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Q
Preventing Side Stitches?

When exercising, I sometimes have to stop because I get a "stitch" in my side. What causes them? And is there anything I can do to prevent this from happening?

A
Answer (Published 3/9/2006)

Medically speaking, the "side stitches" that you experience are called "exercise-related transient abdominal pains" or ETAPs. These stitches are very common and not serious, although they can be painful and can put a crimp in your exercise session. (People who exercise are much more likely than couch potatoes to experience ETAPs.)

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Stitches are cramps or spasms in the diaphragm, the muscle that separates your abdominal organs from your chest and lungs. When you inhale, your diaphragm drops down; when you exhale, it expands upwards. But vigorous movement can jerk the diaphragm down when it is expanding upward, leading to a "stitch." You may have noticed that stitches usually occur on your right side – this is because the diaphragm is attached to the liver, which is on the right.

To prevent stitches, you can try the following tricks:

  • Breathe evenly and deeply, not shallowly, using your diaphragm. You’re breathing correctly for exercise if you can see or feel your belly expand when you inhale.
  • Avoid running downhill (it increases the force on your body, making stitches more likely to occur).
  • Avoid big meals for three hours prior to exercise.
  • Cut back a bit on the fluids you drink before and during exercise to see if this helps.
  • Purse your lips when you exhale and inhale. This can both relieve and prevent stitches.
  • Stretch your diaphragm muscles before exercise. Just raise your right arm overhead and bend to the left. Hold the stretch for 30 seconds and then repeat on the other side.
  • Slow your pace – stitches may not occur as frequently.
  • Watch your breathing to make sure you’re not always inhaling as the same foot hits the ground. Try to alternate breathing in and out on opposite feet.

When you get a stitch, bend forward slightly and massage the area. (Most people do this naturally to ease the pain.)

Andrew Weil, M.D.

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