I work a lot with ultra runners and with new runners and something both groups can experience is getting a stitch. It is really annoying and painful so here are some ways to reduce the risk of one appearing, and suggestions on how to handle it if it does.

What is a stitch…

The official term is an ‘exercise-related transient abdominal pain’ (ETAP). It is a sharp twinge of stabbing pain just below the rib cage, often on the right, that occurs during exercise. It is particularly common in runners, swimmers, basketball players, aerobics participants and horse riders – all activities with repetitive torso movement when the torso is extended or twisted. The pain goes almost as soon as the activity stops.

Who suffers…

Those most likely to suffer include younger athletes, those starting out with lower fitness levels or stepping up a distance and athletes who are drinking sugary hypertonic drinks. There is thought to be no relation to the athlete’s weight, size or the speed at which they perform their sport.

What might be responsible?

No-one has found out yet. There are lots of different theories though. There is nothing on whether stitches might have a psychological origin although most research does suggest they have a somatic (body based) background rather than a visceral (nervous system based) origin. The current theories on what causes stitches are:

Diaphragmatic ischemia – this is where there is a reduced blood supply to the diaphragm limiting how much oxygen is available. It might occur because we are not breathing deeply enough.

Stress on peritoneal ligaments – these are the ligaments which extend from the diaphragm to the abdominal viscera (the internal organs in the upper abdomen; the liver, pancreas, spleen, adrenals, and kidneys) and spasm from the jolting up and down movement we are making.

Irritation of the parietal peritoneum – caused by friction between the visceral and parietal folds of the peritoneum (the lining of the abdominal wall).

Lack of spinal integrity – some athletes who have suffered spinal issues have found to have increased vulnerability to stitches post incident which has lessened following treatment for the spinal issues.

Diaphragm ligaments stretching – the suggestion is that due to our breathing patterns (exhaling when our right foot strikes the ground), our liver drops as our diaphragm goes up, stretching the ligaments, fatiguing and causing pain.

Eating too close to a run – when your body digests food it has less blood flow for the diaphragm, which may induce spasms. Drinking fruit juices and liquids full of sugar seem to be particularly hazardous.

Suggestions to avoid getting stitches…

  • Avoid sugary drinks (hard for runners who need to fuel their body and brain in longer distance runs).
  • Avoid foods that are hard to digest just before a run like those which contain lots of fat and fibre.
  • Do regular core-strengthening exercises, yoga or pilates as these can strengthen weak diaphragm muscles so they are less prone to fatigue and cramp.
  • Warm up properly – it causes less shock to your body.  
  • Practice breathing more fully and deeply – inhale for two steps, exhale for one.
  • When on a longer exercise session sip small amounts of your drink regularly rather than large amounts at once.
  • Learn to belly breathe: Lie down and put something like a book on your tummy. Focus on the book and your goal is to make it rise and fall as you exhale. This also helps strengthen abdominal muscles, which may also help prevent a stitch.

3 suggestions to try to get rid of a stitch when it shows up:

  1. Stop moving, press hand deep under your ribs on the right hand side. Purse your lips and blow out (not relaxing your lips) and this should relax the ligaments as you empty your lungs.  
  2. Slow down and raise your arms over your head to stretch out the tightness.
  3. Slow down, notice which side of your tummy the stitch is on, as the foot on the opposite side hits the ground exhale. Focus on keeping your exhales in time with your opposite foot hitting the ground.