These are not really injuries but can be one of the most painful problems for an athlete during a race.

What is a Stitch?

A “Stitch” is a spasm of the diaphragm, which is a large flat muscle under your ribs, which is involved in breathing. When you are lightly breathing then it is primarily the diaphragm, which is moving up and down to expand and contract the lungs. However when we physically work harder the rib cage and surrounding muscles get involved as well. Because the diaphragm forms the ceiling of th

e abdominal cavity it also serves as the attachment point for many of our organs, primarily the liver which is located on the right side of the abdominal cavity. The liver is often the culprit in causing the “stitch” because it hangs from the diaphragm and is the heaviest organ suspended from the diaphragm. So when we run the up and down
motion of your running stride causes the liver to tug at the diaphragm in combination with the extra work of heavy breathing causes the diaphragm to go into spasm, causing pain

Signs and Symptoms

  • Pain at the side of the rib cage, which is sharp and stabbing and often begins
    with heavy breathing.
  • The pain is mostly found on the right side of the rib cage but can also affect the left side and occasionally the shoulder or neck region.

What To Do About It

The best way to cope with a “stitch” is to control your breathing. If say you had a “stitch” on the right side then exhale when your left (opposite) foot contacts the ground in your running stride. This trick will work in the majority of runners. If the “stitch” is on the left side you can try doing the opposite but tend to be a bit more stubborn than those on the right side. Another method of resolving a “stitch” is to breathe twice as often yet take in smaller breaths or simply just try changing the rate of breathing in some way. Or you could try running faster or slower to alter the pat
tern of the up and down motion of running.

If you find that this becomes a chronic problem you should consider seeing a health care provider who has experience with athletes and diaphragmatic problems so that they can examine if there are other factors involved in causing the problem.