What is a stitch and how to avoid one
What is a stitch and how to avoid it?
Most of us would have experienced a stitch during our time running. That nasty, painful jabbing pain that bends us double, slows us down and in some cases, makes us stop. Unfortunately for us runners, the scientists don’t know exactly what causes a stitch, but we can give you some tips to avoid one.
The scientific term for a stitch is an ‘exercise-related transient abdominal pain’ (ETAP), and it is felt in the lower side of your body, typically just under the rib cage and more often on your right side. Symptoms will range from an ache to a tugging sensation, to a sharp and stabbing pain.
Stitches have no long-lasting effect but they’re painful at the time, will affect your performance and unfortunately, they’re very common; but what is the cause of a stitch? There are three distinct theories:
Theory A – Blood Movement
When running, are muscles are making a demand on us for more oxygen to keep them working. As such, our body moves blood away from areas of little need to the lower limbs where it is needed. One main area is the diaphragm; a muscle that separates the stomach and abdomen from the lungs and one of the main muscles involved in the act of breathing.
The theory is that this lack of blood supply causes the diaphragm to cramp and this cramping pain is felt typically in our side.
Theory B – Fluid Digestion
This theory suggests that a stitch is caused by fluids that our bodies are finding hard to digest. This process triggers the gut to pull on ligaments that are connected to the diaphragm. This causes the cramping feeling.
Theory C – Tiring Trunk
The parietal peritoneum is a membrane that lines the abdominal and pelvic cavities. During exercise there is a lot of movement in the torso, your core muscles become tired and back muscles over-engage to compensate. This process presses causes irritation to nerves in the area causing the jabbing, cramping pain.
Pain can also be felt, typically and weirdly, in the shoulder. Again, scientists are not sure why this happens or how the two areas are linked.
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.
- 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.
- A stitch is not specific to either gender so we’re both unlucky!
- The chances of getting a stitch declines with age
- 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.
What we do know is that getting a stitch is more common in younger athletes. Research untaken by Australian scientists found that younger athletes suffered more than old athletes but again, no conclusive evidence was given as to why this is the case.
Now we (don’t) know the causes, what can we do to avoid getting one?
1 – Stay hydrated but do not drink too close to your run. This fits in with theory B above. Drinking a large quantity of fluid too close to your run will increase your chances of getting a stitch, but scientists also know that dehydration prompts the start of a stitch.
Other research has shown that fruit juice and overly sugary drinks can spark a stitch again so we would suggest sipping during the day to ensure you are generally hydrated and drink water. See our article on hydration here.
The last thing you'll need on race day is a stitch. Imagine wasting all that hard effort in training. Check out our specific race day hydration article here.
2 – Be careful what and when you eat. Do not eat within 2 hours of your run. This fits in to theories A & B above. When you eat, blood rushes to your stomach and intestines. The blood provides the relevant digestive systems with oxygen and transports the products of digestion. Your heart rate will increase to maintain blood pressure and blood vessels will constrict – both of these are the exact opposite to what you want as someone who is running!
Your legs need the blood, but your stomach is using the blood to digest the food… Again, it’s not clear as to why, but most of us could tell you through experience that eating too close to your run increases your chance of a stitch and at best, makes you feel lethargic and uncomfortable so get organised. Make sure you eat the right food and the right time – this may mean packing the right food to take with you during the day.
3 – If you get a stitch, you could try running through it. Bend over slightly and put pressure on the pain using your fingertips. It often relieves the pain. Probably, I’d suggest, because it stretches the internal muscles and ligaments relieving the cramping.
If the pain is too bad or continues, you could try stopping completely, bending at the waist and touching your toes. Stretch back up again with your arms above your head and lean back to stretch the abdomen. Also try side stretches with arms above your head – stretch away from the cramping side to relieve the pain.
You could try combining both methods above. Whilst standing still, sway between your upright stance to leaning forward at say a 45º angle. Sway back upright again then forward again then back etc. Press in to the painful area while you’re doing it.
4 – Control your breathing. If you are continuing to run, you might need to do this while leaning forward slightly. Take slower and deeper breaths.
Try a few things out to see what works for you. I used to pant (like a dog), exhaling until I had no more air in my lungs then I’d take a deep breath and repeat. No idea why it worked or if it would work for anyone else, but it worked for me!
5 – Do a warm-up. There is some evidence that relates to an increase in stitches during colder weather. If you shallow breath as a reaction to the air being cold, the diaphragm can remain in a high position so that the peritoneum cannot relax. This is related to some degree, to theory C above.
I think you could minimise the risk of a stitch by combining some deep breathing before you start your run with some upper body torso stretching. Do some side stretches with your arms above your head, rock your torso forward and back to stretch out your back and diaphragm etc. Just loosen off.
Looking back at all my years of running, I would suggest that the truth is a mix of the theories. I had a lot of stitches as a youngster and didn’t get so many as an adult, probably due to getting so used to running (I ran twice a day, every day for 10 years as an international runner) and being smarter about my food and drink intake. I got to learn the odd trick like the dog panting (!) if I did get a stitch on the rare occasion, and I always did a short warm-up for every run which included some torso stretching.
- 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 stabilise 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.
- It helps prepare the body for movement. An example of this is that increases pressure in the abdomen which acts to increase spinal stability.
- 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!
One quick story of epic failure… In my 20’s I was getting paid to run track races, but my agent suggested I go and run in a 10k road race; 10 laps around a town square somewhere in Spain one Easter time. There was no up-front money but, “it was ok because there’s prize money and you’ll win it easily because there’s no one good in it”. The prize money was for the winner only, but I didn’t recognise the names of anyone in the field, so I thought I’d go.
The race was at 5pm so we went out to lunch. I ordered Spanish omelette; potato for carbs and eggs are easily digested I thought. It was truly delicious, so I ate another large slice of it. A few hours later I’m feeling heavy in the warm-up – I’ve eaten too much! The stitch came on during the race and I ran the last two laps bent double. Rounding the last corner, it was a two-man race: myself and the local hero. The crowd were going mad we only had 100m to go. Trying to sprint when you’re bent double simply wasn’t working and the Spaniard won on the line leaving me to lick my wounds and feel like the idiot I was. It was a good omelette though…
Be smart with your food and drink, and do a warm-up which includes stretching your torso. If all else fails, pant like a dog!