A Stitch in The Side

Photo Credit: Via Flickr @bionicteaching

Have you ever wondered what causes those nagging pains in your side when you are running or doing a high intensity type of exercise? Most of us would refer to it as a “stitch in the side”.

Today, researchers refer to this nagging abdominal pain by the much more technical and scientific term, “exercise-related transient abdominal pain” (ETAP). Regardless of what you call it, the pain is often enough to stop runners and swimmers in their tracks and hold their sides in agony. There are several theories as to exactly what causes these cramps.

The most important factor in developing ETAP seems to be the timing of the pre-event meal. One study reported that consuming reconstituted fruit juices and beverages high in carbohydrate and osmolality (a measure of concentration), either just before or during exercise triggered the onset of a stitch, particularly in susceptible individuals. The symptoms didn’t seem to be related to the amount of food eaten (gastric volume).

Some research indicates that a side stitch is caused by stretching the ligaments that extend from the diaphragm to the internal organs, particularly the liver. The jarring motion of running while breathing in and out stretches these ligaments.

Another theory suggests that side-stitch pain results from gas trapped in the large intestine. Exercise tends to speed up intestinal contractions and push gas toward the colon, or the end of the large intestine. If the colon is blocked by a hardened stool, however, cramping can result.

Regardless of the cause, here are a few tips to help alleviate such cramps:

Drink More fluids: Dehydration has been shown to cause varying effects on athletes.

Belly breathe. Most episodes of side stitch come from shallow breathing during exercise.

While you exercise, try to breathe deeply and slowly, expanding the belly as well as the upper chest.

Try the “grunt” exhale. Making a grunting sound as you exhale seems to help relieve side stitch, possibly because it forces the diaphragm out of its taught “exhale” position.

Slow down. Being out of condition and exercising too intensely causes you to breathe quickly — and more shallowly. Build your intensity slowly over the course of several weeks.

Stop. Some people, particularly competitive runners, believe you should “run through” a side stitch. However, unless you’re in a race, the best idea is to stop completely until the pain subsides.

Use the “one hour” rule. If you’ve eaten a meal, wait at least an hour before exercising, because a full stomach does appear to cause problems for some people during exercise.

Massage it. Gently rub the area with your hands. Massage relaxes the muscles and helps increase blood flow to the area.

Use the “poke and blow” technique. One way to relieve diaphragm pressure is to push your fingers deeply into your belly just below your ribs on the right side. At the same time, purse your lips tightly and blow out as hard as you can.

UPDATE: 11/10/11-
“On a personal note: During a training session for my duathlon training, I got a first hand experience of the famous “side stitch”. It had always been a quandary to me. I remember as a new runner, suffering frequently from stitches. As a seasoned runner, I hadn’t experienced the side stitch until recently. I am personally convinced that one cause IS related to the pre-event meal. Definitely wait at least one hour before doing your run. I got home late from work one evening and decided to hurriedly eat my dinner and go running, as it was getting dark. It was only a 30 minute run, I told myself. Well, I got to experience the famous side-stitch-first hand! I was probably only 1/2 mile into my run, when it hit me.
Note to self: Wait at least an hour after a meal to run or eat when you’re through!”

For more information, you visit the Sports Medicine website, The Stretching Handbook website, and the “How Stuff Works” website.

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