Causes and coping with a stitch

Causes and coping with a stitch

Published April 19, 2018, Author Shoe Guide

How to cope with a stich and prevention measures to stop you getting one in the first place!


What is a stich?

It may or may not surprise you, that the scientific world still don’t know what a stitch actually is. Theories suggest:

  1. Insufficient flow of blood to the diaphragm causing a spasm
  2. Friction between the abdominal wall and the abdominal organs
  3. The liver and stomach are moving causing a strain on the supporting ligaments and also the ligaments supporting the diaphragm

For those of us not with a PhD in something sciency, the diaphragm is the dome-shaped sheet of muscle and tendon that serves as the main muscle of respiration and plays a vital role in the breathing process. It separates the chest from the abdomen.

Scientists have looked towards common denominators to try and find some sort of link. Having looked at many surveys, they can point to certain viewpoints.

  1. Getting a stitch was common in sports where repetitive movement of the torso is common. Running would have a vertical repetitive movement, swimming a longitudinal one.
  2. A stitch is not specific to either gender so we’re both unlucky!
  3. The chances of getting a stitch declines with age
  4. Experience runners were as likely to get a stitch as unexperienced runners

In addition, a stitch also defers pain to your right shoulder; sounds weird but it’s true and many of us would have run for a while have experienced this. It can be quite painful and it is linked to an issue in the diaphragm.

Stitch Facts

  • Stitch is most common with runners (it is 10 times more common than in cycling)
  • The stitch pain position varies, but it is most commonly on the mid/ lateral abdomen
  • Stitch prevalence decreases with age
  • If you train infrequently, you are more likely to get a stitch
  • Food or fluid intake sometimes induces a stitch
  • Shoulder pain is associated with a stitch
  • Stitch can lead to difficulty in breathing
  • Stitch occurs regularly in horse riding and other sports in which the torso is subjected to constant movement

Can food and drink cause a stitch?

Because scientists do not know what causes a stitch, research has focused on what measures they think could be the cause of a stitch, then trying to prove their theory. Some of the research has been focused on the intake of food and drink.

Tests have focused on the amount of fluid taken onboard and also different type of fluids. The amount of fluid was non-conclusive, however, there was good evidence to suggest that taking fruit juice as opposed to a sports drink or just water was more likely to induce a stitch.

The shoulder pain, being linked to the diaphragm muscle, suggests that food and drink is a factor in getting a stitch.

Stitch causing breathing issues

For those of us who have been bent double trying to catch a breath while not stopping on a run or worst still, in a race, we know that a stitch can make it difficult to breath. This is another pointer to the diaphragm muscle being responsible for, or at least, having some impact on us getting a stitch.

It is well understood by most people that the diaphragm is the main muscle of inhalation, but the diaphragm is also a vital part of the core stabilising muscles. Core muscles aren’t just your six pack abs, they are all the muscles around your middle that help keep your body upright during exercise and also, the deeper muscles that help stabilize your pelvis and spine. All of these muscles come in to play during movements such as twisting, bending, running, jumping etc. All of these muscles stabilise us and help prevent damage to our bones during lifting or any actions that impose stress on our skeleton.

The diaphragm, as part of its stabilising job, plays two key roles.

  1. It helps prepare the body for movement. An example of this is that increases pressure in the abdomen which acts to increase spinal stability.
  2. When we exercise, the diaphragm needs work harder as we place and increased demand to breath upon it.

Due to these competing demands, it is easy to overload the diaphragm. It is also stressed by the movement of large organs around it such as the stomach and liver. During exercise, these organs move and this movement can stretch the diaphragm and the diaphragm also works to ‘buffer’ the movement of these organs, so it is forced to undertake a number of different roles, all at the same time! Phew…

Ever had a stitch while running off-road or more stitches off than on-road? It is because the muscles and diaphragm are working harder to stabilise you, i.e. keep you from falling over on an uneven surface.

It is highly likely, that diaphragm discomfort arises from our inability to cope with the demands placed upon it. We might need to focus on training for the diaphragm.

How do I get rid of a stitch? - Diaphragm training

The upside is that we’re breathing all of the time so the diaphragm is strong and resistant to fatigue, the downside is that most of us are inefficient breathers and we may need to help ourselves by training the diaphragm.

The muscles (including the diaphragm) responsible for breathing are collectively called inspiratory muscles. These can be trained using a POWERbreathe device. You will need some foundation sessions (just like starting to run and getting your lungs and legs to a point where you can cope with a faster session for example), and these sessions will give these inspiratory muscles a good base level of strength.

Using a POWERbreath device, start by inhaling against a moderate training load (50% of max) for 30 breaths. Towards the end of the set of 30, you should be finding it difficult to breath and the last few will feel like maximum effort. You will need to find out where this point is for you via trial and error (you might be doing it too easy or too hard to begin with until you ‘learn’ what’s right for you) but you’ll soon get there. You repeat this exercise twice a day for 4-6 weeks in a standing position.

Once you have the base, you move on to the breathing exercises in your sport-specific position, i.e. on a bike if you are a cyclist.

Check out the POWERbreath website for more details.

We hope this helps – good luck!


A final stitch story from one of our shoeguide team members, ex international athlete, John Gladwin.

I was invited to run in a spring 10k road race around a town square (10 laps of it!) in Spain. As a middle distance runner, I didn’t fancy my chances but there were no Africans in it so that helped! We went for our pre-race lunch and I ordered the Spanish omelette. OMG, it was delicious – so I had another slice! You know what’s coming – I’d had too much to eat now…

I felt ok in the race as the massive pack of European internationals vied for positions around this beautiful square packed full of spectators all hoping for a Spanish win. With two laps to go, the pace picked up and 50 became 10 of us. With a lap to go, someone took off and the 10 became 4. That’s when the stitch kicked in! I ran the whole of the last lap bent double panting like a dog (see below!). I rounded the final bend with the Spanish star, him and I well clear of the third runner and the finish line in sight.  At this point and being a miler, I would have been favourite to outkick him but sprinting in a bent-double position doesn’t work and he won by 2 metres. Ha ha – good luck to him – my lunchtime greed had put paid to that win.

Note to self – go easy before a race and stick to what you know and have practised with.


Dog Panting – don’t ask me who or how we came up with it (and there is zero science behind it!) but I was out running with the training group when I got a stitch. Someone recommended panting like a dog! Keep breathing (panting) out until you have no more air in your lungs then breath in again. Keep repeating. For some mad reason, it worked. We all practised this whenever we got a stitch in training or in races. It didn’t always work but give it a go – it’s better than stopping. Good luck.

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