Side Stitch Pain: Myths, Causes, Prevention and Alleviation
There is nothing worse that a sudden side stitch pain when you are running, swimming or working-out.
Recent research has suggested that the cause is related to your posture rather than your breathing pattern - a cramp in the diaphragm. Side Stitches are cramp-like painful spasms that hit you suddenly and make you stop you in your tracks, breathe deeply and eventually fade.
While the exact cause or causes of side stitch pain is unknown it has been generally attributed to a spasm in the diaphragm, the membrane beneath your lungs which is vitally important for breathing. The theory or myth has been that you have overworked your diaphragm during a vigorous run or work-out and it begins to spasm. The recommended way to alleviate the pain is to stop running and to take deep controlled breaths.
Causes of Side Stiches
Stitches seem to occur more frequently with inexperienced runners and those who return to exercising after a break. Various possible causes have been suggested including:
- Cramp in the diaphragm - The theory is that a lack of blood flow to the diaphragm muscle, which is stressed during exercise causes pain. It is though that blood is being directed away to supply the limb muscles, the respiratory muscles and lungs during exercise. It may also be related to a change of blood flow to the gut to absorb fluids. Research has shown that there is a higher incidence of stitch pain for runners who had recently had a drink of water or a high-energy fluid supplement.
- Tugging on the peritoneal ligaments in the abdomen (ligaments that hold the organs in place). The idea is that when running, the stomach and liver and other organs are subject to jostling and bouncing causing tugs on the ligaments suspending the organs, causing periodic pain.
- Thoracic spine pain - the theory is that side stitch pain really starts from strains in the mid or thoracic spine. Research has shown that in about 50% of runners tested the exact stitch pain could be reproduced with manipulation of particular joints in the spine of the thorax. Researchers have found that runners with poor running posture such as slouching or other unnatural gaits were more likely to have pain originating from the spine.
- Irritation to the abdominal cavity lining - there are two layers of membrane that line the inside of the abdominal cavity. One layer covers the organs and the other layer attaches to the abdominal wall. the theory is that a stitch occurs when the inside and outside layers of the membrane rub together. A full stomach or a decrease in fluid between the layers may cause this irritation.
- Tightness or strain in the thorax muscles - This theory suggests that stitch pain could abe caused by strain in thorax muscles such as the psoas and quadratus lumborum.
Recent research seems to rule out muscle spasms in the diaphragm and a myth. In this study, a device was used to measure muscle activity in the diaphragm when test subjects were experiencing side stitches. The researchers found no signs of increased muscle activity or spasms in the diaphragm when stitches where occurring.
A series of studies by Morton and Callister, at the Faculty of Education, Avondale College, Australia supported posture as the major cause of side stitch pain.
These study indicate that body type (weight, age and sex) had no measurable effect on the incidence of stitches whereas poor posture, particularly in the thoracic region was a significant cause. the poor posture was related to "slouching" - curving of the spine causing a bowing or rounding of the back, which leads to a slouching or hunchback posture. Side to side curving of the spine during running was also a cause. An excessive inward curve of the spine was not identified as a major cause of the pain.
One theory is that poor posture during may 'pinch' nerves that run from the upper back to the abdomen. Another theory is that hunching over when running increases friction on the peritoneum, the membrane that surrounds the abdominal cavity. This friction leads to pain.
This theory has some merit as it could provide an explanation for why breathing deeply may to help alleviate the pain of stitches: taking deep breaths fills the lungs, tends to make you straighten up and no slouch and so improves posture. It may also explain why stitches occur more regularly in 'occasional' runners who may develop an unusual posture due to the strain of the exercise.
Alleviating and Preventing Side Stitch Pain
Alleviating Side Stitch Pain
If the pain appears to be related to improper breathing it is recommended that you try "belly breathing", which is the opposite of what you normally do. When you inhale, push your abdomen out; when you exhale, pull in your abdomen. This is simply the reverse of what you normally do. Taking a series of long deep breaths, and holding your breath for 10 - 30 seconds can also work. Bend forward, inhale deeply, and push your belly out in and out while breathing.
Another tip is to treat the pain in a similar way to any other muscle cramp. Try to stretch the cramping muscle as much as you can by changing how you breath. Take a deep exaggerated breath, drawing in the air as quickly as possible. This to forces the diaphragm down. Hold the breath for a few seconds and then push the air out through closed lips to restrict the flow of air out of your mouth to stretch the diaphragm. Bending your body forward can often help you expel air and to stretch your abdomen. Stretching your body up as high as you can, and extending your arms high above your head, and then crouching forward also stretches your cheat area and may alleviated the pain.
If you develop a stitch when running, stop briefly and position your hand on the right side of your abdomen and push up and in while inhaling and exhaling evenly. As you run or swim, try to take regular, long and deep breaths. The stretched ligament theory would argue that shallow breathing tends to increase the risk of a stitch because the diaphragm is kept in a raised position and never lowers far enough to allow the ligaments to stretch or relax. When this happens the diaphragm becomes strained and a side stitch can occur.
If you can stop the pain it is generally OK to re-start your run after the stitch goes away.
Avoidance Tips for Preventing a Side Stitch
Most of the advise for avoiding side pain stitch related to not eating of drinking large quantities of fluid before or durng the exercise. Do not consume a large meal in the three hours prior to the start of your walk. Eating large amounts of food especially fatty food, before exercise may cause stress on the diaphragm, may affect the circulation or may stretch the ligaments in the gut area.
- Avoid consuming a large meal within two hours of exercise. Consuming a large bulky meal close to starting exercise has been shown to provoke a stitch.
- Avoid drinking soft drinks or fruit juices, or eating concentrated foods prior to exercise. Water or isotonic drinks such as sports drinks appear to be less likely to cause a stitch.
- Ensure that you are well hydrated prior to starting your exercise and continue to drink fluids in small portions in order to cover losses in sweat.
- Avoid consuming large quantities of fluid but drink small quantities frequently.
- Try to maintain a good posture when running, especially as you get tired. Avoidi adopting a slouching position.
- Avoid shallow breathing and try to take deep, full "belly breaths" while running. This allows the diaphragm to lower fully down and so reduces stress.
- Make sure you have a thorough warm-up before your exercise and start slowly and gradually increase your speed.
- Avoid running in very cold temperatures as this may cause side stitches, or get well warmed up first. The cold air may be a problem.
- Strengthening your lower back and abdominal muscles may help prevent stitches and may help you maintain a good posture when running.
© 2011 Dr. John Anderson