Dear Doctors: Every once in a while when I'm running, I get a sudden jabbing pain in my side, right under my rib cage, that makes it hard to get a deep breath. Our gym teacher used to call it a "stitch." It feels like your lungs can't expand. Is that what is happening? How do you get rid of one?
Dear Reader: Your description of the physical phenomenon known as a stitch -- sometimes also called a "side stitch" -- is quite accurate. The sudden onset and the stabbing pain that interferes with breathing are classic symptoms. Some people also experience a tugging sensation, and for others, the discomfort is limited to a dull ache. However they present, side stitches are surprisingly common. It is estimated that about 70% of runners experience at least one per year. They can also arise during other forms of exercise or exertion. And while the "I can't breathe" element can feel alarming, a side stitch is generally considered to be a temporary and harmless episode.
So, what's going on? The primary physical sensation of a side stitch can make it feel as though the lungs are ground zero for the phenomenon. However, the true location is found in the medical term for these episodes, which is exercise-related transient abdominal pain. If that sounds a bit vague, there's good reason: For all that side stitches are universal, recurring and common, the reasons why they occur are not yet fully understood. One premise is that the discomfort is triggered by exercise-induced irritation in the lining of the abdominal and pelvic cavity. Another theory suggests the stabbing pain and the subsequent effect on breath is caused by spasms of the diaphragm. Stress on the visceral ligaments that support or suspend the abdominal organs is also suspected to play a role.
What everyone can agree on is that side stitches are both painful and inconvenient. To try to avoid them, be sure you're hydrated before and throughout physical activity. However, being too full can actually contribute to a side stitch, so you need to find a middle ground. Avoiding food and sugary drinks two or so hours before a workout can be helpful. The 10-minute warmup period that some people now choose to skip may lower side stitch risk.
When an episode occurs, don't try to power through it. Instead, ease the pace of the exercise you are performing. Take a slow, exploratory inhale to test the amount of "give" in your breath. Make subsequent breaths slow and deliberate, gradually increasing the volume of each inhale when possible. Some people find that putting direct pressure on the stitch can mute the pain. Others say bending over while breathing slowly during an episode can speed recovery. It often takes several minutes, but the stitch will loosen its hold.
If episodes of side stitches escalate from occasional to frequent, if they occur independent of exercise or if they don't ease after exercise has stopped, it would be wise to seek guidance from a medical professional.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
