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The Dreaded Side Stitch*

*From the forthcoming book Be Your Own Running Coach

If you have ever suffered a side ache (often described as a side "stitch") while running, you know it can be one of the most bothersome of all temporary running maladies. In fact, it can hurt your running performance just about as much as a serious injury. A strong side ache will slow even the best runner to a survival crawl. But, because it is usually a temporary problem, many don't take it seriously. However, if you "run through it," if you keep on running hard while suffering from a bad side ache, you may suffer a painful "after effect" for days.

In the end, it doesn't matter much to us runners whether the muscle is spasming or cramping or just hurting: what we care about getting it to stop hurting, quickly.

Most of the experts agree that the best solution is to slow down a little and get rid of the side ache as fast as you can. And - if you learn the techniques described below - you may not have to slow down very much, or for very long.

What causes a Side Stitch?

But what causes that familiar sharp pain in our side when we run hard? Before we can find a solution, we need to understand what causes the problem. The few researchers who have studied the problem generally agree that the pain emanates from muscles or ligaments somewhere in the region of the abdomen. Some think the pain is caused by a muscle spasm of the diaphragm, but it could also be cramping or straining of the ligaments in the diaphragm/liver area (the liver is the largest and heaviest organ). The diaphragm is a somewhat small muscle that lies between the chest cavity and the abdominal cavity. It separates the organs that are contained in the abdomen from those that are contained within the chest cavity (the heart and lungs). Some believe that runners who breath out when their right foot strikes the ground put more pressure on the right side, where the diaphragm is located. Others think it is just due to the rhythmic nature of running and its stressful effect on our internal anatomy. Regardless of what actually causes them, side aches are usually centered somewhat to the right side, just below the ribs. In fact, some researchers think that left side pain or centrally located stomach pain, that occurs while running, is caused by different factors than the typical right side stitch.

Some researchers believe the pain of a running side ache is not restricted to the diaphragm, but involves a variety of muscles or ligaments in that area. In any case, the pain of a side stitch is almost always related to the breathing process. In fact, it usually happens only when we are breathing hard for an extended period of time. The diaphragm - and other stomach muscles - participate in the breathing process. They move every time we breath in or out. When we inhale, we move air into the lungs, expanding them. This forces the diaphragm and other muscles down. When we exhale, we expel the air and as the lungs shrink these muscles move back up. Some think rapid moving up and down can eventually cause a spasm of the diaphragm or other related muscles or ligaments.

This leads us to consider a number of factors. For example, a side ache could be related to the strength of the related muscles, and how much bouncing occurs in there during running. That is, the combination of weaker stomach muscles and excessive bouncing during running could aggravate the condition, making a side stitch more likely. And, if the stitch occurs because of the movement of the internal organs as they bounce up and down while running, then we may be able to help get rid of them by getting our stomachs in better shape.

Another issue is related to the side of our internal organs. The side stitch could be aggravated by the size and weight of the internal organs involved. This means, for example, that a full stomach could be putting excess stress on the related muscles and ligaments. Making sure the stomach is as empty as possible before running might help some runners. But a large organ such as the liver is going to be forced up and down during running, and there is not much we can do about that. In the end, the trick is to watch for the first signs of a side stitch and learn how to quickly get rid of it.

Getting Rid of a Side Stitch

Researchers in sports medicine have focused on two primary methods to quickly get rid of the right-sided type of side stitch. They have to do with breathing technique, posture and running style, or a combination of both.

Breathing Techniques

If the side stitch is caused by a muscle or ligament problem related to rapid breathing, then changes in our breathing methods can often help get rid of the side ache. Some researchers have found that shallow breathers have more problems with side pain than deep breathers. To find out whether you are a shallow breather or a deep breather, try this test. Lie down and put your hand on your stomach and then take in a typical breath. Your stomach will move inward as you take in air. But if you are a deep breather, as you complete the intake, your lungs will get so full of air it will force your stomach back out again. Shallow breathers don't have this outward movement at the end of each breath. It could be that this in and out movement is more relaxing to the stomach muscles, thus avoiding the resulting pain. The next time you get a side stitch, try slowing down for a few steps and taking in some really deep breaths. This technique alone will often bring many runners some relief. Then, as you pick up speed again, remember to add a very deep breath every so often.

Other methods are also related to how and when we breath during running. Some runners have reported relief from side stitches by focusing on somewhat forceful exhaling while running hard. They purse their lips and force the air out for several breaths, a if blowing out candles on a birthday cake. If this works for you it may again be related to consciously changing the rhythm of your breathing, which can change the way you are using your internal muscles and ligaments. This change helps relax the muscles or ligaments that are causing the pain. If you have a side stitch, try several different styles of breathing as you continue to run. Watch for any breathing method that, after a while, seems to relieve the pain. Some also suggest pushing in at the painful area at the same time you are trying the pursed lip breathing technique.

Posture and Running Style

Some writers have suggested that your posture and running style can be related to side aches. For example, if you tend to lean forward slightly while running, it could be putting too much pressure on your stomach muscles. This means you may be more likely to get a side ache when running up a long hill (requiring more of a forward lean). Therefore, to get rid of a side ache, try leaning forward even more for a few steps and then leaning backward for a few steps. If this helps, then remember to add this forward and backward leaning to your running every once in a while. It may also help to lean to the left and right once in a while. The idea is to break up your repetitive running habits that could be contributing to the problem. The same goes for varying the foot you land on in relationship to your breathing patterns. According to some writers, you should pay special attention to which foot you land on as you breath out. Just as changing your running posture might help get rid of a side ache, varying which foot you land on as you breath out might also help.

Combining Techniques

The real cause of side aches could be a combination of things that cause stress on our internal muscles and ligaments while running. The villain seems to be repetition: running is, after all, a rhythmic, repetitive activity. Therefore, the solution is to develop techniques to break up that stressful rhythm. Try working out your own solutions using a combination of the methods described in this article. For example, some runners report that it helps to change their posture while changing their breathing patterns. Here is the problem: for most runners, one foot will be come habitually related to inhaling or exhaling. When we run, we all tend to become either right-footed or left-footed. We develop a running rhythm with slight differences in which foot uses the most push-off during each series of strides. As part of that running rhythm, we may get into the habit of exhaling as the right foot hits the ground. Some believe the pain of a side stitch is related to those kinds of unconscious habits; that is, the running/breathing rhythm puts unnecessary stress on the same set of muscles or ligaments with each stride. The solution is therefore to vary your stride pattern. If you get a side stitch, try consciously focusing on exhaling when your left foot strikes the ground for a while and then switch so you exhale when the right foot hits the ground.

Also, pay attention to your eating and drinking habits. Wait for at least three hours after eating or drinking before running. But don't get dehydrated; that can cause other problems, including muscle cramps.

In the end, you will probably have to work out your own techniques. Each runner should develop his or her own methods systematically, by trying out varying combinations of the following:

And if you find something that works, be sure to share it with other runners. You can post a message about your side stitch experiences on the TrailRunningUSA forum by clicking on this link : TrailRunningUSA Forum

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