Wednesday, May 28, 2008


Someone just posted a question about sticthes. That's another nagging problem I see a fair amount of in athletes. I've experienced it myself and once lost a race due to this. The following is an article I wrote on this topic many years ago. I've not found anything new to cause me to revise it...

In the early 1980s I trained with a fellow who was plagued by side stitches. I'm sure you've experienced one of these yourself when running. Gradually, a sharp pain in your upper abdomen forces you to slow down dramatically. You jog along gasping for air and pushing on the painful spot. A few minutes later the pain subsides and you cautiously resume your earlier pace.

My friend, an excellent runner, tried everything from stretching to acupuncture to special diets. Nothing helped. He wasn't alone in his quest for an answer. For years, the stitch has been a mystery to everyone including exercise physiologists and the medical community. Here is a possible solution.

It's clear that gravity has something to do with the malady—they are rare in biking or swimming. Sports that involve the up-and-down motion of running are most susceptible. It also appears that most stitches are on the right side of the abdomen, in the area of the liver, the heaviest organ in the gut.

The liver, stomach, and spleen all hang from ligaments attached to the diaphragm, a large, flat muscle in the gut that creates inhalation as it contracts. During running these organs bounce pulling down on the diaphragm, and sometimes, perhaps, causing the gut cramp known as a stitch.

Here's what to do. With a stitch on the right side, exhale when your left foot strikes the ground. This will transfer most of the jarring force away from the afflicted side allowing you to take the stress off of the diaphragm. Give it a try. Several of the athletes I coach have had success with it.


At May 30, 2008 12:23 PM , Blogger Adam said...

I have heard breathing deep into the abdomen helps to "stretch" the diaphram and I have done it ever since with success. I know ultrarunner Scott Jurek and others use yoga breathing and they run 100 miles at a time breathing really hard in the mountains up and down.

At June 1, 2008 7:41 AM , Blogger Seth Hosmer said...

I have found that if I tighten my abs with about 50% contraction, it provides enough compression that the side stitch goes away. Sounds like the mechanism might fit with the "heavy liver" theory, and I'll have to try the left foot strike with exhale technique as well.

At June 3, 2008 1:38 PM , Blogger Tim said...

I should have checked your site last week as this happened to me this past weekend. I was leaving T2 in about 9th place and dropped to 15 b/c of the stitch.

Any thoughts on what other factors may help cause them? I ask b/c I have prob only had 1-2 in the last 4yrs of training and this was the first time in a race. I was thinking either dehydration or the lack of sustained LT efforts in training (i.e. not use to running after a hard bike). I mention the latter b/c the race was a sprint but I just completed a Base 2 phase in my run-up to IMFL.


At June 3, 2008 2:29 PM , Blogger Joe Friel said...

Tim--It's possible that some types of stitches could be related to training. It could also be dehydration. Too much fiber in a pre-race meal may set you up for it, too. There's very little known about what causes them.

At June 9, 2008 12:56 AM , Blogger FP said...

Thanks for this - I certainly have not tried the approach. I'll let the group know how it goes.

At June 19, 2008 2:42 AM , Anonymous Götz Heine said...

To my experience stitches occur due to eccess blood in the organs situated or left or right of the chest. Usually its the liver or the spleen. A simple treatment if they occur during a workout is to breath normally into this side and then force the air out of the lungs thus putting pressure onto the organ full with eccess blood. This will relieve pain within minutes as the blodd gets pressed back into the vena cava superior. Instead should these sensatons occur regularly, one should take an inflammatory situation af the respective organ into consideration and have blood checked for further indicators.
Also there is a slight possibility that stitches can be caused by maldigestion/intolerance of certain foods, especially when eaten too close to a workout, mostly starches. As a rule of thumb try to resort to fruit only prior to the sports and see whether it works.

At April 8, 2009 7:44 AM , Anonymous Karen Ashbrook said...

The British Journal of Sports Medicine 2004, published a case report on Abdominal pain in long distance runners: case report and analysis of the literature.

Here is the abstract:
Abdominal pain is a common complaint among participants in endurance sports. It may be severe, recurrent, and resistant to treatment. There is no direct evidence of the cause of this phenomenon. This report is of a long distance runner who had severe pain in the upper right abdominal quadrant during strenuous exertion. The symptom had been present for several years and did not respond to conservative treatment. Laparoscopy showed congenital supernumerary ligaments binding the gallbladder to the abdominal wall. The complaint resolved after cholecystectomy and resection of adhesions. There was evidence of chronic cholecystitis on histopathological examination. Two years after the operation, he remains free of symptoms. The differential diagnosis of abdominal pain in athletes is discussed.


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