Have you ever been running and suddenly you get that “stitch” in your side – typically low in the rib cage on your side. You feel like you have to grab your side and maybe stop running or slow your pace? What is that “stitch” and how do you prevent it from happening?

What Causes a Side Stitch?

The cause of a “side stitch” is well debated, but most research centers around three different hypotheses.

  1. 1. Your diaphragm is in spasm because of poor blood flow
  2. 2. Your abdominal ligaments which attach to the diaphragm and ribs are being stretched or tensioned
  3. 3. Your neck is being stressed and putting pressure on a nerve coming out of your neck (C3-5) which innervates the diaphragm and central tendon

The central theme in these theories seems to be the diaphragm! The diaphragm is a large dome shaped muscle that sits in the bottom of your rib cage and is our primary muscle for inhalation or breathing in.

Three Tips to Prevent Side Stitches

  1. 1. Work on your breathing.

  2. Often times, we tend to breath very shallowly in just our upper chest, not fully expanding our lungs or using our diaphragm. This not only is bad for oxygen exchange in the lungs, but also can cause muscle and soft tissue restrictions in the neck, upper back, low back, abdomen, and chest. This addresses all three causes above – you breath better with your diaphragm, you have better blood flow to the diaphragm, you have less restrictions in your abdominal ligaments, and you have less restrictions around your neck with better nerve gliding. When first learning to breath with your diaphragm, lay on your back with one hand on your upper chest and one on your belly. Try to take a deep breath with the hand on your chest moving very little and the hand on your belly rising as the air moves deep into the lungs. You want the breathes to be slow with a count of 4 on the inhale and 4 on the exhale. The diaphragm attaches to all your ribs, so you also want to work on breathing into your side ribs and back ribs. Start with working on your breathing laying down and progress to sitting, standing, and then during exercise. Obviously, this is going to be much harder to do when running, but trying to inhale deeply into the sides of your lungs while running can help prevent or calm down “side stitches” if they are happening.
  3. 2. Avoid large meals and sugary drinks before / during running.

  4. The theory behind large meals has to do with both blood flow and pulling on the abdominal ligaments. If you eat a large meal, more blood is shunted to your intestines to help digest your food, which leaves less blood flow for the diaphragm and other muscles. Also, if your intestines are full, they are going to pull on the abdominal ligaments and soft tissues attaching to the diaphragm causing more tension or spasm in the diaphragm. Sugary drinks tend to cause adverse effects to muscle performance and can lead to cramping especially if you are already dehydrated. This cramping can also happen in the diaphragm muscle, causing pain or “stitches”.
  5. 3. See a physical therapist.

  6. Get a program for properly releasing your diaphragm and abdominal soft tissues, stretching your neck, upper and lower back, and working on strengthening your spinal stabilizers or “core” for better neck and back support. Working on proper posture during standing, walking, and specifically during running can be very beneficial in taking stress and strain off the neck muscles and nerves and improving breathing patterns. Having the proper posture and stretching / strengthening program can affect all 3 of the above causes for “side stitches” – it will improve overall blood flow, muscles and tissues around the abdomen and around the neck and back.

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