Ask Julia: What to do when running is a pain in the side

Today's running question comes from RunningStart. She asks:

When running, what do you do about the awful side stitch? You know. Where you get that pain in your side that won't go away until you stop running? When I'm running, my legs, my breath, and my head are all saying, "Keep running!" but my side says, "Oh! No! You'd better stop and stretch that out again." Please help!

Our running guru Julia Jones says:

In order to cure yourself of a side stitch, you have to first understand what is happening to your body. The pain you feel is actually caused by a spasm of your diaphragm muscle. The diaphragm muscle separates your lung cavity from your abdominal cavity and moves up and down while your inhale and exhale. So when you inhale (try this while you’re reading!) your lungs fill up with air and pushes your diaphragm down (see how your stomach pushes slightly out?). As you exhale your lungs contract and your diaphragm rises back into place. Now try that a few times: breath in and vision your diaphragm pushing down, breath out and see it returning back up.

While we run the rising and falling of the diaphragm is happening at a faster speed than normal with this added catch: most runners exhale when their left foot strikes the ground, while about 30% exhale when their right foot hits the ground. Why is this important? Most stitches occur on the right side, which is why a lot of people attribute a side stitch to a liver problem! As your right foot hits the ground, gravity forces your internal organs down also which in turn are attached to the diaphragm pulling that down too. So if you’re exhaling at the same time as your right foot hits the ground, your diaphragm is being pulled DOWN on one end just as you are exhaling and having it pulled UP by contracting your lungs. I know, you’ll have to read that over again to really understand what is happening. It’s like the diaphragm is being pulled in two directions at the same time and then… SIDE STITCH!

Also, please note that side stitches are exacerbated with downhill running, there's a lot more jostling happening with the diaphragm and those internal organs while you scoot downhill!

Now that you understand what is going on, here’s how to take care of a side stitch so you can start running normally again:

  • Stop or slow down. Stop for a few seconds while you get your breathing under control. You can keep walking while you get your breathing in sync. If you have more running experience and the stitch occurs while running at a faster speed you can also try just slowing down.
  • Push up on the right side of the diaphragm. Take your fingers and push right up underneath the right hand side of your rib cage. Just a gentle nudge will be enough to alleviate some of the pain.
  • Take full, deep breaths. Avoid any shallow breathing, take nice deep, controlled breaths for a few minutes.
  • Get your running and breathing in sync. Try exhaling when your left foot hits the ground. Once you have everything under control and you beginning running again, concentrate on exhaling every four counts when your left foot hits the ground. This should avoid any reoccurances for the rest of your run.

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