Running Cramps - Side Stitch

The side stitch or cramp is something I think we all have to deal with as runners at some point.  I won’t call myself an expert on this by any means but I’ve compiled some basic information about it here so that we can all have a better understanding of how it occurs and what we could do to prevent it or at least deal with it when it happens. So for starters what exactly is the side stitch?

A "side stitch" is a sharp, intense pain under the lower edge of the ribcage caused by a muscle spasm of the diaphragm. Such pain can occur during vigorous exercise, such as running, and seems to occur more commonly in novice exercisers who have not yet established proper pacing and who tend to breathe more quickly and shallow. link

I’d like to think that I’m not novice anymore and I still occasionally get them!

However, about 30% of all runners will experience stitches at some point. What exactly causes them? On inhalation, we take air into the lungs, pressing the diaphragm downward. When we exhale, the diaphragm moves up. If the body has some trapped air/gas below the diaphragm, if we've eaten too close to exercise, or if we start exercising too vigorously, the diaphragm may cramp, causing pain under the rib cage on the right side. link

From what I can tell this explanation seems to be pretty consistent across the board.  There are some other theories but they all seem to do with the diaphragm.  So besides not eating or drinking right before we run what can we do to prevent the stitch?

 

To prevent a side stitch, take even, deep breaths while running. Shallow breathing tends to increase the risk of cramping 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. link

"Strong abdominal muscles provide a supportive 'internal girdle' so there is less bouncing and pulling on the diaphragm," says Dr. Anderson. link

The current issue of Runner's World has some great core workout suggestions.

There are other suggestions but the two I listed seem to be the most common and make the most sense.  Another suggestion I'd like to mention is to make sure you're not starting too fast and that you are taking breaks when needed.  The thing about distance running is that we are in it for the long haul.  Any one of you will know the awe that you experience at actually being able to complete your first real long run.  It seems like the training goes by quickly once you get there. So we might as well take it slow, enjoy it and not injure ourselves.

Now if you are running and you get a side stitch or cramp what can you do to make the pain stop?

Like any other muscle spasm, when a side stitch occurs it is important to stop the activity that brought the stitch on in the first place, or at the very least reduce the intensity of the activity.

Another effective treatment for a side stitch is to alter your breathing pattern. First concentrate on taking full, deep breathes and avoid shallow breathing. link

Stop and blow. If you can't lie down when the stitch strikes, at least stop and press your fingers deeply into the painful spot, says Dr. Shangold. That's normally just below the ribs, on the right side. Then, purse your lips tightly and blow out as hard as you can. This should ease the tension on your diaphragm and you'll be running stitch-free, according to Dr. Shangold.

Reach for the clouds. Walking slowly with your arms raised over your head is another fast way to stretch out the tightness, according to Kim Edward LeBlanc, M.D., clinical assistant professor of family medicine at Louisiana State University School of Medicine in New Orleans. Inhale deeply as you raise your arms up, and exhale slowly as you drop them. link

If any of you have suggestions on relieving the side stitch please let us know.  One thing I have always done, and I haven't seen this anywhere, (maybe that means it's not a good idea) when I get the cramp I bend over, hands to toes and take deep breathes blowing out as much air as possible.  I will never forget a run I did with a teacher when I was in grade 7 or 8.  After about 5 minutes I was hurting pretty bad and I had to do this bending over thing to get past the cramps I was experiencing.

If you have any questions about other running issues send them in and we'll see what we can dig up for you in a future post.  Until then.

Moving Forward,
Glenn

Comments

[Gina]

Thanks Glenn!
I tried some of your tips during a run today. Not sure if it was taking even strides or monitoring my breathing pattern, but I only got a minor side-stich around the 3/4 mile point (slowing down and breathing helped this time!) I walked/ran about two miles today... a first! (thanks to your tips and a new pair of running shoes :-)

For the other running newbies out there... I'm trying the Couch to 5k running plan (http://www.coolrunning.com/engine/2/2_3/181.shtml) Maybe it'll help, maybe not... but it is worth a try!