Exercise-related Transient Abdominal Pain (ETAP) is the medical term for the pain that many runners experience near the front lower part of the rib cage, usually on the right side.  This pain is due to the pull of ligaments that attach the liver to the diaphragm.  With repetitive motions, usually in an up and down manner (such as in running), the ligaments pull on the diaphragm and eventually make the diaphragm spasm.  Muscle spasms or cramps typically occur because the muscle is in a prolonged shortened position, are repetitively contracting, are too cold or too hot, are compressed, or the individual is not properly hydrated and/or lacks certain electrolytes for proper cellular processes.

There are several options for preventing a stitch: 

1. Do not increase your exercise intensity too quickly, either within a single run OR in your overall training program.  
2. Be sure to properly hydrate and have a proper intake of electrolytes prior to running.
3. While running, try to avoid shallow (short) breathing.
4. Alternate which foot is on the ground when you exhale.  (This sounds strange, but it actually alters the action of the diaphragm in relation to the downward force of hitting the ground.)
5. Perform respiratory exercises.  One example is to imagine you have "wings" on the back of your ribs.  When you inhale, attempt to "spread your wings" by emphasizing expansion of the posterior aspect of your ribs.
6. Have your posture analyzed.  Certain types of postures, including scoliosis or a history of rib fractures, can predispose you to cramping.

There are also several options to alleviate a stitch when running. 

1. Stop running and "walk it off." 
2. Push your fingers into the area of the pain and push upward, under the rib cage followed by a deep full exhalation.
3. Exhale hard when the foot hits the ground on the side of the stitch or conversely, exhale hard when the opposite foot hits the ground.
4. Slow your breathing down, take slower deeper breaths.
5. Press a finger into your belly button and hold for several moments. 
6. (This works best for me!) Stop and lean as far sideways and forward as you can toward the side of the pain.  Hold for 30-90 seconds.  (If you're stubborn, you can attempt this while running but be cautious as this could strain other parts of your body.)  This movement will put the diaphragm into a shortened position and may cause a release of the spasm.

* Guest writer Dennis Eldridge is a local runner and physical therapist, who works for Outpatient Physical Therapy in Enumclaw and Bonney Lake.  Dennis also does monthly Medical Q & A nights at Fleet Feet. *