The Side Stitch

You’re part way through a training run and then it shows up, that pesky cramp in your ribs on the right side. You contemplate if you drank too much water, or too little electrolytes, you try to raise your arms above your head and lean away from it, all to no avail and you slow your pace until the pain eventually subsides, and you finish your run feeling dejected and confused. Cramping on the right side of the ribs or the “side stitch” as it is commonly called in the running population has many myths about where it comes from, and twice as many folklore remedies on how to get rid of them. Today I am going to clear the air a little bit and help provide some insight into these pesky pains. 

First, is it a cramp? While it can be a cramp, it typically is not. If your run is not longer than 90 minutes or in a hot and humid environment, you more than likely have not depleted your electrolyte stores to a point that you would be experiencing cramps. It most often comes from something called reference pain. The diaphragm is the main muscle of breathing. It covers the bottom of the rib cage and moves up with breathing out and down with breathing in. This muscle is innervated by something called the phrenic nerve which carries both movement and feeling information to and from the brain. Some of the nerve fibers go through the diaphragm and insert on its underside. On the underside of your diaphragm on the right is the liver. When we have a dysregulated breathing pattern, it can cause a spasm of the phrenic nerve which is experience as pain on the right side where it interfaces with the liver. So, what then is the cure for this? This is something known as the physiologic sigh. The physiologic sigh is a double inhale, preferably through the nose, followed by a prolonged exhale, ideally through the mouth. This double inhale causes a forced opening of the little air sacks (alveoli) of the lungs, helping use restore normal function. For a side stitch, typically 2-3 sighs are done in succession. This helps calm the phrenic nerve and restore a normal breathing pattern to the diaphragm. 

A couple closing points: first, if you are around 90 minutes into a workout and experiencing cramping elsewhere in the body as well, your side cramp may be due electrolyte and fluid balance. If you are experiencing pain on the left side, this is often due to air or excess fluid in the stomach. The physiologic sigh is a powerful tool, but only on this particular type of side cramp. So the next time you get one of those annoying side cramps on a run, give this tool a try.