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Ask Dr. Pribut

Q. I'm 15 and have just started a cross country program. I get "side stitches" which hurt just under my ribs on the right side. What causes this and what can I do to get rid of it?

A. Side stitches are pains that occur usually just under the ribs when running. It seems that an unconditioned diaphragm is the cause of this pain more often than not. Some other causes for this pain include food allergies (often milk), "gas", or just having eaten before running. Either running a greater distance than usual or at a faster pace than usual will bring this pain on.

The diaphragm is a muscle that separates the chest cavity from the abdomen. It moves down when you inhale and moves up when you exhale. When it is subject to more or faster exercise than it is accustomed to it can "cramp" and cause pain.

Side stitches seem to occur most often on the right side of the body. It is possible that the liver may alter the motion of the diaphragm more on that side because of the larger right lobe.

Treatment:

When it is caused by lack of conditioning a few strategies can be employed. First run slower and longer. Breathe fuller and try "belly breathing" where you allow your stomach to be "relaxed" and pushed out as you inhale and then contracted slightly as you exhale fully. Breathe rhythmically and make sure that you are not holding your breath. You can also try counting your breaths 6 in hold 3 out with a forceful exhalation for a 4 count or whatever seems to work best for you and your running rhythm.

Another breathing tactic that is tried is exhaling against resistance through pursed lips. This combined with belly breathing may be the best approach. To conditioning related stitches.

Also I suggest adding an abdominal strengthening exercise to your regimen such as "Crunches".

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© 1998 Stephen M. Pribut, D.P.M. All rights reserved. Materials copyrighted by Stephen M. Pribut may be reprinted for personal use only. Permission to reprint or electronically reproduce any document in part or in its entirety for any other reason is expressly prohibited, unless prior written consent is obtained from Dr. Pribut.