Posted by: teejford | April 16, 2008

Body in Focus: TJ Ford on the agony of side stiches

Editor’s note: We’ve looked at the issue of side aches or side stitches before, but today Contributing Writer TJ Ford takes a look at side stitches for a different perspective. Although there is much debate about the causes of the problem, one thing’s for sure: a lot of runners get them. If you suffer from side aches, read on for more.

They hit almost every runner at some point – that stabbing, unrelenting pain in your right abdomen just below your rib cage that goes away only when it feels like it and puts you in all sorts of contortions trying to get it out. My 17-year-old niece, a track star out in Minnesota, just wrote to me asking what the heck they were and what she could do about them. My 15-year-old nephew, a rising track star in Seattle, also asked me about them last week. And since I’ve had bouts with these things myself, I thought it was time to address it.

First I think we should rename them. ‘Side stitches’, or ‘side aches’ , especially, sound so benign, so temporary, so removed from the stop-you-in-your-tracks pain that they really are. Something more descriptive, perhaps, like the ‘Being-stabbed-in-the side-with-a-red-hot-poker pain’. The medical community calls them ETAP, an abbreviation for the insipid Exercise Related Transient Abdominal Pain. I think the running community can do better than that!

A quick review of how we breathe: the diaphragm is a large, circular skeletal muscle that sits up inside our rib cage like an open parachute. It’s attached by three very strong ligaments (like the parachute strings) to the spine, and it’s also attached all around the inside lower border of our ribcage. When we are ready to take a breath, it descends (the parachute deflates). This decreases the air pressure in our chest cavity relative to the air pressure outside, so air rushes in and we ‘inhale’. When it’s time to exhale,the diaphragm simply relaxes and floats back up, decreasing the air pressure inside. When we forcefully exhale, or cough, the diaphragm gets stretched out.

Exactly what causes these stitches? Why do we get them more often when we’re running fast than simply going for a walk? The first, most well-known theory is that side stitches are caused by dehydration. So – no news here – make sure you are drinking enough before, during and after every run. Keeping your abdominals. low back and QL muscles stretched (remember the Mr Peanut stretch?) can help too.

But what about us well-hydrated runners who still suffer? A recent batch of research seems to indicate that the stitch is caused by stretching the ligaments that extend from the diaphragm to the internal organs, particularly the liver. The jarring motion of running while breathing in and out overstretches these ligaments. The faster you run, the faster your breathing gets, and the more they get stretched. Interestingly, most runners tend to exhale as the left foot hits the ground, but some people exhale whentheir right foot hits the ground, and these folks are more susceptible to the side-stitches. The liver is on the right side of the abdomen, and as you step down with your right foot it drops down. At that very moment the diaphragm is rising for the exhalation, thus stretching that diaphragm-liver ligament.

So what can we do to help prevent these? First, when you run be aware of which foot hits the ground when you exhale. If it’s not hard on your running form, try exhaling when your left foot hits. This may be enough to stop your side stitches from starting in the first place. Also, focus on taking deep even breaths while running – the shallower your breaths are, the more likely you are to get a stitch – the diaphragm never lowers far enough to give the ligaments a chance to relax.

If you get a stitch while running, you can stop running and push your hand into the right side of your abdomen, lifing up slightly to elevate the liver. Inhale and exhale deeply and evenly while you do this. This is often a quicker way to release things than stretching.

If you’re still getting stitches, you can try a type of bodywork called Visceral Manipulation, where the therapist works in your abdomen, releasing the tight ligaments and separating organs that might be stuck together. It’s not as painful as it may sound – it’s more just wierd feeling. But it does work.

And if you’ve got suggestions of things that have worked for you, I’d love to hear them. Because as long as there are runners, there will be ETAPs.

TJ Ford, Portland Oregon, USA
for Running Advice and News
 

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