By Coach Frank Pucher

Here is an email I recently received from a concerned parent on the subject of side stitches along with my response.

Q: My son is distance runner. He runs cross country and track. He is 16 yrs old. His PR in cross country is 15:57, 2 mile is 9:55, and the mile 4:41. He could do better but he has trouble with side stitches. When he gets one of these he is dead in the water. Some races he goes on. He is ranked 3rd in the state of WV in cross country. We never know when he will get one. One race he will do very well. The next race he will get a stitch or maybe not. Usually these are under the right rib cage sometimes the left or both. Is there some type of training we need to do, what do you think? What do you think on the subject of stitches? I have asked our coaches at school and others such as physicians but I don't think anyone knows what to do.

A: Congratulations to your son on some impressive PR's. My initial instinct is to ask the question "what did his Physician say/suggest?" Assuming no medical explanation, I'll assume that it's nothing more than the dreaded Runners Side Stitch. Usually a Stitch is the result from a diaphragmatic spasm. They aren't dangerous although as you noted, they stop you in your tracks (no pun intended). Something I have used with success in some of the athletes I consult with is to:

(1) Take in a large deep breath, hold it for 5-10 seconds, and forcefully blow it out. Repeat this 2-3 times.

(2) Always use a an easy warm up before competition and perform step #1 several minutes before race time.

The bottom line is that the diaphragm is usually just cramping up and like any muscle needs to be stretched out. Deep breathing helps to do just that (like a balloon filling with air).

One final preventative measure is to suggest an exercise to strengthen the diaphragm: it's called the Dumbbell Pullover. Your son may be familiar already with this exercise - if not his Coach/PE instructor will be.

• Slowly take the dumbbell back over your head, breathing in and keeping arms straight;
• If your back starts to arch as the arms go back, use your abdominal muscles to maintain the neutral lumbar spine position. (This exercise can boost your core stability as well as your arm strength);
• If your back starts to arch a lot or you feel the stretch in the shoulders, stop. Be careful not to stretch your shoulders too far with a large weight, as you could strain them;
• Taken to the correct range of stretch, the weight will improve range of motion in your upper spine and shoulders. You will feel your chest pointing up and your upper back arching a little, while your lower back remains in neutral.

Pull Movement

• Keeping elbows straight, pull the dumbbell back over your head to the start position;
• Focus on keeping shoulders wide as you pull, and avoid hunching up;
• Breathe out once the dumbbell has returned to the top;
• As before, use your abs to control your back position throughout the pull movement. Only your arms should move during this exercise.

This is a great exercise to again practice "deep breath, forceful exhale" just like before race time. Have him perform this exercise 3x weekly (2-3 sets of 10-12). After a couple of weeks he can do this exercise 2x weekly and he'll be fine.

I hope this helps! Good Luck to your son the rest of the season.

Final Thoughts

My response to her is not meant to replace medical advice or diagnosis. Any pain that an athlete complains of for any period of time should always be evaluated by the proper practitioner!

I've never finished a run and thought, "that was a waste of time." - Frank Pucher

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