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How to prevent a Running Stitch

Whilst it causes no long-term physiological harm, the intense pain of a running stitch can stop even the most resilient runner in their tracks. It is surely one of the biggest frustrations when racing at high intensity and can wreak havoc with your pacing on race day. Learning how to prevent a running stitch can help you reach your goals and enjoy your racing.

Running stitch
A hard track session forced me to think about the causes of running stitch, and how to prevent it from happening.

First, it is important to know your enemy. What is a running stitch and what are the probable causes?

A running stitch is an intense and sharp pain that is felt during exercise, usually just below the rib margin, but sometimes in the shoulder tips. It seems to be caused by the vertical jolting motion of hard running. Traditionally the explanations for running stitch centred on the fact that the group of ligaments that support the stomach, liver and spleen are all attached to the diaphragm (Sinclair 1951, Abrahams 1961, Rost 1986), and vertical jolting of these organs causes a strain on the diaphragm, which goes into spasm, causing pain. The fact that stitch also exists in swimmers suggests that there may be more than one mechanism causing the pain (Morton and Callister 2000), perhaps by some other irritation or inflammatory response of the diaphragm and abdominal lining. Stitches tend to be more prevalent when running downhill after a tough effort or uphill, which may be attributed to parts of the large intestine suddenly contacting the diaphragm. Recent research has also found that a great many runners settle into a regular respiratory cycle while running. Usually breathing subconsciously on the same leg in a regular stride-breath ratio. Repeatedly training like this may cause a further imbalance in our core muscles, which may contribute to pain on the under trained side.

It is far better to try and prevent a running stitch from occurring than try to recover from it mid-race. Based upon the probable causes above, the following should be incorporated into your race day routine and training to help prevent running stitch:

  • No eating or drinking 2-4 hours before running. This should help reduce mass inside the stomach and therefore reduce the jolting motion of the organs attached to the diaphragm. Repeated racing and training will help you to know your ideal time before a run that you can still eat and drink without developing running stitch.
  • Incorporate core exercises into your training routine to help strengthen the diaphragm and supporting muscles.
  • Try to practice breathing with your diaphragm or belly, rather than your chest. This is also known as “yoga” or “belly” breathing and can help prevent a stitch from occurring in the first place by maintaining control over your diaphragm and breathing deeper, to ensure the diaphragm is stretched.
  • Always try to warm up properly before your training runs and particularly fast races. Warming up slowly to your race pace will reduce the shock to your body once the gun goes off and help stop you from starting too hard.

If you’re mid race and suffering, then there are a couple of things which can be done to break the stitch:

  • Try exhaling fully to stretch the diaphragm and break its spasm. Avoid taking short breaths. Just like other muscular cramps, lengthening the muscle can break the cramp.
  • Try to change your breathing pattern. If your stitch is caused by the intestines or organs impacting the diaphragm, then changing your breathing so that you exhale on the side opposite the pain may help to reduce this internal impact by moving the diaphragm away from the problem area. Through practise out on the road, I have always found this to be the most effective method to reduce or eliminate a running stitch that has developed. Whether this is physiological, or a psychological effect caused by concentrating on breathing rather than the pain, I may never know, but for me it works!

Running stitches are likely to affect us all as we progress as runners. Trying to understand their potential causes and understanding our own bodies better through training are the best ways to prevent them from spoiling our race days and know how to deal with them when they do occur.

Learn more about belly/diaphragmatic/yoga breathing on Runners World.

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