From http://www.hhp.ufl.edu/keepingfit/ARTICLE/stitch.HTM
Patrick J. Bird, Ph.D.
Keeping Fit
Column 675
1999
Q. What at causes a "side stitch" when running? I experience it every so often when running hard. Also, my daughter, who is starting to run with me, gets it about every time we go for a run. What can be done about it?
A. Many of us have experienced this cramp like pain. It usually strikes when performing vigorous, upright, jolting activities such as running (particularly when going down hill) and aerobic dancing. Cyclists and swimmers, however, are not immune to the experience.
The "stitch" is felt on the side, just below the ribs. Sometimes it is accompanied by a stabbing pain in the shoulder joint. It can be briefly excruciating, with some discomfort lasting several days. And the desire to avoid this pain can turn kids and adults alike into life long coach potatoes. The "stitch" is generally not known to indicate or lead to anything serious.
The cause of the problem is not fully understood. There are two main theories. One is that the diaphragm cramps during exercise because blood is shunted away from this respiratory muscle to meet the increased fuel requirements of the exercising muscles. The second theory, which seems to have the most support, is that the "stitch" comes from the tugging of organs on the diaphragm. That is, ligaments supporting the stomach, liver and spleen are also attached to the diaphragm, and the bouncing of these organs during exercise places stress on the diaphragm. Since this tension is greatest where the diaphragm attaches to the ribs, the pain is felt mostly under the ribs. There seems to be no explanation of why the pain is sometimes also in the shoulder.
Stich Stoppers. Fortunately, there are techniques that may help you or your daughter relieve or prevent the problem. To relieve a "stitch" here are some things to try. :
 | Lie down with your hips elevated. This can provide immediate relief and help differentiate the "stitch" from other conditions, including chest pain due to heart disease.
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| Do some "oblique" situps – that is, on the way up in the situp, twist toward the side of the pain.
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| While running, contract your stomach muscles, lean a little forward, and push your hand against the site of the pain. Also, as you breath out, don’t release all the air from your lungs and resist the expiration of air with pursed lips. |
To decrease the risk of getting a "stitch":
| Exercise on a relatively empty stomach. That means waiting two or three hours before exercising after a meal.
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| Avoid consuming a lot of fluids at one time. To stay hydrated drink, take small amounts of fluid, preferably a sports drink or water, at intervals before and during the run.
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| Strengthen your stomach muscles.
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| Finally, follow a progressive training schedule that incrementally increases the exercise intensity and duration. Start easy and build slowly. |
