9 Ways to Avoid the Nuisance
A stitch or catch in the side—a sharp, temporary pain—is caused by a spasm of the diaphragm. It happens when your diaphragm, a muscle between your chest and your abdomen, can't get the oxygen it needs.
"Sometimes running can block the flow of blood to the diaphragm," explains Gabe Mirkin, M.D., a private practitioner at the Sportsmedicine Institute in Silver Spring, Maryland. "Every time you raise your knee, you contract your belly muscles, which increases the pressure inside your belly. When you breathe deeply, your lungs expand to a much larger size than during normal shallow breathing. The dual pressure from the contracted belly muscles below and the expanded lungs above can shut off the flow of blood to the diaphragm." Unable to get all the oxygen it needs, your diaphragm will go into a cramp and hurt.
If you don't breathe evenly, you can get side stitches when you're running or walking or even laughing.
Here's how to handle them.
Stop. When the pain hits, stop whatever you are doing. You need to relax to calm your twitching muscle.
Press there. Using three fingers, press on the area where the pain is the worst until the hurt stops. Or, use those three fingers to gently massage the painful area. Often this is enough to release the pain, says David Balboa, a sports psychotherapist and co-director of The Walking Center in New York City.
Exhale deeply. As you begin to knead the cramp out of your diaphragm, take a breath, then purse your lips and blow it out as hard as you can. Take another breath and exhale again. The inhaling followed by a deep exhalation works like yoga, says Balboa, giving you an internal massage for your pinched muscle.
Breathe in, breathe out. Continue to massage your aching side and work to slow your breathing to a regular pace. Getting your breathing back to a steady rhythm will help stop the ache.
Slow down and walk. If you are running when you get a stitch, sometimes just slowing to a walk is enough to calm that jerking muscle, says Suki Jay Rappaport, Ph.D., director of the Transformations Institute in Corte Madera, California, and a movement educator. When the twinge fades, speed up again.
Belly breathe. Before you go out to walk or run again, you need to know how to breathe to prevent stitches from taking sides.
Balboa suggests you try this test: Look down at your chest. Watch closely as you suck in a giant breath. What moved? If only your chest moved, you're breathing with your chest cavity and that's not enough. To fight side stitches, you want your diaphragm involved in the breathing exercise. One way to tell if you are using that muscle is to get your chest and belly to move when you breathe. Keep an eye on your belly. Inhale. Exhale. It should move in and out. People need to get out of their military-style postures to exercise comfortably, says Balboa. Besides, who is going to watch you puff your stomach while you walk or run?
As you practice your belly breathing, take deep breaths. Exhale deeply. Become superaware of your breathing while you exercise and within a couple of weeks, diaphragmatic breathing will become habit.
Massage your diaphragm. Like any muscle, the diaphragm needs to be warmed up before it exercises. So, before you stretch your legs, give your diaphragm a breath massage and get it in working order. Sit on the floor and place one hand on your chest, the other on your belly. As you breathe, you want both hands to move up and down, indicating you are using your full breathing capacity, including your diaphragm. A warmed diaphragm is less likely to stitch.
Breathe all the time. People naturally hold their breath when they are frightened, when they are cold, or when they want to avoid pain, says Balboa. If you allow yourself to feel your emotions and not try to avoid them by holding your breath, you're more likely to breathe naturally when exercise demands a constant flow of air, he suggests.
Stop to go. Even though side stitches are caused by a pinched diaphragm, some walkers and runners will get a similar feeling from trapped gas, says Dr. Rappaport.
Any aerobic activity will slow or stop the digestive process while the blood rushes to help the muscles, says Balboa. That's why runners are told not to eat at least 2 hours before a race. And that's why runners sometimes get diarrhea if they drink a lot of water during a race.
Their advice? Be careful what and when you eat before you exercise. Eat plenty of fiber. Try to have a bowel movement before you begin any exercise if you are prone to side stitches.
PANEL OF ADVISERS
David Balboa is a sports psychotherapist and co-director of The Walking Center in New York City. He is an expert on fitness walking and body/mind relationships.
Gabe Mirkin, M.D., is in private practice at the Sportsmedicine Institute in Silver Spring, Maryland. He is also associate clinical professor of pediatrics at Georgetown University School of Medicine in Washington, D.C. He is the author of several sports medicine books, including Dr. Gabe Mirkin's Fitness Clinic, and is a syndicated newspaper columnist and radio broadcaster.
Suki Jay Rappaport, Ph.D., is director of the Transformations Institute in Corte Madera, California. A fitness consultant, her doctorate is in movement education and body transformations.