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How to Avoid and Cure Stitches

Stitches. Those pesky buggers. Just when you’re feeling strong and the trail is flowing beneath your feet – then ouch! A sharp stabbing pain digs into the ribs.

We’ve all had them. They’re the irritating occupational hazard of running, and can be debilitatingly painful. And whilst there are many old wives’ tales, just why they appear when they do can be infuriatingly elusive. Often there seems to be no rhyme or reason.

The unfortunate truth is that the exact cause of stitches is still unknown. They’re linked to cramping or irritation of the breathing muscles (the diaphragm at the base of the lungs, and the intercostal muscles along the ribs) but why exactly they occur has not yet been agreed on.

So rather than dig into the knowns and unknowns, this article outlines the far more useful stuff. What can we do to prevent and get rid of our unwelcome running companion Stitch?


Prevention is always better than cure!

1) Don’t eat too soon before running

There is truth in the old wives’ tale. Stitch thrives on a full belly. Yet for ultrarunners who have to eat on the run, we need to look a little deeper. The theory here is that, after eating, blood is diverted to the gut for digestion, depriving our breathing muscles of the necessary blood flow and causing stitches. So the best bet is to avoid eating soon before setting out, and if you have to eat on the move, keep it little and often for easy digestion.

2) Stay fuelled

Conversely, if we’re out of food, the lack of fuel can cause cramps. Running after many hours of an empty belly can be a sure recipe for stitches.

3) Hydration

Any longer distance runner will have experienced dehydration cramps in the legs. The same principle applies to the breathing muscles. Keep them hydrated! Remember that a deficit of both water and salt can cause dehydration, and try to make sure you’re hydrated before you head out. Don’t get behind before you start!

4) Warm-up

Perhaps an obvious one, but so often ignored. How often have you got a stitch from starting out too fast? Give your muscles a chance to generate some heat, get the blood flowing and man the barricades against Stitch’s assault.

5) Run smooth

Another common theory is that bouncing of the lower abdomen causes stitches by tugging on the ligaments above. It explains why downhill running often causes the worst stitches, even when we’re not trying all that hard. The smoother you run, the less bouncing there’ll be. It’s also another good reason not to eat a large roast before a workout!

A note on fitness

It’s a fact that stitches are more common in the unfit. Whilst even elite athletes do still get them, there’s no escaping that the fitter you are, the more it takes to stress your muscles and cardiovascular system to the point of stitches. Feel reassured that you’re reducing your stitch-vulnerability with every run you do!


However careful we are, it’s going to happen sometimes. So what can we do when Stitch rears his ugly head on the run.

1) Breathe deeper

Stitch is an anaerobic animal. He thrives when the muscles aren’t getting the oxygen they need. Sometimes just a few big, deep breathes can be enough to remove the pain. Another trick is to pull in the diaphragm when breathing out, and push it out when sucking in. By reversing the breath-to-muscle pattern, it seems to get the diaphragm under control again and reduce those low-down stitches.

2) Massage

For the higher-up ones, a good prod under the ribs can sometimes send Stitch running. But beware – he puts up a fight: massaging a stitch can hurt like hell!

3) Swing the arms more

Stitches can be caused by the core muscles being overworked. It’s why they’re so common if you run the day after an intense core workout. When we’re running, the arm swing acts to stabilise the trunk’s rotation. But if the arm swing isn’t enough then the core has to do the job, and often it isn’t up to the job. Sometimes just swinging the arms a little more or a little faster can be enough to bring back the peace. It’s also yet another reason to get strengthening those core muscles!


So, while stitches may all be a bit of a mystery, there are very real steps you can take to avoid them. And when they do strike, give these tips a go – they might just do the trick.


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