Dear footnote,

I'm a fairly new runner and I keep getting stitch. It's really annoying as I feel I can run much further but this stops me. What is it & how do I get rid of it?

Thanks sausageroll

Hello sausageroll (if that is your ‘real’ name!), Merry Xmas and thanks for your question!

The mysterious side stitch or ‘exercise related transient abdominal pain’ (ETAP) for people who probably do not get an ETAP too often! We have all had it; one minute you’re a flowing with style and grace, the next second you feel as though you have been shot in the side by a sniper.

What is it?

I am sorry to say that apparently the side stitch is still considered a mystery! The side stitch commonly occurs under the rib cage on the right hand side that many doctors say is related to the liver. The latest theory is that “the side stitch is caused by stretching the ligaments that extend from the diaphragm to the internal organs, particularly the liver. The jarring motion of running while breathing in and out stretches these ligaments”. However swimmers also get side stitches and they obviously do not have a jarring motion.

They say side stitches are more common when runners exhale when they land on their right foot. When this occurs the liver drops down just as the diaphragm rises up for exhalation. This is said to lead to spasms in the diaphragm and cause that screwed up face you pull!

How do I stop it?

Before I researched ‘ETAP’ I heard (what I thought was an ‘old wives tale’) that if you put your hand under the right hand side of your belly and push up when your right foot hits the floor, it would eventually stop the pain. Well, apparently this works! I have not had a stitch in years so I cannot say I have tried and tested this so I will have to leave the testing up to you.

Other theories include:

• Stop running and take normal long breaths (you probably have figured this one out already!).
• Try and exhale on the opposite side of the stitch when the foot makes contact with the floor.
• Do not panic and try and relax to keep your mind off the stitch. When you pull that face and arch over to one side you are not allowing your diaphragm to relax.

How do I prevent stitches?

Stitches occur more frequently with beginners because the diaphragm is still adapting to the stresses of running. Whatever your natural ability or speed, beginners tend to get stitches more often because they take shallow breaths when they run too fast without an adequate warm up. These shallow breaths increase your chances of getting a stitch which is why many people get stitches early during a run rather than at the end of one. You can therefore help reduce the chances of a stitch in the following ways:

• Review your warm up routine and stretching

A slow jog for 10 -15 mins is recommended by the footnote followed by side stretches and over-exaggerated breathing. Remember a good warm up jog is when you can perform conversations with full sentences! If you are going for a long run and tend to ‘warm up’ as you go along then I suggest you take the first 10-15 mins easy before increasing your pace.

• Review your eating habits

A full stomach with increase the force on your diaphragm and therefore the risk of a stitch. Personally I cannot eat food 2 hours before I run without getting a stitch. This is very annoying but it is just how certain bodies are. Trial and error is the only way to find out what works for your body.

Sadly there seems to be no perfect answer to stop your stitch or ETAP but I am certain that once you investigate the above suggestions you will get to the bottom of your problem.

I'm sure the community have some other tips on how to get rid of a stitch? If so share!

Tags: stitch, side stitches, ETAP, pain in my side, stitch face

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