years ago; is a masters All-American in multiple events… had a heart attack.
So, I am not an alarmist, but I did want to share that the pain you experience is not typical. That does not mean that it is anything other than deferred pain from the diaphragm. But, I would be remiss if i didn’t introduce other possibilities.
Hi, Thanks for this useful site. I have been running for several years and for the past several months approximately 20 or so miles a week. I have never had issues with stitches except for the last 4 weeks at the tail end of my long run (10 miles). It is always around the same time (9.67 miles), where I have to run a long downhill, and it is usually after having second gel pack (which doesn’t cause any issues the first time). It feels like a bubble in my right side that starts to move over my belly button and causes such pain that I have to stop, double over and can barely finish running. I wonder if I should just skip the 2nd gel? Can’t tell if I’m getting too much fluid or not enough. It has been extremely hot and humid, I generally take a small swig of coconut water every 10 min or so but continue to feel thirsty. I do have asthma and although I’m on practically every inhaler under the sun, my asthma is not always well controlled so I tend to breathe heavily especially on hill ascents and descents. I try putting my hands above my head (no help), to slow down (no help). Any thoughts you have are welcome. Thanks.
Alex,
Thanks for your inquiry. Please see the post on 8/16/09 for further discussion on this topic.
hey. Im a junior in high school and run on the varsity cross country team. I ran my first race two weeks ago and did great with a 20 second PR of 17:19 in a 5k. This race was on a extremely flat course. Then a few days ago i ran a race witch i have ran three different times. Every time i run it i get a terrible side ache in the same spot on the course. Its just after the second mile and down a huge hill.
I seem to only get side aches after or during the down hills when in races. It is significantly making my times really bad on these hilly courses. Do you know why this is and what i can do?
Jacob,
Within your reply is in fact your answers. Steep downhills are notorious for causing side cramps. Your pattern is unmistakable.
In your case you are in very good general condition and your times show it. So what remains is DOWNHILL conditioning. Downhill running is not a passive thing… it isn’t some natural activity that we all do well or fast. If it isn’t practiced you will suffer for it.
Cure:
Run repeats downhill at top and near speed (this will also serve as overspeed training which is excellent).
Focus on relaxing your upper body – don’t flail your arms all over the place.
Run erect and do not lean backwards giving a sort of braking effect to your running.
Allow gravity to take you. You should be able to run quite fast without the effort. But, it requires very fast leg turnover to become smooth.
Don’t take huge overstriding strides… strive for faster moderate length strides (though certainly they will be longer than on flat ground).
A couple weeks of practicing downhills 2-3 times per week should greatly reduce your incidence of cramping.