What exactly is a "stitch in the side"?

Question

When we run for a long period or overexert ourselves, sometimes we feel a sharp pain on a side of our torso that stays for a while until we've recovered. What is that? Jokes are fine, but biological or medical explanations, are preferred.

Answer 1

If you have ever suffered a side ache (often described as a side "stitch") while running, you know it can be one of the most bothersome of all temporary running maladies. The problem generally agree that the pain emanates from muscles or ligaments somewhere in the region of the abdomen. Some think the pain is caused by a muscle spasm of the diaphragm, but it could also be cramping or straining of the ligaments in the diaphragm/liver area (the liver is the largest and heaviest organ). The diaphragm is a somewhat small muscle that lies between the chest cavity and the abdominal cavity. It separates the organs that are contained in the abdomen from those that are contained within the chest cavity (the heart and lungs). Some believe that runners who breath out when their right foot strikes the ground put more pressure on the right side, where the diaphragm is located. Others think it is just due to the rhythmic nature of running and its stressful effect on our internal anatomy. Regardless of what actually causes them, side aches are usually centered somewhat to the right side, just below the ribs.

Researchers in sports medicine have focused on two primary methods to quickly get rid of the right-sided type of side stitch. They have to do with breathing technique, posture and running style, or a combination of both.


Breathing Techniques
If the side stitch is caused by a muscle or ligament problem related to rapid breathing, then changes in our breathing methods can often help get rid of the side ache. Some researchers have found that shallow breathers have more problems with side pain than deep breathers. To find out whether you are a shallow breather or a deep breather, try this test. Lie down and put your hand on your stomach and then take in a typical breath. Your stomach will move inward as you take in air. But if you are a deep breather, as you complete the intake, your lungs will get so full of air it will force your stomach back out again. Shallow breathers don't have this outward movement at the end of each breath. It could be that this in and out movement is more relaxing to the stomach muscles, thus avoiding the resulting pain. The next time you get a side stitch, try slowing down for a few steps and taking in some really deep breaths. This technique alone will often bring many runners some relief. Then, as you pick up speed again, remember to add a very deep breath every so often.

Other methods are also related to how and when we breath during running. Some runners have reported relief from side stitches by focusing on somewhat forceful exhaling while running hard. They purse their lips and force the air out for several breaths, a if blowing out candles on a birthday cake. If this works for you it may again be related to consciously changing the rhythm of your breathing, which can change the way you are using your internal muscles and ligaments. This change helps relax the muscles or ligaments that are causing the pain. If you have a side stitch, try several different styles of breathing as you continue to run. Watch for any breathing method that, after a while, seems to relieve the pain. Some also suggest pushing in at the painful area at the same time you are trying the pursed lip breathing technique.
Posture and Running Style
Some writers have suggested that your posture and running style can be related to side aches. For example, if you tend to lean forward slightly while running, it could be putting too much pressure on your stomach muscles. This means you may be more likely to get a side ache when running up a long hill (requiring more of a forward lean). Therefore, to get rid of a side ache, try leaning forward even more for a few steps and then leaning backward for a few steps. If this helps, then remember to add this forward and backward leaning to your running every once in a while. It may also help to lean to the left and right once in a while. The idea is to break up your repetitive running habits that could be contributing to the problem. The same goes for varying the foot you land on in relationship to your breathing patterns. According to some writers, you should pay special attention to which foot you land on as you breath out. Just as changing your running posture might help get rid of a side ache, varying which foot you land on as you breath out might also help.
Combining Techniques
The real cause of side aches could be a combination of things that cause stress on our internal muscles and ligaments while running. The villain seems to be repetition: running is, after all, a rhythmic, repetitive activity. Therefore, the solution is to develop techniques to break up that stressful rhythm. Try working out your own solutions using a combination of the methods described in this article. For example, some runners report that it helps to change their posture while changing their breathing patterns. Here is the problem: for most runners, one foot will be come habitually related to inhaling or exhaling. When we run, we all tend to become either right-footed or left-footed. We develop a running rhythm with slight differences in which foot uses the most push-off during each series of strides. As part of that running rhythm, we may get into the habit of exhaling as the right foot hits the ground. Some believe the pain of a side stitch is related to those kinds of unconscious habits; that is, the running/breathing rhythm puts unnecessary stress on the same set of muscles or ligaments with each stride. The solution is therefore to vary your stride pattern. If you get a side stitch, try consciously focusing on exhaling when your left foot strikes the ground for a while and then switch so you exhale when the right foot hits the ground.

Also, pay attention to your eating and drinking habits. Wait for at least three hours after eating or drinking before running. But don't get dehydrated; that can cause other problems, including muscle cramps.

In the end, you will probably have to work out your own techniques. Each runner should develop his or her own methods systematically, by trying out varying combinations of the following:
Strengthen the stomach muscles.
Avoid eating large meals or drinking large amounts of liquid before running.
Periodically take deeper breaths while running.
Periodically purse your lips and forcefully inhale and exhale.
Lean forward or back, left or right to change the pressure on your stomach muscles.
Change the foot you land on during exhalation.

Answer 2

A stitch is usually a pocket of gas in the colon, specifically at the splenic or hepatic flexures. The intestine presses against the diaphragm and causes a shooting pain. Usually arching your back or massaging your abdomen will get the gas moving.