This is long, so be patient. Thank you to all who helped create this entry.
From what Ive gleaned from texts, journals, professional coaches,
doctors, and triathletes, there is little consensus on the cause and
prevention of side stitches. What follow is the collective wisdom of
those people who contributed. All of the submissions here should be
taken with that in mind " most of these are submissions based on
personal experience, while some come from professional expertise. Where
there is a submission by a doctor or professional coach, Ive made note
CAUSES OF SIDE STITCHES:
side stitches are the result of ischemia which is defined as a
deficiency in blood supply to a body part. When you run, you frequently
use parts of your body that demand a higher blood circulation, meaning
that this supply is sent to a location, other than your abdomen. The
resultant decrease in perfusion causes pain because the tissue at the
cellular level is hungry for
oxygen rich blood. (M.D. and triathlete)
A side stitch is caused by stretching the ligaments that
attach your liver to your diaphragm. Humans breathe out once for every
two steps. More than 70 percent of humans breath out when their left
foot hits the ground, while 30 percent breathe out when their right
foot hits the ground. Those who breathe out when their right foot hits
the ground are the ones most likely to suffer side stitches because the
force of the right foot strike causes the liver to go down when their
diaphragm goes up during breathing out. So the ligaments are stretched
and hurt. (local M.D.)
researchers believe that the 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. Exhaling when the right foot hits
the ground causes greater forces on the liver (which is on the right
side just below the rib cage). So just as the liver is dropping down
the diaphragm raises for the exhalation. It is believed this repeated
stretching leads to spasms in the diaphragm.. (periodical)
Side stitches occur when the connective tissue that suspends
our internal organs cramp. They are more likely to act up on the run
because of the vertical bouncing but can also occur on the bike simply
from the diaphragms activity. That connective tissue holds the liver,
stomach and sections of the large and small intestine. (professional
I have heard that side stitches occur from a spasm of the diaphragm
muscle (yes it is a muscle) and usually when we start out too fast at
something and in oxygen debt. There are many debates on this.
TO PREVENT SIDE STITCHES:
First of all, make sure that you are hydrated, in advance. If you
become dehydrated, your blood is more concentrated, thicker, making
efficient flow more difficult and increasing the liklihood of poor flow
to your abdominal vasculature. Secondly, make sure that you are
practicing appropriate breathing as oxygen depletion at the cellular
level is the root cause of the pain. As a consequence of the normal
aging process, alveolar closing capacity begins to approach the same
volume as normal tidal volume. You need to practice doing things while
you run that keep your lungs inflated and all the little alveoli open
as much as possible. A good example of this is singing or doing another
maneuver that causes you to exhale against resistance such as pursed
lips. Deep breathe periodically and cough as well. Lastly, there is
some indication for the use of agents that help to keep your blood
flowing smoothy, such as aspirin, ginko biloba or even ibuprofen.
These, however should be your last resort after you have tried the
other two suggestions (especially the hydration). (M.D. and
Time your eating. Having food in your stomach during a race
may contribute to cramping by creating more force on the ligaments. Try
to avoid eating one to two hours before a race.
This year I did a half and full Ironman for the first time and I took
MANY thermolytes on the bike and run (2 every hour in the half and 2
every half hour in the full). I had NO cramping issues anywhere on my
body. So, at Malibu this year (where I often get a side cramp), I took
4 thermolytes on the bike and had NO stitches. It was such a relief.
Nobody ever talks about taking salt pills or anything in a sprint or
even an olympic but they might have helped. I have no idea if they were
the answer, but it can't hurt. It makes sense to me that a cramp would
come from an eclectrolyte imbalance. If you aren't familiar with them,
thermolytes are electrolyte pills that you can get at Triathlete
Zombies. Endurolytes are similar but have 1/3 the amount of
electrolytes in them, so you have to take 3 times more.
Stretch more. Stretching is a good additional way to prevent
or relieve a cramp. To target this often overlooked muscle, raise your
right arm straight up and bend your trunk toward the left. Hold for 30
seconds, release, then stretch the other side.
not to eat or drink during the last few miles of the bike/t2/first
mile or so of the run.
Eat earlier and give the intestines longer to empty before racing.
One thing I noticed I was doing, was while on the bike, sometimes when
I went to "suck" on my water bottle I noticed just that, that I was
sucking on it. So I figured I was taking in air, I have been much, much
more careful drinking on the bike. Squeezing instead of sucking, and it
has helped considerably. Hope this helps.
Often side stitches develop when you don't exhale deeply
enough. Try to always exhale deeper and longer than you inhale when
running, for example, 3 steps out and 2 in.
the best way is through brick workouts, conditioning your body to get used to bike to run stress
Do core exercises, especially focusing on your obliques.
Run with your hips and torso still and level. a)Don't bounce.
b)Shorten your strides and increase your cadence (this usually helps
decrease the hip tilting). c)keep your torso upright and still. d)Don't
allow you hands to cross over in front of your torso. e)Feel like you
have a plate on your head and a ceiling right above the plate. This
doesn't mean you go slower.
Breathe rhythmically, on your steps, in-in-out-in-in-out, etc.
the key to avoiding side stitches (for me, anyway) is
decreasing my fluid intake. I have found that the more I drink, the
more likely I will develop a side stitch. In fact, I have had such
problems over the years that I drink very little at all. Of course, I
wouldn't recommend this for longer races in very hot conditions, but
for sprint distance triathlons it seems to work for me. I can get away
with drinking very little if I stay cool during the run. To ensure
this, I pour water over myself at the start and have the water station
people splash me along the way (they seem to enjoy this). You stay
cool, sweat less, don't have to drink along the way and ultimately
eliminate the dreaded side stitch.
My husband swears that doing sit ups before a run helps him.
TO DEAL WITH SIDE STITCHES DURING A RACE:
David Brennan, MEd, an exercise physiologist at Baylor College
of Medicine recommends specific breathing techniques to relieve the
pain and keep you running. The prescribed technique is to exhale with
force with each stride. According to Brennan, "If the stitch is on the
right side of the abdomen, push your breath out when your left foot
hits the ground, and use the opposite approach if the pain is on the
left side." He also suggests that runners develop the habit of using
the abdominal muscles for breathing, contracting and extending them in
and out with each breath. Brennan suggests building workout intensity
gradually. Increasing abdominal strength, especially the obliques and
the transverse abdominis, can also help stave off side stitches.
Pete Pfitzinger, of American Running's Editorial Board
recommends the following technique to relieve side stitches: Push your
fingers into the diaphragm just below the ribs and bend forward,
exhaling forcefully against the pressure of the fingers. The maneuver
releases the spasm and the runner can continue with a jog. Keep
intensity low after the stitch since there is a tendency for it to
To stop a side stitch when running, stop running and place
your hand into the right side of your belly and push up, lifting the
liver slightly. Inhale and exhale evenly as you push up.
When you get a side stitch, stop running immediately, reach
your fingers into the right side of your belly and push your liver up.
And breathe out with you lips pursed at the same time. Then you can
resume running without feeling any pain.
suggested I grab the skin right where the stitch was and pull
it hard. I did this and it about 90% went away and I was able to finish
the race. I have also used another method in running races - slow down
a bit and hold your arms up over your head until it goes away. I have
heard it comes from drinking too much water at once. I try to just take
small swigs as I go.
Hold your breath and press the area near the side stitch.
Also, slightly bending your side of body (stretching it) can help.
i.e., a basic yoga stretch that can be done in 20 seconds.
whenever they occur I start inhaling and exhaling very slowly
& deeply, focusing on my breathing...takes awhile, but usually
suggested breathing out all the way when the cramp happens and holding my breath out for a few seconds.
I would also raise my arm up in the air to try and stretch out
the side. I think that it has something to do with the diaphragm, which
is why a breathing technique should work.
Concentrate on deep, smooth breathing even before they start.
I'm convinced they are breathing related. I found that I often get a
stitch on a downhill -- and an ultra-runner friend said we have a
tendency to hold our breath on downhills, so I'm extra cautious then.
If I feel the slightest twinge of a stitch, I start a pattern or deep
exhales (pushing the air out of the lungs). A good exhales, forces a
good inhale. I also try to tighten my stomach muscles - almost as if
doing a crunch without the movement (this has been my best trick yet).
Lastly, my coach said to purse your lips together. This seems to
trigger a tightening of the stomach.
take even, deep breaths while running. Shallow breathing
tends to increase the risk of cramping because the diaphragm is always
slightly raised and never lowers far enough to allow the ligaments to
relax. When this happens the diaphragm becomes stressed and a spasm or
"stitch" is more likely.
Rub it away. Massage or press on the area where you feel pain.
You may also want to bend forward slightly. This seems to stretch the
diaphragm and ease the pain.
Breathe in sharply and quickly through your nose, then exhale
hard and long through your mouth. This helps to eliminate the gas
buildup that you're experiencing. In recent runs with two fellow
triathletes -- two separate runs -- they were experiencing a stitch and
I suggested the quick inhale, deep hard (loud) exhale, and it relieved
the stitch for both of them within a few minutes.
If you are breathing with your mouth, it could be because you
have too much air traveling into your system too quickly. When this
happens, try to breath with your nose, deep steady breath. I know when
you are racing it's kind of hard to breath with your nose, I know I
never do, even when I'm just training.
Here is a trick I learned when I was in the track team. Breath
with your tougue against the roof of your mouth, this acts like a
filter for the air that travels into your mouth. It works for me every
time. But try to do this before it start to hurt, to prevent it from
My way of dealing with them was through breathing. A good
coach and friend in South Africa once told me to think about my
breathing when they appeared and breath into your diagphram instead of
into your top part of the lung. When breathing like this it should feel
and look like you are breathing into your stomach. This is a good way
to relieve the cramping feeling as it stretches the side muscles that
reduce the amount of fluid you drink on the ride
Once you have side stitches, you can try to completely exhale
and hold it for 10 steps (I know it sounds like torture) before you
inhale several times. Or if that still does not help, exhale, stop
running, bend over forwards, exhale more, wait until the stitches go
I find if you raise both your arms above your shoulders and
take slow deep breaths it slowly goes away. You can also try raising
the opposite arm of the side that you have cramps.
I used to run with an amazingly fast woman (she was kind
enough to wait for me). I learned alot from her including where to find
the best trails and how to get rid of side stitches. I haven't had a
problem since. Anytime you get them, she says you are supposed to
breathe out as much air as you can, while running, contracting your
diaphragm really hard, then inhale and do it again. You repeat this
process each time you exhale, contracting the diaphragm by pressing
down and closing the space in your rib cage. Works for me. She learned
it from Pat Cunningham, I think.