WTF is that Side Stitch While Running

Hey!

Had a great question the other day after a couple of rascals pranced around the track, dashing 400m in negative 12 seconds.

What the heck is the side stitch you get when you run at a near max effort? In my head, I’ve always called it a bear claw. It feels like a bear, grapsing your rib cage from behind, ripping out your obliques, puncturing your lungs, leaving you gasping for air.  Such a pleasant experience!

Causes

A couple of different theories out there on the causes of the dreaded stitch. The earliest I found is from 1923, theorizing that it is a result of stomach distention on the suspension ligaments in the diaphragm. Back in the day, they found it only happened with rhythmic exercise (running, walking and other bouncy repetitive motions).

More recently, the theories are far and wide and nobody is immune. It occurs in swimmers, runners but less commonly in bikers. The potential pathways are:

“ischemia of the diaphragm; stress on the supportive visceral ligaments that attach the abdominal organs to the diaphragm; gastrointestinal ischemia or distension; cramping of the abdominal musculature; ischemic pain resulting from compression of the celiac artery by the median arcuate ligament; aggravation of the spinal nerves; and irritation of the parietal peritoneum”

A crap ton of things it could be…and it really seems we haven’t figured out exactly what the cause of it is!

Speculatively, when you run, you’re bouncing which could cause you to have a hard time breathing. The stress of impact combined with the twisting rhythmic movement of your arms and upper body causes your lungs and lumbar region to take a beating. The arm swing force is transferred to the legs. And the leg drive is transferred to the upper body. If you aren’t well conditioned for the stress, you’ll feel it more frequently and earlier on. So run more. And work on strategies to improve your running economy (midfoot or forefoot strike, decreased vertical force while running, and a ton of others).

Prevention

The most effective strategies I have found for people in terms of treating the acute symptoms have included a bit stretching, breathing through it and manual pressure. In the long term, you should aim to strengthen your midline (abs, butt, lats, everything connected to your spine) and increase your efficiency in running.

For relieving the stitch, take deep, rhythmic breaths from the diaphragm. It helps relax the deep abdominal muscles, which helps in terms of relieving the stitch stress. If that doesn’t help…

Stretch! I would recommend a hip flexor(above) stretch with the painful side’s knee on the ground, reaching overhead to the opposite side of your body leaning away from the painful side. Go by the feel of it as each person’s body will be positioned a little different to relax the painful region. If that doesn’t help…

Apply manual pressure to the area! If you have a tennis ball or lacrosse ball, you can dive into the area with a little bit of pressure along the area that has the feeling of being knotted up. Or you can use your hands. Just dive in and take those deep breaths to get some bloodflow to the area and work out the tissue.

Other strategies include wearing a tight belt around the abdominal region and abstaining from food consumption within two hours of exercise.

Beyond that, work on getting stronger and conditioning your body more. Work on breathing while you exercise. It may never go away while varying intensity – but usually if you can grit it out beyond the stitch it will clear up!

Other questions? Leave a comment! Thanks for reading and own the day!

–Mike Goose