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Side Stitch


According to Doctors Janet Travell and David Simons in their widely acclaimed medical textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual, myofascial trigger points (tiny contraction knots) in overworked serratus anterior muscles are the most frequent cause of the incapacitating stitch in the side that afflicts runners and other athletes.

The serratus anterior muscles are located under your arms, just down from the armpit. Their function is to aid inhalation by assisting expansion of the ribs when you are breathing strenuously.


Hampered Breathing

Pain from trigger points in a serratus anterior muscle is usually felt in the side and in the mid back at the lower end of the shoulder blade. Typically, you can’t take a deep breath without pain, nor can you exhale completely. Normal breathing may hurt too, so you may be limited to shallow chest breathing in an effort to avoid pain.

Cascade of Symptoms

When serratus anterior muscles are in trouble, additional stress is put on the scalene, sternocleidomastoid, and serratus posterior muscles, all of which aid in forced inhalation. This can result in a growing cascade of myofascial symptoms, from headaches and jaw pain to dizziness and numb hands, making a whole list of mistaken diagnoses possible.

The Dual Function

The serratus anterior is an interesting muscle in that it has a dual function. In addition to being an auxiliary breathing muscle, it also rotates the shoulder blade to position it for raising your arm.

Without the serratus anterior, you wouldn’t be able to raise your arm above shoulder level. Since the serratus anterior is so active, not only in strenuous breathing, but also in movements of the arm and shoulder, it’s particularly vulnerable to overuse in tennis, swimming, running, chin-ups, push-ups, weight lifting, and workouts on the pommel horse or the rings.


You can find the primary serratus anterior trigger point on the most prominent rib on your side, about three fingers widths straight down from your armpit. Generally, this will be the site of greatest tenderness. When this trigger point is very active, you won’t like touching it.

Luckily, it doesn’t take much pressure to have a beneficial effect. Be aware, however, that trigger points can exist on any of the nine ribs this muscle attaches to. If you have trouble getting rid of the pain in your side, search the whole rib area under the arm, clear up into the armpit.

The fingertips can be used for massage of serratus anterior muscles, but they will tend to tire quickly. To save your fingers, try using a tennis ball against the wall. Or just hold the ball in your hand and pull it slowly across the trigger point.

A few slow, deep strokes across serratus anterior trigger points can give immediate relief. On the chance that the diaphragm muscle is also involved, search for trigger points with your fingers deeply up behind your ribs in front.

Trigger points should be at the top of the list during any examination for side stitch and other kinds of pain suffered by athletes. When healthcare practitioners have had adequate training and experience, trigger points are easy to locate and treat. In fact, there are ways to treat them yourself quite effectively.

trigger points workbook

In The Trigger Point Therapy Workbook, nationally certified massage therapist Clair Davies simplifies Travell and Simons’s extensive research into myofascial pain and makes it accessible to the layman. When trigger points are the cause of your side stitch, you can gain significant relief using safe, precise methods of self-applied trigger point massage.

To find out more about the book and the method, please visit the homepage. To read a growing number of reviews by people who have been helped by the book, take a look at the book’s page at Amazon.com.

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