Unraveling the truth about running stitches

Running is a great way to exercise. A common side effect of running is known as stitches in the side. This can be a very sharp painful condition that feels like a knife stuck in your side. The pain is so intense it will stop you in your tracks.

For a long period of time, controversy existed on what actually caused this condition. Many authors today are still speculating about the cause. The current literature and testing has provided satisfactory results to confirm that it is a combination of muscle spasms and visceral ligament stretch, which all result in this intense pain.

Both the diaphragm and the intercostal muscles that are between each rib, are primarily involved in the side stitches pain. Another cause of the “stitch” pain is with the altered blood supply to visceral ligaments associated the side lung area.

When you run at a faster pace, than you are conditioned to handle, your body requires an intense amount of oxygen. The breathing becomes labored and results in the body’s own autonomic response of hyperventilation.

This process of fast paced breathing will often result in a spasm in the muscles that normally are used to breath. Sedentary breathing doesn’t require the intense contractions required for the deeper breathing, which is necessary to provide the additional oxygen required during intense activity.

The “stitch” can even occur while laughing intensely, and that fact rules out several of the possible causes from gas in the intestines and blood clots forming in the lungs.

Breathing muscles

The diaphragm is located under the bottom of the lungs and sits like a dome over the entire abdominal contents. When it contracts, the lungs are stretched drawing air into them.

Other respiration muscles are the triple layered intercostal muscles located between each rib. These allow the chest to expand and force more air into the lungs and also drive the exhaling of air.

Neither of these two groups of muscles are used in any real capacity until someone is exercising 30-40% greater than typically seen at rest. Most people only use 20% of their diaphragm’s capacity in every day sedentary life. So once anyone starts an intense physical activity of a long duration, fast breathing kicks in, respiratory muscles strain and this can result in muscle fatigue and cramping.

Several things can elevate the fatigue of the inhalation and exhalation muscles resulting in a quicker onset or a more intense “stitch.”

The most common cause is from a lack of conditioning. Even if you have been training for six years, but take on a more intense training protocol, you will have a ticket for the side “stitch” pain train. It isn’t a pleasant ride either.

Steps to prevent the “stitch”

Since your body needs all of the respiration muscles conditioned, it is important to apply some interval training techniques to avoid the “stitch.” Doing any activity at a progressive gradual increase of intensity will prevent the onset of the rib splitting side pain.

Running wind-sprints is the optimum way of conditioning to prevent the “stitch.” Use this sample program to progressively build a resistance and improve your lung strength.

21 day training protocol to prevent stitches in any sport

Day

1

2

3

4

5

6

7

8

9

10

Distance (yards)

10

10

10

10

10

10

10

15

15

20

Reps

5

6

7

8

9

10

10

8

10

5

Rest (seconds)

30

30

30

30

30

30

20

30

20

45

Rest for one day and begin at day 12.

Attempt to maintain your same running time from the first rep to the last.

Day

12

13

14

15

16

17

18

19

20

21

Distance (yards)

20

20

20

20

20

20

20

20

20

20

Reps

5

6

7

8

9

10

10

10

10

10

Rest (seconds)

30

30

30

30

30

30

20

20

15

10

At the conclusion of this first 21 day training protocol, you should be fit enough to run an entire distance of 200 yards/meters without stopping. The 200 and 400 meter runs are considered the toughest races to run for a true test of all out speed strength, power and endurance.

Another common running technique is known as “jogs and gassers.” This simple technique involves jogging at a slower pace and then implementing a time or distance interval that is performed at a faster pace.

In field sports it is common to run the length of the field at a jog, but sprint the ends.

Basketball suicides are very similar. You run forward to the foul line and sprint back to the base line, then forward to the 3 point line, then sprint back, etc, etc. This format quickly builds a resistance to fatigue and helps athletes avoid getting the “stitch.”

You can use this technique with any type of training that requires activities longer than 10 seconds. Cross-fit training is a huge event specifically directed towards this type of special interval training.

Other tips to avoid the stitch

Learn to breathe in a rhythm while you run which is important and prevents hyperventilation. Pattern breathing is easier to learn at a slower pace.

While jogging, learn to breathe in during every two or three steps. Then exhale forcibly during only one or two steps. This also will improve your oxygen uptake system and make your lungs more efficient.

Think of it like a swimmer who obviously has to pulse their breathing. Rarely does anyone training in swimming produce a side “stitch.”

Pacing yourself is a great way to prevent stitches. Slowing down or altering any activity provides additional improvement and may be a crush to your ego, but produces a base level that you can build on.

Avoid eating or drinking for at least an hour prior to any strenuous activity. A significant amount of research has shown that running or training on an empty stomach helps prevent “side stitches” from occurring.

When you eat or drink prior to running, you significantly increase the blood supply to your digestive system. This pulls blood away from the lungs that often results in a poor supply to the breathing muscles. This is specifically true for high fat or high starch meals, which literally take hours to digest.

Drinking carbonated substances specifically results in a volume that imposes a pressure on the chest cavity that often results in stitches.

Many athletes can train themselves to ignore meal timing and so what may harm one athlete, may benefit another. Practice and experimental training are the only way to know for sure.

It is important to note that you will not die from a “side stitch;” however, you can die from dehydration. So consuming clear simple water before and during and after any physical activity can save your life.

Another likely cause of “stitches” is related to spinal curvature. Spinal scoliosis is commonly associated with pre-mature onset of the side splitting pain. Spinal manipulation often helps improve mobility and can have a positive effect on preventing side pain while running.

Individuals with hiatal hernias will also have significant problems with “stitches.” This defect is when the abdominal contents have broken though the protective dome just below the diaphragm.

Both massage and stretching show limited success with improving the onset of the stitch. This is due to both not providing actual solid conditioning to the appropriate muscles.

Most of conditions of stitch should automatically improve with simple training in less than a few weeks. If symptoms persist or have any repetitive sharp pain, consult a physician.

Yours in Health!

Dr. David Ryan

Columbus Chiropractic Center Director

One Response for Unraveling the truth about running stitches

  1. Victor Ranilla

    avatar

    May 4, 2013 12:22 pm

    Very interesting article Dr. Ryan very well done!