18/02/2023
The Side Stitch – It’s a real pain in every runners side!
Why do we get them, what exactly are they & how I personally get rid of them instantly – Every single time.
Kev Moseley – Vale Of York Athletic Community
The last time I developed a stitch when running that stopped me in my tracks was thankfully, many years ago. Before this, I would get them pretty much every time I put on my running shoes and headed out.
Within minutes of setting off, you would often see me on the side of the road or even at a local parkrun, doubled up, both hands grabbing my side and stepping out of the way, waiting for the pain to end.
When I first started, it did not matter whether I was on a treadmill or doing couch to 5k, it hit and it hit hard.
The side stitch is a common issue that plaques those of us who exercise – be it walking, jogging, or running, or even doing something that gets the heart rate up. For those who have learnt how to master, control, prevent and break its agonising pain quickly, it becomes one less thing to think about when running. We are able to enjoy the exercise, push harder and reach our goals faster.
As the season starts and a lot of us are training with long distance runs (or indeed, you may be just starting out on your own running journey), the thought of being side-lined for a few minutes is not something that any of us want.
What is a side stitch?
Ok, let’s be honest – do we really care? We just want rid of it, don’t we? The truth is though, we really do not know!
There have been many articles written, meetings, conferences and discussions had over the years by everyone from runners to medical professionals and more.
Some of the theories are that stitches occur because of a lack of blood supply to the diaphragm. The oblique muscle producing lactic acid could be a reason. Or you have been taking short, shallow breaths whilst exercising.
Other theories include having had a stomach upset, a strain of the muscles around the abdomen and liver. It could be about the amount of food/ fluids taken prior to the run (too little or too much) and this could be to blame and how long it is since you had this ? Or that you did not warm up enough before heading off. Like I said though, we really do not know what causes it, but we do believe it relates to the Diaphragm, so let’s look at this quickly.
Where is it and what does it do?
Before we learn how to stop it, maybe we should understand briefly exactly where the diaphragm is and its purpose.
We all seem to get a stitch in the same place. Under the bottom of the ribcage, on the front of our bodies and it can be on either side. This is where your diaphragm is.
The diaphragm has an extremely important function within our bodies. When we breathe in, it contracts and flattens, and the chest capacity enlarges.
This action then creates a vacuum which pulls air into our lungs. Simply put, the lungs expand, the diaphragm contracts.
In order to complete the breath, we need to exhale and in doing so, the diaphragm then relaxes and returns to its shape (as shown in the illustration above) and air is forced out of the lungs.
Please, please, please – make it stop and go away!
I have seen many methods tried, written and talked about in how to stop this blasted pain in our side. Everything from stopping during the run and bending over to touch your toes.
Having gone from bending, others stop and go the opposite way, putting their hands on the head and stretching upwards and lifting the head and hands high. I have tried placing my hands on hips and bending the opposite way to stretch the muscles. The best for me though was seeing someone doing the letters to the song YMCA whilst singing to The Village People through their earphones!
I have read that staying well hydrated during a run will prevent a stitch – although it has not worked for me. Ensuring you stay hydrated is common sense and extremely important. It is something we should all do and even more so on the longer runs or hot days. As the majority of races start circa 9am, it is still cooI enough to manage and I do not take fluids in on any run under 10k. After this, I only start sipping from a bottle as I go through 16k (10 miles) and onwards.
Finally, I have seen about slowing the breathing and pace down (not easy if you are on for a pb and it was all going so well) and possibly, changing your rhythm. If you are anything like me, the last thing you really want to do is reduce your cadence when you are pushing hard.
How do I Personally do it?
I have been running a few years now, with thousands of miles under my feet. I have run everything up to and including a full marathon (and slightly more) and in those first few years, I got a stitch every time I ran.
When I first started the couch to 5k program and then took part in my 1st ever parkrun (Portobello, Scotland), I could not get past 500 meters, before the dreaded pain hit.
I watched in amazement at everyone else going past whilst I fought with the demon in my side. So, what did I learn?
I eat, drink and warm up!
I am going to parkrun (or I am racing), I will have something light to eat 2 hours before the actual start and no nearer. I like peanut butter on toast as it is a slow release of carbs, so would have this around 6:30am (we have a 21-mile drive to Selby parkrun from home), so leave around 7 when doing the course inspection.
Others have something like a banana, overnight oats etc, but you must not eat within 2 hours of going running. Whatever you had prior to this time, it must have time to digest and get into the stomach. I do not drink acidic fruit juices before I run either (the acid makes me feel sick) but I do often drink water/coffee or other energy drinks (that remain nameless) on the journey – so I am well hydrated and I do enjoy my caffeine. Not great for everyone’s stomach though, so to each their own and be aware.
Upon arrival, I will always have a gentle warm up starting with a 10 minute walk. Get the air into the lungs. Expand the chest cavity with deep breaths. I then start getting quicker, gradually building into a jog and run for couple of miles at varying paces to really get the heart rate up. I build it up from a walk to a run, then for a hundred meters or so, I go as fast as my morning legs can carry me before backing down all the way to a walk pace again.
Now, Let’s stop it!
Imagine you are at Selby parkrun, after applauding the incredible volunteers etc, the RD shouts GO, and you with many others head off up the track to the 1st km mark. Passing the distance cones, you feel good, the sun is out, lots of talking and friendly chat behind you. There is a cool & gentle wind, the deer are hiding in the trees and with the sound of the Skylarks singing as they rise out from the crops, it is perfect conditions. Then suddenly & without warning – the intense pain hits.
The problem now is that you are running well, your cadence is high and if you can keep it going, you could be on for a new personal best. But the pain in your side is intensifying and you need it to stop and stop now.
For me, having experienced thousands of stitches, I have had to learn to deal with them swiftly, without breaking too much with my pace and look to maintain position and momentum. My method may not work for you, but so far, it has for everyone I have known and who has tried it. When you have one though – then surely anything is worth a crack?
If I get a stitch on my right side (this seems to be the most common side for some reason) then whilst running/moving, I use one of my hands and make it flat & with the palm facing upwards. I keep the fingers rigid and straight.
Now I take my hand and push it into the area direct where the pain is. Right in and under the rib cage.
In doing so, I bend forward and exhale as much as possible. Whilst doing this, I push my palm in further and hold it there, getting as much air out of my lungs as I can. Exhale, exhale, exhale. Do not breathe in.
Given that this takes a couple of seconds and bearing in mind that I have not broken my pace or stride too much, I hold it, hold it, hold it, then slowly and steadily start to return to my tall running position whilst removing the fingers completely.
My experience has found that whilst I am/was running (I am no medical expert and this is just my personal opinion), I believe that the diaphragm goes into spasm. In doing the above, (the upturned palm pushing into it and holding, whilst exhaling) this seems to stop the spasm swiftly in its tracks.
If I got a second stitch (extremely rare), then I would repeat, however, I did not tend to experience two in any run that I had or have had again.
Even if I thought I could feel something starting in the area where the diaphragm is, I would do the same with the plan to stop it before it even started.
Having now broken the stitch, you can concentrate again on putting each foot forward and pushing on towards the finish line. Becoming stronger, fitter, maybe faster (if that is your individual aim) but the overall plan is to get to the end, having enjoyed the run / exercise and without pain or discomfort.
I do hope that this method works for you and if so, do let me know. Sometimes, the most basic and simplest things are those that work best. It is all just from experience and if you continue to experience pain, then of course, stop and seek medical advice.
Keep pushing and may the only stitches you experience or find, are those in the clothes you wear.
Best wishes to each and every one of you.
Kev
Vale Of York Athletic Community – February 2023