Ever go for a run, or worse, you’re in the middle of a race, and all of a sudden you feel a sharp pulling sensation in your side that stops you in your tracks? Commonly known as a side stitch, this pulling is thought to have a variety of causes, including contraction of the diaphragm or the visceral ligaments, drinking energy drinks with high sugar content, and eating meals high in fat right before you run. However, none of these causes is proven.
What we do know is that a side stitch has a tendency to affect you when you least expect it! Here are a few “tricks of the trade” that have worked for me and for my athletes and patients, and may work for you, too.
To get a side stitch to subside:
Slow down your breathing. Inhale and exhale for the same number of strides—every two strides for a faster race pace, every four strides for a slower jogging pace. This allows the diaphragm—the major muscle of respiration—to fully expand and contract with each breath, which is thought to help release a stitch.
Change the timing of your foot strikes and your breathing. Time each exhalation to the strike of the foot opposite the stitch: If you have a right-side stitch, your left foot should strike the ground every time you exhale; if you have a left-side stitch, your right foot should strike the ground every time you exhale (although right-sided stitches tend to be more common). Changing this pattern is thought to help stretch the diaphragm and the abdominal cavity, which may help release the stitch.
To prevent a side stitch:
Avoid eating foods high in fat or fiber one to two hours before a run. This timing may not give the body enough time before the run to digest the foods. As the diaphragm expands and contracts with each breath during the run, a full stomach may create more pressure in the abdominal cavity; this causes the diaphragm to expand and contract rapidly, which might lead to a stitch. Try eating meals that are lighter a few hours before a run.
Breathe deeply. Shallow breathing doesn’t allow the diaphragm to fully expand and contract during each breathing cycle. Maintaining a shallow breathing pattern during a run may create tension in the diaphragm and cause a stitch. Try practicing diaphragmatic breathing by placing your hand on your stomach while you take deep breaths. As you inhale, you should feel your diaphragm expand. As you exhale you should feel the diaphragm contract.
Varsha Parasram Semangal, PT, DPT, MST, is a physical therapist at Hospital for Special Surgery’s rehabilitation department. She received her doctorate in physical therapy from Columbia University. Seemangal is a lifelong runner and has completed two marathons, several half-marathons, and many 5K races. Her clinical interests include sports-related injuries and how they relate to musculoskeletal deficits.