How to Eliminate the Painful Running Side Stitch!

A common runner’s complaint is coping with a side stitch while running. And, it’s not just new runners that can benefit from improved breathing, and strategies that will keep a running side stitch at bay.

Given I’ve run thousands of miles, and 14 marathons, you’d think even I would have this down. Well, not exactly. Last November while running Wineglass Marathon, I had a severe side stitch that completely derailed my “BQ” (Boston Marathon qualifying time) attempt. I was on the struggle bus for the entire second half of the marathon.

Granted, a running side stitch is mostly harmless, but it can be very painful. And, it certainly can derail your training and racing attempts. Given that, this post focuses on how to prevent side stitches, and then some strategies to rid yourself of them.

But first, a brief description, and even briefer anatomy lesson about the running side stitch! And, did you know the “scientific term” for a side stitch is exercise related transient abdominal pain (ETAP)?

In most cases, a side stitch that occurs while running is a muscle spasm of the diaphragm (and its supporting ligaments), the muscle directly below your rib cage. The diaphragm is critical in our breathing efforts, so much so that without its involvement, we can not breath on our own.

As we inhale, the diaphragm moves down (allowing our lungs to expand), and the opposite as we exhale. Often the stitch is a sharp pain, and more often on the right side below the rib cage. Like other bodily muscles, the diaphragm can spasm due to the increase in workload when your breathing accelerates with exercise.

Other factors that lead to the spasm, & stitches are: improper breathing and posture, poor pacing (starting too quickly), nervousness/anxiety, and even a full stomach.

How do I Prevent a Running Side Stitch?

- Eat light before your run or race, and avoid fiber and fat. An exception would be a small snack right before your race (ie: GU, a banana, etc.)
- Warm up! This benefits all your muscles, and helps promote optimal breathing (not to mention decrease chance of injury).
- Pace yourself. Start out slower, and then increase your pace. Often, a side stitch is a sign that you’re overwhelming your body.
- Improve your posture. Avoid hunching at shoulders and bending forward at the waist. Both will make it more difficult for you to breathe properly. Think shoulders back and down, and a slight lean forward of your upper body without bending your waist. (Bonus tip: keep your chin tucked. If you allow your head to tilt back, the rest of your posture suffers.)
- Stay hydrated. But note that higher sugar content drinks (even sports drinks) can increase the odds of a side stitch. Also, avoid drinking large amounts of liquid directly before your run.
- Improve core strength. A stronger core reduces movement in your trunk while running, thus less disruption/spasm of supporting organs/muscles. Plus, your running efficiency improves, too.
- Control your breathing. A quicker pace increases your oxygen needs. If you breathe with a shallow breath and an irregular pattern, that can promote a side stitch.
- Stay relaxed. The more anxious and nervous we are about our run/race, the more shallow our breathing.

UH-OH. How do I Get Rid of a Running Side Stitch?

- Let’s start with breathing! A proper breathing pattern and habit can help relax your diaphragm and the other supporting muscles. Breathing through the mouth and nose (but mostly mouth) while keeping your jaw relaxed is important. Secondly, focus on belly breathing (more below). This means your stomach should expand on the inhale, versus your chest.
  Once that side stitch has begun, think about breathing in for two steps, and then out for three steps. Frankly, it is a good habit to do this in general. Plus, occasionally, purse your lips (as if blowing out a candle) as you exhale to ensure you’re fully exhaling and relaxed.
- Put pressure at the stitch site. As you inhale, apply some pressure with your hand (gently), and then let go/release as you exhale. Repeat until you feel relief.
- Slow down. As said before, a running side stitch may mean your pace is too quick for your body to cope. I took walk breaks while I had my terrible stitch(es) during the Wineglass Marathon
- Relax. As best as you can. With me, I do believe some of my stitches/cramping were a direct result of being so anxious about doing well during the marathon.
- Take a bow. This will require that you stop briefly. Take an inhale with arms over head, then slowly exhale while bending forward and letting your arms dangle. This can be effective in relaxing your diaphragm and abdominal area.

Breathing Properly – An Abridged Course

While breathing is an activity that in many ways “occurs on its own,” it doesn’t mean we can’t improve upon the way we breathe while running. In short, you want to avoid shallow breathing in your chest, and focus on deeper breathing into your belly. Of course, the faster your pace, the more difficult it is, but it is NOT impossible.

An exercise to help you work on belly breathing:

Lie on your back with knees bent & feet on floor.
Put your hands on your belly and think/focus on taking deep breaths into your stomach (versus chest). As you inhale, the stomach should rise, and while exhaling, it should flatten.
If possible, do this while breathing through both your mouth and nose while keeping your jaw and face relaxed.
Repeat 8-10 times.
Before a run, do this same exercise (standing!). You can do it along with your dynamic warm-up, or on its own.

Do you have any other methods to combat a running side stitch? Please comment or share what works for you!