Expert: Dr. Simon Yeung - Associate Professor of Department of Rehabilitation Sciences, the Hong Kong Polytechnic University
Many runners have experienced side stitches; the pain that strikes during exercise often named as exercise-related transient abdominal pain (ETAP). Causes for side stitches are to be found, but most theories focused on four reasons: 1) Diaphragmatic Ischemia; 2) Diaphragmatic cramp; 3) Visceral ligament stress; and 4) Parietal peritoneum irritation.
The abdomen houses most of the vital organs. They are linked with visceral ligaments, abdominal peritoneum and nerves. Any frequent stimulation would cause irritation. Side stitches during running is common, it may be caused by the upward and downward movements of the diaphragm as you breathe. When beginners start to increase their training intensity, the accelerating pace would lead to greater movements of the diaphragm. If your diaphragm fails to adapt to the increased load, diaphragmatic ischemia or diaphragmatic cramp may occur. For beginners, mastering the breathing techniques is of prior importance. The movements of the diaphragm and the shocks created when your legs strike on the ground would be stressing the visceral ligaments, resulting in stabbing pains. Breathing tempo should be adjusted to lessen the stimulations. The main functions of the parietal peritoneum, in which nerve tissues are widely spread, are to provide lubrication and protection for internal organs. Any actions that increase the friction between the parietal peritoneum and the organs would stimulate the nerves and causing pain. As a result, we recommend a 3-hour grace period between meals and high intensity exercise, avoiding high-sugar beverages before training could also decrease the workload of the digestive system that create frictions between abdominal peritoneum and the organs.
Ways to eliminate side stitches
No matter what reasons caused side stitches during running, ways to relieve pains are similar. The first thing that runners could do is to slow down the running speed or even walk, press on the area with pain and lean forward. Try to have full and deep breathing; adjust the breathing tempo. The pain will be relieved and dismissed. For proper breathing techniques, please refer to: http://www.hkmarathon.com/Training/Training_Tips/Breathing_tempo_s4_p17194.htm
In the long term, sustained training, regular eating habits and having sports drinks are the most efficient ways to prevent side stitches. Increase the strength and speed of training progressively, utilize your deep muscles to control the breathing. This would help runners to maintain posture, lowering the consumption of energy and chances of injury. These are specifically important to runners preparing for the marathon. If you suffer from side stitches recurrently, or the pain sustained or even intensified after stopping training, consult a doctor as soon as possible.