Saturday, April 23, 2011

Dealing with Side Stitches

When I was starting, and even until now, I'd usually get a side stitch while running.  The pain really disrupts my running form and causes me to slow down my pace.  And it really sucked if I'd fail to beat my (or set a new) personal record because of it.
Last week I got an inquiry from a colleague, who started to love the sport, about side stitches and how one can prevent/treat it. But before I go into the detail on how to treat it, let us go through first what it is and what causes it

What is a side stitch?
A side stitch (exercise related transient abdominal pain or ETAP) is a sharp, intense pain under the lower edge of the ribcage caused by a muscle spasm of the diaphragm. They're common in novice runners who tend to breathe more quickly and shallow.

What exactly causes them?
When we inhale, our lungs fill with air, which press the diaphragm downward. When we exhale, the diaphragm moves up. If you have some trapped air below the diaphragm, if you've eaten right before running, or if you start running too vigorously, your diaphragm may cramp, causing pain under the rib cage on your right side. Contrary to popular belief, drinking before or during running does not cause side stitches

Now consider what’s happening when you run, for instance.  You are bouncing up and down while in turn breathing in and out.  It turns out that most people naturally time their exhale with one of their feet striking the ground.  When our foot strikes the ground, our organs are going down while their diaphragm is going up.  This puts quite a bit of strain on the ligaments that are connected between the diaphragm and the various organs connected to it, such as our liver and stomach.  Over time, this can cause pain due to strain on the ligaments and can also contribute to spasms in the diaphragm itself

How can I prevent it?
- Eating before running.  Try to avoid eating within one hour before any activity.  I'd usually eat a very light snack at least 1~2 hours before I run.  Generally it is better if we allow 2-3 hours (regular meal) before any jarring activity so as to allow your body to digest the food properly prior to the event
- Breathing in and out through your mouth when you're running.  Breathe deeply from your belly, not your chest.  Deep belly breathing allows you to take in more air.  Breathing technique/method will vary from one person to another.  I usually breath in through my nose and breath out through my mouth
- Work those abs.  Stronger abdominal muscles will do a better job of limiting the jarring on your internal organs and thus limiting the strain on the ligaments connected to the diaphragm.  That only means that you can't escape doing those crunches or planks
- Avoid taking shallow, quick breaths.  Breathe deeply and methodically while you are doing a jarring exercise.  Some would say to breath-in every 3 foot strikes and breath out on the next two (3/2).  While others uses a 2/2, some prefer the 3/3 pattern.  For me, whatever floats your boat
- Stretching will also help reduce the likelihood and help get rid of side stitches.  Before running or doing some other jarring activity, warm up then do various abdominal stretches (if possible).  My regular pre-race regime is to do some quick warm-up (10-15 minutes) then partnered with a couple of dynamic stretching

What if I get a cramp/side stitch in the middle of a race?
- Most people exhale as they land on one foot or the other. It turns out, majority of people exhale when they land on their left foot rather than their right.  This is a good thing and will help prevent side stitches.  When you exhale when landing on your right foot, it particularly causes extra strain on the ligaments between the liver and diaphragm, as well as added friction between the two.  This is why most side stitches occur on the right side rather than the left.  Thus, if you are in a race and you can’t stop just because of a side stitch, focus on exhaling when your left foot lands, instead of your right, as well as taking deep methodical breaths, rather than short quick ones as noted above.   If, in this “can’t stop” case, you have a very rare left side stitch, focus on exhaling when your right foot strikes the ground until the side stitch goes away
- Reach towards the sky as you inhale and let your arms slowly fall as you exhale.  This will help relieve some of the tension in your diaphragm and help get rid of the side stitch.  However this will require you to stop running and start walking
- Stretching may relieve the pain of a stitch. Raise your right arm straight up and lean toward the left. Hold for 30 seconds, release, then stretch the other side
- An alternative to the “reach for the sky” method is to press your fingers deeply into the area the pain is coming from and massage the area firmly while deeply breathing in.  Then release your fingers as you exhale.  This should accelerate the demise of the side stitch.  This is my personal favorite.  This particular method has worked for me many times



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