Side Stitches/Cramps and Running

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?