On To Sport,  Got a stitch while running?

By: Kate Simmons
The sensation of a "stitch in the side", otherwise known as "exercise related transient abdominal pain (ETAP), is most often caused by an activated trigger point in the serratus anterior muscle, pain projected to the side of the ribs and the back of the chest, also sometimes down the ulnar (inside/pinkie side) of the arm:
 
This is often experienced by those who have stiffness or lack of tone in this and other muscles of the myotatic unit: pectoralis minor and upper fibers of pectoralis major.
 
Symptoms can include the pain pattern above, especially precipitated by deep breathing, i.e. a "stitch-in-the-side" while running.  Similar pain may also arise from TrPs in the abdominal oblique muscles. 
...Patients with this myofascial syndrome may report that they are "short of breath," or that they "can’t take a deep breath, it hurts". They frequently are unable to finish an ordinary sentence without stopping to breathe; patients find this especially bothersome while talking on the telephone.  Although these patients are likely to receive a cardiopulmonary work-up (rightly so) for dyspnea, the cause is reducedtidal volume due to restricted chest expansion. [1]
 
Serratus anterior is a muscle, with functional properties the same as any other muscle.  If it is out of tone (meaning lack of regular and successful functional usage), it has less robust circulatory return, less strength and endurance, and it is more likely to cramp in the short-term and to develop latent or active trigger points in the long-term.  You are, simply, more prone to getting a "stitch-in-the-side" as a beginning runner.  This is something I experienced a lot when I was beginning to learn to run, as have countless others trying to learn; even those returning to it after a hiatus. 
 
Good ways to deal with it:
1. While running, press against, or squeeze, the painful area in order to keep going.  This will hopefully produce a powerful counter-stimulus to interrupt the trigger point’s activation pattern signal. 
2.  If this doesn’t work, you need to slow down or stop running for a bit, in order to slow the forcefulness of breathing.  If the muscle isn’t being as aggressively utilized, it will be able to release and relax more easily. 
3.  Try feeling for an area in the muscle around the "x" (pictured above), where you might feel a "knot" or trigger point: it feels like a knot in taut rubber band following the lines of the fibers of serratus anterior.  Once you find the "knot/TrP", apply steady and tolerable pressure to it for at least 60 seconds, in order to feel it relax, like a water balloon with holes in it beginning to deflate.  
NOTE: If the "band" is in a hard spasm (tight and painful) and you are finding it hard to breathe, STOP,  lie down and rest: wait until your breathing normalizes and the pain recedes a bit: the spasm will not abate until the muscle’s functional load has been reduced enough to return to its’ level of normal capability.  Trying to run "through the stitch-pain" will most likely result in a massive sprain, inflammation, and months or years of therapy = Not Worth It.
4. Once the knot has been released (the feeling of the knot dissolving like a water-balloon), take the muscle through it’s full length of stretch, while inhaling carefully, slowly and fully, like an accordion expanding:
 
When I asked him about stiches and why I was experiencing them, he informed me I was not breathing correctly.
His advice was to learn the correct breathing technique - in your nose, draw the breath into your upper abdomen, not your chest, where your stomach actually pushes out slightly, then finally, out your mouth. 
The breathes should not be long, deep breaths, but short and succinct.
To see if you understand the method, place the palm of your hand above your belly button and breath in through your nose. Take the breath in until you feel your hand moving slightly outward with your stomach, then exhale through your mouth and your stomach recedes.
This technique works. If you can master this breathing you can eliminate stiches altogether. Getting the technique under control, while you’re actually running, walking, etc., is a little harder than it reads. Give it a try.
 
Louis Tracy also commented about the the breathing tequnique
I can only attest to what I was told by my friend, who runs marathons. When I asked him about stiches and why I was experiencing them, he informed me I was not breathing correctly. His advice was to learn the correct breathing technique - in your nose, draw the breath into your upper abdomen, not your chest, where your stomach actually pushes out slightly, then finally, out your mouth. The breathes should not be long, deep breaths, but short and succinct. To see if you understand the method, place the palm of your hand above your belly button and breath in through your nose. Take the breath in until you feel your hand moving slightly outward with your stomach, then exhale through your mouth and your stomach recedes. This technique works. If you can master this breathing you can eliminate stiches altogether. Getting the technique under control, while you are actually running, walking, etc., is a little harder than it reads. Give it a try.