Lateral stitches, or exercise-related transient abdominal pain (ETAP), are caused by a contracting diaphragm and stretched ligaments, often triggered by a runner’s foot hitting the ground at the wrong point in the respiratory cycle. They can be relieved through rest, self-massage, and stretching, and prevented through proper warm-up techniques, dietary changes, and a change in running mechanics. Switching the preferred foot from right to left can also prevent lateral stitches.
Many runners and other athletes experience short, sharp pains originating from a point just below their rib cages. These often debilitating cramps are known as lateral stitches or, more formally, exercise-related transient abdominal pain (ETAP). They can literally bring an athlete to his knees, but the pain can be relieved through rest, self-massage of the diaphragm area, and careful stretching. They can also be largely prevented through proper warm-up techniques, dietary changes, and a change in running mechanics.
The stitches are not caused by excessive gas buildup or lack of oxygen to the chest muscles. They are mainly caused by a contracting diaphragm, the muscle that aids in breathing and keeps the internal organs separate from the chest cavity. When a person inhales, the diaphragm moves downward, which tends to stretch the ligaments attached to it. Normal exhalation causes the diaphragm to rise and the internal organs connected to it, especially the liver, to relax. This process should continue without fail throughout a runner’s entire session.
The problem starts with gravity. A runner’s internal organs are naturally pulled down by gravity, but the diaphragm is mechanically pulled upward during breathing. If a runner’s foot hits the ground at the wrong point in the respiratory cycle, the diaphragm rises while the ligaments connected to it lower. This stretching of the ligaments, especially on the runner’s right side where the liver is attached, can be very painful. The diaphragm may go into spasm, its normal cycle having been disrupted by the shock of runner’s foot. Pain generated by both stretched ligaments and spasmodic diaphragm constitute lateral stitches.
Treating side stitches after they’ve developed is often a matter of rest, self-massage, and stretching. If the runner can press several fingers under his rib cage, the stretched ligaments can often be manipulated back into a healthier state. Using deep breathing techniques, also known as abdominal breathing, the runner’s diaphragm should also stop spasming after a few minutes.
Experts suggest blowing out a strong breath with pursed lips, like blowing out birthday cake candles. Avoid taking shallow breaths, which tend to keep the diaphragm trapped in a state of limbo.
Preventing spots in the first place may involve a few changes to your running routine. Drinking enough fluids before a run can keep your muscles hydrated and reduce your chances of cramping. There should also be at least a two to three hour gap in eating before a run. Stretching exercises before a contest should include some slow side-to-side movements to stretch the ligaments in the abdomen attached to the diaphragm.
Many side stitches are caused by a running technique used by approximately 30% of all runners. Most runners have a preferred foot that matches the exhale. Most runners exhale at the same time their left foot hits the ground. The internal organs on the left side of the body are usually smaller, which means that the chances of a stretched ligament causing lateral stitches or spasms are slim. The liver, however, is a fairly heavy organ located on the right side of the body. If a runner favors their right leg on the exhale, the shock of the foot strike and the position of the diaphragm can trigger lateral stitches.
The solution to avoiding side stitches may be a matter of rethinking your running style to avoid exhaling when your right foot hits the ground. By switching their preferred foot from right to left, a runner can prevent the kind of stress on the abdominal ligaments that often trigger lateral stitches.
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