Side Stitch

Exactly why the diaphragm cramps, however, remains unclear. Some believe that exercise like running decreases blood flow to the diaphragm, causing it to go in to spasm. Raising the knees to run contracts the belly muscles, which increases pressure inside the belly and presses on the diaphragm from below. During exercise, air tends to get in to the lungs more easily than it gets out, so the lungs fin with air and press on the diaphragm from above. The dual pressure, says the theory, squeezes the diaphragm and shuts off its blood flow, resulting in cramping. Another theory suggests that side-stitch pain results from gas trapped in the large intestine. Exercise, like running, speeds up intestinal contractions and pushes gas toward the end of the colon, or large intestine. If the colon is blocked by a hardened stool, cramping can result. Some experts believe that, in some people, side stitch may be related to an intolerance to wheat or dairy products. People with such allergies, they say, who exercise within 24 hours of eating these foods may develop cramping or even diarrhea. Others suggest side stitch can be brought on by any food in the stomach and exercising too soon after eating. While the experts haggle about what causes side stitch, you can learn to prevent it and, if it does occur, make it stop quickly. Here's how.

Belly Breathe : Competitive distance runner and sports medicine expert Joan Ullyot, M.D., author of Women s Running and Running Free, says most side stitches come from improper breathing. "Many people, especially beginning runners, don't breathe properly when they're exercising," she says. "They breathe too shallowly." Michael Martindale, L.P.T., a physical therapist at the Sports Medicine Center at Portland Adventist Medical Center in Oregon, agrees. "People often learn to breathe using only their upper chest muscles rather than the diaphragm muscles," he explains. "During exercise, when they need more air, they breathe faster and even more shallowly. " Ullyot says the key to side-stitch prevention is deep belly breathing. To help people learn how to breathe, Ullyot has people lie on their back with a book on their abdomen. "I have them breathe in all the way in to the belly," she says. "The book must move up when breathing in and down when exhaling. "

Try The "Grunt" Exhale : Because it's much more difficult to empty the lungs than fill them during exercise, it's important to exhale all the way in to your belly. Force air out while exhaling by pushing your abdomen out while making a grunting sound.

Slow Down : Being out of condition and exercising too intensely causes you to breathe quickly and more shallowly. Martindale suggests cutting back on the intensity of your activity. "Slow down," he says. "Build your endurance over several weeks."

Stop : Some people, particularly competitive runners, believe you should "run through" a side stitch. However, unless you're in a race, Ullyot says the best idea is to stop completely until the pain subsides.

Use The "One Hour" Rule : If you've eaten, wait at least an hour before exercising, says Ullyot. "Food in the stomach doesn't bother some people, but for others it can cause cramping," she says.

Massage it : "Anytime a muscle is denied blood, it will go in to spasm and cause pain," says physical therapist Ellen Nona Hoyven, PT., owner and director of Ortho Sport Physical Therapy Pc. in Clackamas, Oregon. "Massage increases circulation and relaxes muscles." If you develop a stitch, gently massage the area with your hands.

Use The "Poke And Blow" Technique : One way to relieve diaphragm pressure is to reach deeply with your fingers in to your belly just below your ribs on the right side. At the same time, purse your lips tightly and blowout as hard as you can, advises Martindale.

Practice Running Fast : One of the possible causes of side stitch is weak abdominal and diaphragm muscles. To increase endurance and strengthen the diaphragm, try running fast a couple of times a week.

Strengthen Abdominal Muscles : Strong abdominal muscles can help prevent side stitch. Try doing bent-leg partial sit-ups in which you raise the shoulders about six inches off the ground (it's less stressful to the back than full sit-ups). Or lie on your back and lift your straight legs a few inches off the ground and hold for 20 to 30 seconds at a time.