Severe side stitches

Hi everyone,
I was hoping someone would have more insight on this because it's really driving me crazy. I've been an on-and-off runner for year, but only recently in the past few months really gotten back into it again, where I'm running about 3-4 times a week. However, in the past 2-3 weeks, I've found that every time I run for about 7 minutes, I start to get really painful and severe stitches under left and/or right ribs. It becomes worse when I run harder, but it'll be a proper stabbing feeling at about 9km/hour. As you can imagine this is extremely frustrating because I'm not unfit and even that tired but it is so hard to have to work through the pain of stitches rather than fitness. I've tried stretching beforehand, eating a good meal more than an hour before I run, trying to run more 'smoothly' so that there is less of a jolting feeling on my body, tensed my abs the entire run (helped a little but not an incredible amount). If anyone has had this before and can help on prevention, or if not then combating the problem that would be greatly appreciated.
Many thanks


  • edited January 2014
    We've all been plagued by stitches at one time or another -- usually at times when the body is responding to our workouts as if it belonged to a newbie, whether we agree with its opinion or not.

    We've all also tried inverse breathing patterns ( 3/5, 5/7, etc.) to hold it off during a race, with varying degrees of success.
    Quick answer: for the moment, slow down.

    What to do to not get them in the first place? I had a coach who used stitches as an opportunity to motivate us to strengthen our abs. Were weak abs the PRIME cause? At the time, I thought maybe, maybe not. But I can tell you that after gradually increasing my situp count to 250/day, I never felt them again unless it was the third lap of a sub-5:30 1500. This convinced me that he was probably right.

    My theory has since been that the faster one runs, the more endurance and strength one's abs, obliques and erector spinae must possess. So if you can't do at least 100 situps as if it were as simple as brushing your teeth, as well tolerate the same number of PROPER back extensions without locking up, you are vulnerable to responding to your workouts just as you did in the first year of running -- even moreso as you demand pace increases. As an individual example, I was stitch-free while maintaining daily:
    150-250 situps (speeding up for sets of ten between 60 and 120, cruise-interval-like)
    100 back extensions
    Every other day:
    5x15(50-70 lbs) R/L oblique rotations
    5x 20 (25-35 lbs) R/L side pulls

    WARNING: DO NOT rush into back extensions if you haven't been doing them; 2 sets of 12 the first time are MORE than enough. Be sure to GENTLY stretch after each set. Add no more than 2 to each set at the next workout, and don't even think of adding resistance greater than yourself until you can easily breeze through 5 sets of 15 in perfect form, without fear of any soreness the next day.

    Why all this other stuff if you mainly need strong abs?
    Hard-to-fatigue abs guard against stitches, but they must be counterbalanced by an equally strong back. The combination of abs and back muscles supports the spine as a team. To stave off future posture related injuries, your situp/ BE ratio capacity should remain roughly 1:1. If situps are done alone, the resulting imbalance will eventually pull the body into a hunched position. And we all know where that leads.

    [OK, safety brief over. :)]

    That said, you're running 9k/hr, which is more or less a 9:40 pace. This may or may not be a decent clip for you relative to your current fitness level. (Make sure you're not "remembering your paces through a fitter body".)

    You didn't mention a warmup -- we've all fallen into the trap of shortchanging ourselves where it's concerned. You deserve a complete warmup, and so do your muscles. Stretching a "cold" muscle can cause it to tighten undesireably -- leaving you more prone to a mild strain.

    At a minimum, save your stretching for after the workout -- this way, you're guaranteed to be completely metabolically warm when you stretch, which will give you the best results.

    Be patient with yourself. The fix is not a "snap your fingers" one. (It took me 4 months to get from 50 to 200 situps. Stitches during competitive 1500s didn't go away until I had incorporated the "situp intervals" regularly for one full month.) But the rewards of balancing your strength and increasing your core's strength endurance are long-lasting, and well worth it.

    Hope these thoughts prove helpful. (In the meantime, breathe in for 4, out for 8...)

  • Hi there,
    Thanks very much for your quick response and great advice. I suppose I hadn't really thought about increasing my core in order to combat these stitches. My core muscles are okay, but of course they could be better. I have been working them out quite often as of late, and I'm wondering if maybe they're being effected as a result when I run? Basically I'll run for 4km or so and then stretch and do 10 minutes of core strengthening. Maybe I need to done down both and incorporate stretching into my routine.
    Thanks again I'll see if any of it makes a difference!
  • edited January 2014

    Hey, my pleasure. I totally feel for you -- Stitches were so annoying -- I even got a sympathetic twinge reading your post! :)

    As long as you're gentle, gradual, consistent and balanced as you incorporate the new ideas, you should notice some gentle progress within 2 weeks, and a noticeable difference within a training cycle (6 weeks). It's also a great time to learn the names of some new muscles!

    And yes, you suspect correctly. Any new training load can affect your running, even if it's as simple as having greater fatigue at the start of a workout. Your abs might have been overtaxed, and thus less able (for the moment) to maintain their supportive function at the intensity you used. Once you adapt to the new load, and own the strength, your abilities should last longer.

    Consider adding grapevine -- also know as kariokee in some places -- form drills into your warmups. Say, 3 sets of 100 meters or ten paces leading with your left side then aame to the right. (Soccer and basketball players might remember this drill from high school.) While this is often presented as a way to strengthen the ab/adductors in motion, it can also be used to focus on oblique flexibilty and strength.

    NB: If you try to do this drill too quickly at first, or if your form is poor, you can actually bring on a stitch -- so go slowly until you have your form nailed down.

    Looking forward to hearing that you banished them!
    Happy running!

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