Your Health Matters
By Claudia Parks, R.N.

"What is that awful pain you get in your side when you walk fast, run real hard or play soccer?" This is the question that I'm often asked, especially by young people. (Probably because older folks don't "run around" as much as the younger crowd.)

While running or walking briskly, nearly everyone has experienced the sharp pain in the side known as a stitch. A stitch or catch in the side--a sharp, sometimes an incapacitating, but temporary pain. No one knows what causes a stitch, though there's no shortage of educated guesses. One theory is that the diaphragm (the large muscle that separates the chest from the abdominal cavity) sometimes fails to receive enough blood, (which has the oxygen it needs) during its contractions, and much like a leg cramp, these results in spasm and pain. Another theory is that trapped gas pockets brought on by exercising immediately after a meal cause a stitch.

"Sometimes running can block the flow of blood to the diaphragm," explains Gabe Mirkin, MD, a private practitioner at the Sportsmedicine Institute in Silver Spring, Maryland. "Every time you raise your knee you contract your belly muscles, which increases the pressure inside your belly. When you breathe deeply, your lungs expand to a much larger size than during normal shallow breathing. The dual pressure from the contracted belly muscles below and the expanded lungs above can shut off the flow of blood to the diaphragm." Unable to get all the oxygen it needs, your diaphragm will go into a cramp and hurt. If you don't breathe evenly, you can get side stitches when you're running or walking or even laughing.

To prevent side stitches:

• If stitches seem to hit you after a meal, wait thirty to ninety minutes after eating before exercising. Be careful what and when you eat before you exercise. Eat plenty of fiber. Try to have a bowel movement before you begin any exercise if you are prone to side stitches.

• Warm up before exercising a good policy in any case.

• Work out at lower intensity for longer periods, rather than suddenly increasing the intensity of the workout. If you are going to increase intensity, do so gradually.

• Well-conditioned runners and walkers don't seem to get stitches as often, so work at increasing your aerobic capacity.

• Learn to be a belly breather. Look down at your chest and take in a big breath. What moved? If only your chest moved, you're breathing with your chest cavity and that's not enough. To fight side stitches, you want your diaphragm involved in the breathing exercise. One way to tell if you are using that muscle is to get your chest and belly to move when you breathe.

• Keep an eye on your belly. Inhale. Exhale. It should

move in and out.

If you get a stitch:

First stop or slow down, then bend forward and push your fingers into the painful area until the pain stops. Or, gently massage the painful area.

__ Exhale deeply. As you begin to knead the cramp out of your diaphragm, take a breath, then purse your lips and blow it out as hard as you can. Take another breath and exhale again. Continue to massage your aching side and work to slow your breathing to a regular pace.

__ Stretch the abdominal muscles by raising your arms and reaching above your head.

__ Stop to go. Even though a pinched diaphragm may be the cause of side stitches, some walkers and runners will get a similar feeling from trapped intestinal gas.

The American Medical Association Encyclopedia of Medicine gives this brief definition of stitch: "A temporary, sudden, sharp pain in the abdomen or side that occurs during severe or unaccustomed exercise, usually running. The cause of a stitch is unknown. Stitch is also commonly used to refer to a suture used to close a wound (see Suturing)".

It is obvious that what is known, as a stitch is not high up in the pecking order of concerns for the AMA. I've told you all that I know about a stitch--always check with your doctor with a pain that concerns you.

Claudia Parks, RN, is a former doctor's office and emergency room nurse and retired as an educator from Fulton County Schools. She writes Your Health Matters as a public service; the information here is designed to help you make informed choices about your health. It is not intended as a substitute for the advice of your physician. Claudia and her husband make their home in the beautiful north Georgia Mountains. You may contact Claudia at yhm@windstream.net