Side Stitch from Running

We’ve probably all been there: often in a race, running so well, and then suddenly, out of nowhere, that pain in your side, a STITCH. What can you do? Here are some thoughts and some possible things to try out, based on my own running experience, and the experience of my fellow colleagues at Run and Become. If your pain persists, do seek medical advice, in case it is something more serious than a stitch.

Firstly, what is a “stitch”, or “side stitch”? It is essentially a cramp in the diaphragm – the big dome-shaped muscle separating the lungs from the stomach, and the main muscle used for breathing. So a side stitch could potentially be caused by pressure either from above (the breathing), or below (the digestive system). Common causes in running are: pushing too hard (in a race), incorrect drinking or incorrect eating.

A stitch from incorrect breathing

Quite possibly this is one of the most common times to get a stitch is when pushing hard in a race, so why does it come? My thoughts are that it is caused by incorrect breathing and more precisely because of too much carbon dioxide (waste air) in the lungs. When you are really pushing it, generally your breathing becomes stronger, the rhythm changes and often you start breathing in more than you are breathing out.

Try ‘panting’ right now, as though you are really pushing it, what is happening? The more intense it gets, the less and less you are breathing out?  Isn’t all the emphasis on breathing in, rather than out? I have found that when I have got a stitch, if I have really focused on doing the opposite, i.e. breathing out really loudly and ‘fully’ my stitch has gradually gone away.

Something to try next time you get a stitch, would be to really focus on breathing out. You could even try breathing in through your nose and breathing out 3 short breaths through your mouth. This may take a bit of practice if you are not used to breathing in through your nose, but it will definitely help to lessen the probability of you ending up with too much air in your system.

Some people find it helps to exhale on the opposite foot strike. So if you have a stitch on your right side, exhale only when your left foot hits the ground, and vice versa. That doesn't mean you have to exhale every time your left foot hits the ground, but say every 2-4 times, whatever feels comfortable.

A stitch from drinking

A stitch can come from drinking too soon or too much water before a run. Monitor your fluid intake before your run. Of course you need to be well hydrated especially on a hot day, but maybe you need to give yourself a bit more space in between having some water/electrolyte fluid and running. The other thing that could help is taking water with you when you go for a run, so you don’t feel the need to drink so much water before you run. There are many really convenient way of carrying water, check out our website for some good options.

A time when I have often found I’ve got a stitch is when drinking water during the run, I think one reason could be because your regular breathing pattern has changed while you take the drink. Some people have found slowing down and walking a few steps while they drink can help. If you don’t want to slow down, try not to gulp the water, try taking small sips of water over a longer period of time, while focussing on keeping the rhythm of your breathing as normal as possible.  

A stitch from eating

Another reason for a stitch can be if you have eaten too soon, too much or the wrong thing before a run. Generally speaking most people prefer a 2-3 hour gap in between eating a proper meal and running. As it is very individual, try varying what you eat, if you feel the need for a snack before you go out. Some people find an energy bar half an hour before going out works well. I’ve found I can eat some fruit – for example, a banana – literally just before going out the door and I’ve never had an adverse effect, but it is such a personal thing. (For more information on this vast topic see our article What to eat before running).

Some further tips

• Some people find holding or pressing in the area of the stitch has helped them.
• Make sure you warm up and stretch a bit before a race, so the muscles don't get a shock when they're called into action.
• It can also help to keep the stomach muscles strong. A regular core strengthening workout can mean this whole area is supported, and there is less chance of anything pulling on the diaphragm.

So those are my thoughts on this topic, I hope that has helped a little, hopefully it has given some ideas and tips of things you can try.