What is the deal with the sharp pain, a.k.a. “stitch”, that occurs in your rib cage, usually on the right side, during sustained cardiovascular exercise, such as running?

Some researchers believe that these twinges are caused by stretching of the ligaments that extend from the diaphragm to the internal organs, particularly the liver (which is on the right side).  The jarring motion of running while breathing in and out tends to stretch these ligaments.  It is believed this repeated stretching leads to spasms in the diaphragm and this spasm causes your pain.

If you don’t know, the diaphragm is a sheet of muscle that extends across the bottom of the ribcage.  It acts to separate the heart, lungs and ribs from the stomach, intestines and liver.  More importantly, it helps us breathe…as you inhale, the diaphragm contracts, moving downward, to allow the thoracic cavity to increase and draw more air into the lungs.

Can you prevent a Side Stitch?

To prevent a side stitch, take even, deep breaths while running.  Shallow breathing tends to increase the risk of cramping because the diaphragm is always slightly raised and never lowers far enough to allow the ligaments to relax.  When this happens the diaphragm becomes stressed and a spasm or “stitch” is more likely.  This is why they happen more often when runners are trying to get back into shape after a layoff.

Ten other tips to alleviate or avoid the pain of a side stitch include:

1. Improve your cardiovascular fitness.

2. Warm up properly before you run.

3. Strengthen your core muscles (lower back, abdominal and oblique muscles).

4. Avoid too much, too soon, too fast syndrome.

5. Avoid eating one to two hours before a workout. Having food in your stomach during a workout may increase cramping by creating more force on the ligaments.

6. Stretching may relieve and even prevent a cramp. Raise your right arm straight up and lean toward the left. Hold for 30 seconds, release and relax, and then stretch the other side.

7. Slow down your pace until pain lessens, or walk it out.

8. Breathe deeper to stretch the diaphragm when you feel a cramp coming on. Then, breathe slowly out of your mouth with pursed lips; this tends to relax the diaphragm.

9. Drink before exercise; dehydration can increase muscle cramps. An electrolyte sports drink may be even more helpful than just plain water. Avoid any carbonated beverages one to two hours prior to running.

10. Massage or put firm pressure on the area with pain. Bend forward to stretch the diaphragm and ease the pain.



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