The feeling you get when you have a good rhythm on a run is just hard to replicate.  Whether you achieve the mythical “runner’s high” or you’re just having an easier run than usual, it’s incredibly freeing.  You feel like nothing in the world can stop you, until you get a tightness building up in the side of your ribs.  All of a sudden you’ve got a cramp in your abdomen that makes you regret ever considering going outside and thinking you could run in the first place.  Running stitches – or a “stitch”, as it’s commonly known – can make running incredibly difficult, if not downright painful.  So what’s going on?  

Running stitches don’t really have a known cause, but there are a handful of theories.  The end result is effectively a spasm (or cramp) of your respiratory muscles.  Your diaphragm is the most common muscle involved, but it could also be your intercostals (muscles between the ribs) or obliques (muscles on the sides of your belly).  So what do you do?  With multiple potential causes, it will take some experimentation on your side, but there are things to try in order to overcome running stitches.  

• Pay attention to your eating habits – Having a big meal before you run probably isn’t a great idea if you want to enjoy your run.  A full stomach can cause extra compression against your diaphragm. Some schools of thought also suggest having food in your stomach will drive blood flow to your stomach instead of your respiratory muscles or muscles you’re using to run. Either way, there’s less blood available, increasing the likelihood of getting a stitch.  In general, wait at least an hour after eating before any strenuous activity.  If you’re going to eat before a run, It’s best to have smaller portions consisting of softer foods.  There’s a reason runners things like bananas and gel-based food get handed out at races.  
• Check your breathing – We’ve discussed breathing before (linked here) and how it relates to running.  A rule of thumb is that your inhalation should occur over more steps than your exhalation.  A common example is to inhale over 3 steps and exhale over 2.  The muscles of your trunk tense and create stiffness in your spine when you inhale (that’s good) but when you exhale you lose some of that stiffness.  By having an uneven breathing cadence, both sides of your trunk get equal force over the course of the run.  
• Work on your breathing habits – Breathing exercises to emphasize good breathing habits can make a huge difference.  You’ll be more aware of your breathing habits and you can make sure you’re fully utilizing your lungs.  A great way to do this is to lie on your back with your feet on a wall so your hips and knees are at 90 degree angles.  Take 2-5 minutes to work on some deep breathing – inhaling slowly through the nose, holding for a few seconds, and exhaling slowly through the mouth with pursed lips (think blowing out a candle) for several seconds.  Breath deeply for 3-4 breaths then regularly for 3-4 breaths.  This could also work in other positions, and works wonderfully during yoga when you’re holding a pose.  
• Work that core! – Exercises like pallof presses (shown here), chops (shown here with a ball and here with a band/cable), and ball tosses (example here) are all options.  You could also simply just do single arm and single leg exercises as those will engage your trunk heavily – think exercises like rows and lunges.  Just be mindful about your breathing!  As you throw or lift the weight try to exhale while maintaining a slight brace in your trunk.  If you don’t have weighted balls or bands/cables, simply use a water jug (close it tight!) in lieu of a ball for chops. And just press into a wall for the pallof press.  It probably isn’t the best idea to throw a jug of water around, though!  

If you get running stitches, give these a try and see what works for you.  Pain with running is a frustrating experience, but if we can stitch it up and keep you going, mission accomplished!  

Got questions?  Feel limited in what you’re able to do?  The staff at Limitless Physical Therapy in Eugene, OR and Albany, OR can show you how to discover your future without limits.  

***The above information, including text, images, and all other materials, is provided for educational purposes only, and not as a replacement or supplement to professional medical advice.  Please contact a certified healthcare professional or your primary physician for any personal concerns.