By Sam Carter, M.D. Orthopaedic Specialist Medical Director, Kentucky Derby Festival Marathon and miniMarathon
We are a couple of weeks into training for the Kentucky Derby Festival races, and as I promised, I have an update on my training progress and some tips for dealing with a common complaint from runners beginning a training program: side stitches. I encourage you to ask questions through this site.
For me, the most difficult part of training has been finding the time and energy to run six days a week. Sometimes after a long day at work, the last thing I feel like doing is hitting the treadmill, but I have only missed one day thus far which I consider a triumph. This is when it helps to enlist support for one’s training efforts – there have been a couple of days when my wife has (gently) asked me when I planned to get off the couch and get on the treadmill!
Another challenge I face is dealing with the treadmill on those days when it is too cold to run outside. I love to run outside, but cold-weather running appeals to me less and less as I get older. On the treadmill, my biggest problem is keeping myself from constantly watching the display to see how much longer I have to go. Those miles seem to tick off very slowly when I stare at that little red digital readout. I find watching television, especially a basketball or football game, seems to help distract me during the early parts of my runs. But toward the end, when fatigue sets in, I seem to glance down every 30-60 seconds. I think I may try to cover up the display next week to see if it helps. Otherwise, I’ll hope for more of the unseasonably warm winter days Louisville has been having.
I have been glad that so far during this training I have not had to deal with an issue that I struggled with when I first began to run: side stitches. However, I know from past experience that this can be a frustrating obstacle in successfully completing a run.
What causes a side stitch? Side stitches are caused by a muscle spasm of the diaphragm, the large sheet-like muscle that separates the chest cavity and lungs from the abdomen, and is one of the major muscles that controls breathing. Side stitches are a common occurrence with vigorous activity such as running and are more frequent in beginners, or in those who haven’t developed proper pacing or breathing techniques. About a third of all runners will experience side stitches at some point.
When we inhale, the diaphragm presses downward, increasing the size of the lungs and bringing air in. When we exhale, the opposite occurs, and the diaphragm moves upward forcing air out of the lungs. There are abdominal organs attached to the diaphragm, which during running, place additional strain on the muscle and can cause spasm. The organs on the right side, particularly the liver, are larger than those on the left and lead to more frequent right-sided stitches (but they can occur on either side). It is believed that shallow, quicker breathing makes side stitches more likely to occur. This is common when running in cold weather because taking in a big breath of frigid air is uncomfortable. Other factors that can increase the likelihood of side stitches are exercising too soon after eating, running downhill, or starting exercise too vigorously without a proper warm-up.
How do you get rid of a side stitch? In general, the immediate treatment for a muscle cramp is to slowly stretch the cramping muscle. Stretching the diaphragm may not be as intuitive as stretching a cramping calf muscle, but it can still be done. One method is to run as upright as possible and stretch your arms over your head if a side stitch occurs. Altering your breathing pattern also can be helpful to combat side stitches. Try taking in a deep breath quickly and hold it for a few seconds, then exhale against pursed lips to increase the resistance. You may have to stop and walk for a few seconds, focus on your breathing pattern, then resume running when the stitch goes away. If you get a side stitch in the middle of a race, try to mix up your breathing pattern. If you get into a rhythm of always exhaling when the right foot strikes the ground, try exhaling on the left instead. Relaxation techniques can also help get rid of side stitches as they promote deep, calm breathing.
In summary, if you are plagued by side stitches that are limiting your ability to run or train, remember the following: