What is IT Band Syndrome?
Iliotibial Friction Syndrome is one of the most common causes of “Runner’s Knee” and can account for up to 22% of overuse injuries in runners (Worp et al., 2012). The ITB attaches to a bony protuberance on the outside of the knee, and slides back and forth across this point with movement. Repetitive sliding in this area can create excess friction, especially when the knee is bent at 30 degrees, which is the motion that commonly happens just as your foot strikes the ground while running. ITB Syndrome is typically caused by poor biomechanics due to underlying muscle imbalances, such as weak hip rotators, gluteal muscles, or core muscles.
Symptoms of ITB Syndrome include sharp or burning pain right above the outer part of the knee, swelling over the outside of the knee, and pain during early knee bending. ITB Syndrome also worsens with continuance of running or other repetitive activities. If you detect any symptoms, the best way to get rid of ITB syndrome is to rest immediately, and take a break from running for a few days (Worp et al., 2012).
Perform exercises or stretches such as the following:
Lateral Quad Stretch:
Rolling Out The IT Band:
If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.
Worp, M., Horst, N., Wijer, A., Bacx, F., & Sanden, M. (2012). Iliotibial band syndrome in runners: A systematic review. Sports Medicine. 42(11). doi:10.1007/BF03262306
A proper warm-up prior to a run is important to increase the heart rate, blood circulation to the working muscles, and joint efficiency. However, cooling down is an essential component of the training process and should be completed at the end of every exercise session. It is important to cool-down after a run to transition the body back to a steady, resting state by decreasing the heart rate, breathing rate, and body temperature. Cooling down also returns the muscles to their optimal length-tension relationships and returns blood from the extremities back to the heart. Skipping a cool-down or performing it incorrectly can cause your muscles to become sorer and stiffer which may lead to unwanted injuries.
The following is a guide for optimal post-race recovery:
1. Slow jog or walk
Immediately at the end of a run, it is ideal to slow your pace down to a jog or a brisk walk to gradually lower your heart rate. Ending your run abruptly may cause blood to pool in your legs instead of returning it to the heart and brain. This can lead to a risk of fainting or feelings of lightheadedness. Jog or walk for approximately 5 to 10 minutes.
Exercising will cause more sweating and loss of fluid in the body which may lead to dehydration. Restore fluid levels in your body by rehydrating with water. It is important to stay hydrated to help manage your body temperature, remove waste from your body, and protect your tissues and joints.
3. Total Body Stretching
a. Pigeon Pose:
Begin in 4 point position on a yoga mat. To stretch the right posterior hip, including the Piriformis muscle, straighten out the left knee pushing the left foot back. Then bring the right knee forward towards your chest while supporting yourself with your hands in front. Making sure that your left and right pelvises are level with each other, bring your right foot across turning it to the left side. Then reach forward on the mat with your hands bringing your elbows towards the mat while keeping both sides of the pelvis level and down. Hold for 30 seconds and do 3 sets on each side 2 times daily.
b. Hip Flexor Stretch:
Kneel down onto your left knee. Then rotate it about 45 degrees past the midline of your body. To keep your posture nice and tall imagine there’s a string pulling your whole spine upwards from your pelvis, right up your entire back and neck and up to the top of your head. Then engage your inner core muscles tight below your belly button and keep your low back flat. Next, bend the right knee forward and keep your posture nice and tall without leaning backwards. Then reach your left arm up pointing the fingers towards the ceiling nice and high and point your right finger tips to the floor. Hold this stretch for 30 seconds and repeat 3 times for each side.
c. IT Band / Lateral Quad Stretch:
Start by lying on your good side with the tight Iliotibial Band or “IT-Band” facing up. Keep your inner core muscles below the belly button engaged while keeping your low back flat. Then, bring the bottom knee towards your chest and with your left hand, reach down and back for your other leg above the ankle. Pull the heel back towards the bum while keeping the core engaged and the low back flat. Keeping the top knee and ankle parallel and level with the floor, lift your bottom heel onto the top part of your knee. Next, guide your lower leg down toward the floor with your heel while keeping the top leg, knee and ankle parallel and level to the floor. As the top leg is lowered down, have the top knee and thigh pointed downwards so it’s in alignment with your whole spine. Hold this stretch for 30 seconds and repeat 3 sets 2 times daily.
d. Lat Stretch:
To stretch the right lat, place the back of your right hand to your left side in front of you while clasping it with your left hand. Reach forward to your left and keep your elbows straight. Keep your knees wide apart and the back of your feet flat on the mat. Reach forward and lean to the right arm pit. Hold for 30 seconds, do 3 sets. Repeat on the opposite side if it’s also tight!
e. Shoulder Stretch:
To stretch out the right side, reach your right hand up and down your back keeping your right elbow pointed upwards. Avoid arching the back by keeping your spine in neutral. Pull the right elbow towards midline with your left hand while keeping the right elbow pointed upwards. Hold this for 30 seconds doing 3 sets on each side daily.
f. Rolling out the Hamstrings:
Put the roller on the ground and bring your hamstring onto it. Roll up and down onto your Hamstring muscle while supporting yourself with both hands. Find the sweet spots (or the areas that hurt in a good way) and continue to roll over these areas for 3-4 minutes in total. Do this 2-3 times a day just before you stretch out the hamstring.
g. Rolling out the Calf Muscles:
4. Additional Measures
Take a 5-10 minute cold water bath to reduce swelling. Allow 1-2 days post-run to allow the body to recover before massaging any tight muscles.
Running is a great way to improve aerobic fitness and cardiovascular health. Running not only burns calories, but can contribute to one’s mental and physical health. However, a large percentage of individuals who run are exposed to a wide range of running-related injuries, most of which are due to overuse. Up to 80% of the injuries occur in the lower extremities with the knee found to be the most commonly injured body part (Callahan, 2018). Patellofemoral pain, medial tibial stress syndrome (shin splints), achilles tendinopathy, iliotibial band syndrome, plantar fasciitis, and stress fractures are the most common diagnoses.
In the majority of cases, pain may arise in the lower extremities due to intrinsic factors such as being overweight, having weak core and leg muscles or with changes in foot type such as having flat feet. Extrinsic factors such as poor footwear, not stretching, or an unbalanced diet may contribute to running-related injuries. The main risk factor to running-related injuries was due to having a previous injury in the last 12 months. It is important for your physiotherapist or coach to be aware of all previous injuries that you may have sustained.
Acute treatment includes stretching the posterior structures, massage, ice, activity reduction, taping, corticosteroid injection, or orthotics. Long-term treatment includes strengthening the intrinsic foot, ankle and hip. New footwear, night splints, or surgery may be indicated if conservative treatments are unsuccessful. Consult your physiotherapist or coach for the appropriate treatment.
RETURN TO RUNNING CHECKLIST
Ensure there are no signs or symptoms of inflammation and you have gained the full ability to weight bear through your legs and feet. You should be able to hop in multiple directions on each leg and should be able to walk at a speed of at least 5.6 km/h (or 3.5 mph). Toe dexterity, or precise control of the toes, should be present in each foot and you should be able to balance in a wobble-free manner for more than 30 seconds.
Below are some key exercises to stretch and strengthen muscles essential to improving running performance and reducing the risk of running-related injuries:
A) Wall Squat
The exercise shown above can help with the retraining of the core stability, hip, leg and ankle muscles.
B) Psoas March
The exercise shown above helps increase hip flexor and core strength.
MUSCLE STRENGTHENING & STRETCHING
A) Bridging Hamstring Curls
The exercise shown above helps strengthen the hamstrings, glutes, and core stability muscles to help protect the ligaments of the knee.
The exercise shown above helps strengthen the hip, quad, and core muscles to prevent leg injuries.
C) Wall Plank Resisted Knee Highs
The exercise shown above helps reduce anterior hip pain and weakness that may contribute to running-related injuries.
D) Lateral Quad Stretch
The exercise shown above is particularly helpful if the Iliotibial Band is tight due to stiffness in the lateral quadriceps muscle. Overuse knee pain can be caused by excessive running.
No one wants an injury to derail their training plans. It doesn’t matter if you run for your mental health or are training for a race, an unplanned break is something we’d all like to avoid. Although no plan is 100% injury-proof, there are steps you can take to prevent running injuries.
Many runners go from standing on the curb to running without a workout. We’ve heard pre-run stretching may be bad, so what else is there? A great way to prepare your body for the work ahead is to add Neuromuscular Activation & Dynamic exercises to your pre-run routine – particularly on strength, speed, or distance workouts.
NMA (or Neuromuscular Activation) refers to communication between the nervous & muscular systems. The goal is to prepare your muscles for a specific movement pattern – in this case, a certain type of run. The result is increased force and power from the muscle fibers, which is an ideal way to get the most out of your workout. The Dynamic stretching part of the helps you improve range of motion, without reducing power force and power and is an alternate to the static stretching you may have tried in the past. It also offsets any reduction in force and power that can result from static stretching.
2. Smart Mileage Increases
Too much, too soon is a very common reason for an injury. The most common recommendation (and good starting point) is to keep you mileage increases at 10% per week. And plan recovery weeks after no more than 3 weeks of increasing mileage (3:1 ratio).
But those recommendations are not cast in stone and the more you run, the more you can test out different approaches. For more experienced runners – you can try larger increases with steady mileage, instead of the 10% rule.
Another variable to adjust is the time between recovery weeks. The 2:1 ratio (versus the standard 3:1) works best for many runners – both physically and mentally.
3. Distance, Then Speed
This one is particularly important for new runners (and those coming back from a break). We want it all – to run further and faster all at once, but it’s a risky plan. Take your time and focus on building your mileage first.
Once you have build a solid base mileage (at least 15 miles a week), you can start to add in quality work. Start with hill repeats to build functional strength in your legs – then you can progress to speed work.
4. Consistent Running
When life gets in the way, sometimes your running takes a backseat. Be very careful in this situation and watch your weekly mileage. Having one week with reduced mileage is okay, but if you’re constantly missing workouts and having large fluctuations in weekly mileage is a problem.
This is the time to think about your goal – should you adjust down to a lower mileage that you CAN sustain or find a way to fit in your planned workouts. Be honest with yourself!
5. Strength Training
Often overlooked, but a critical factor in avoiding injury! Strength training is key for any balanced athlete – which includes healthy runners. Including strength in your training plan will help you avoid muscle imbalances that can lead to injury. Like a hamstring strain from overdeveloped quads & underdeveloped glutes and hamstrings.
A full body strength training program will help keep you healthy, as well as building muscle that will help your run performance. It’s a win-win! You can get an effective workout at home or in the gym, so find a plan that fits your schedule best.
6. Stretching & Foam Rolling
Although pre-run stretching has mixed results, stretching post-run is less controversial. It works best for your running routine to help keep your muscles loose and prevent injuries caused by tight muscles. A combination of static stretching and foam rolling is great for best results.
Many injuries that runners experience are due to the repetitive motion of running. One way you can counteract that (in addition to strength training) is to add in complementary sports to use your muscles in different ways. This is one reason many runners add duathlon or triathlon to their list, as biking and swimming can be very helpful for running! And you may find a new sport that you love!
Biking helps build leg strength and many people find that results in better running! Swimming builds your lung capacity, which helps you run harder. And variety is almost always good for your mental enjoyment!
Last, but not least, is nutrition. Think of nutrition as building your body’s ability to withstand the effort of training. You need to fuel your body with what it needs to power your workouts – resulting in better performance. If you don’t eat enough, your body doesn’t have enough fuel to power the workouts you’re asking it to do. Two keys to consider for running include daily calcium (1000+mg for bone health) and refueling with carbs & protein (3:1 ratio) after workouts.
For general health, you should be drinking plenty of water (start with your bodyweight divided by 2, in ounces), eating tons of dark colored veggies, and focusing on lean protein. A healthy body will be in the best position to support your training – eat like an athlete, not a weekend warrior!
Training for a race is no easy task, and proactively preventing injuries is key to crossing the finish line with zeal. Here are some stretching and strength-training exercises to keep you healthy and strong as you log all your miles. Performed in order, this combination of exercises can help minimize common running injuries that often occur as you increase your weekly mileage or up your speed.
Lying Knee Tucks
- Lying on your back, hug one knee into your chest while fully extending the other leg, hovering it above the ground.
- Keep your focus on lengthening your leg away from your body while simultaneously squeezing your knee to your chest.
- Hold for 2-3 seconds then alternate legs, complete 10 reps.
- Lying on your back, extend your arms out to your side as an anchor. Bring your knees up to a 90-degree angle. Starting the movement from your core, rotate your knees to the left, hold for 5 seconds. Then, slowly rotate to the right.
- Complete 10 reps in each direction.
Tip: If your back feels strained from this, place your feet on the floor with bent knees and rotate your knees back and forth, keeping your feet on the ground.
Runner’s Lunge Stretch
- Starting in a plank position, bring your left foot up and around and to the outside of your left hand.
- Hold for 5 seconds and bring the foot back into the plank position. Repeat this movement on your right side.
- Complete 10 reps on each leg.
Tip: If it is difficult for you to swing your leg up to the above position, start on your hands and knees, then extend your back leg in the lunge position.
- Start in a seated position. With your feet flat on the floor, bend your knees and place your hands behind your back, directly under your shoulders.
- Supporting your body with your arms and feet, lift your hips toward the sky, pressing through your heels.
Try to fully extend your hips so that your body is completely straight, in a reverse plank. Slowly bring your butt back to the floor, repeat for 10 reps.
- Lying on your back, bend your knees keeping both feet flat on the ground.
- Extend your left leg straight, keeping it raised about two inches from the ground.
- Then, with your left leg extended, press through your right heel, lifting both hips off the ground. Make sure to keep your foot directly beneath the knee to protect the joint and continually press through the heel of the foot to lift the hips.
- Slowly lower and repeat for 10 times before switching sides.
- Standing with your feet shoulder distance apart, pick your toes as high off the ground as possible so that only your heels are touching.
- Walk toward your left for 20 yards, keeping your heels on the ground while flexing the toes towards the sky.
- Repeat the same motion back toward your right, resting at your starting point. Repeat three times.
Single-Leg Lateral Hops
- With your right foot slightly off the ground, balance on your left foot.
- Hop back and forth over an imaginary line, laterally for 30 seconds.
- Repeat the same motion, balancing on your right foot.
- Rest 30 seconds and repeat the exercise three times. This will strengthen the peritoneal and calf muscles.
Calf and Soleus Stretch
- Standing at a wall, stagger your feet placing the left foot a few inches from the wall and the right foot about one to two feet behind your left foot.
- Lean forward into the wall while bending your left knee, pressing your right heel into the ground. Hold this position for 20 to 30 seconds.
- Then step your right foot forward six to eight inches, and bend both knees but shifting your weight onto your left foot while pressing your right heel into the ground. This position stretches the deep calf muscle, aka soleus, and lengthens the Achilles tendon. Hold this position for 20 to 30 seconds, then switch sides.
Match your workout to the weather by slowing down during exercise and seeking shade afterward. Check out these tips to beat the heat:
Pick sunrise or sunset. Your best bet on a hot day is to head out in the early morning or evening, when your shadow is twice as long as you are tall. According to The Weather Network, exposure to direct sunlight can increase how hot it feels by as many as 15 degrees.
Mind the 90-degree line. When the mercury is above 90 — the temperature of the surface of your skin — you’ll gain heat from the air around you, and your body heat will have nowhere to go. At that tipping point, you’ll sweat more and your body temperature will rise rapidly, making you more susceptible to heat-related illness. Go easy or go inside.
Bottom’s up! Stay well hydrated throughout the day by drinking at least eight cups of water, then make sure to have eight to 12 ounces about 15 minutes prior to your run. Sip three to eight ounces every 15 or 20 minutes as you run, and don’t forget to drink after your workout.
Field the heat.Rule number one before you run: Check the heat index — a combination of air temperature and humidity — rather than your thermometer to get a better idea of the real feel outside. (At 70 percent humidity, an 29-degree day can feel as if it’s 32.) Also, the more humid it becomes, the less your sweat evaporates from your skin, meaning your body’s key cooling mechanism is disabled. To run sun smart, determine the day’s heat index (see the Weather Network), then follow the guidelines below.
Higher than 40 degrees: No-brainer: Move it indoors, because you’re at severe risk of heat-related illness, including heatstroke. (A 38-degree day with just 40 percent humidity will feel like 43 degrees.)
Between 33 and 39 degrees: Exercise early in the morning, when it’s coolest, and keep your workout superlight.
Between 27 and 32 degrees: Keep workouts shorter than usual and moderate.
You’ve been running for a while, and it feels good, but you’re ready to take the next step — and make it a faster step, at that. The good news is that the more you run, the better your chances are of increasing your speed. But how you run can be the key difference between shaving minutes off your mile and staying steady at your current pace. If you’re feeling like improving your time, these tried-and-true techniques will build up speed while minimizing injury.
With any workout, you want to build up your intensity gradually to avoid injury — this is where sprinting intervals come into play. On your next run, alternate between running at a sprinting pace for 30 to 60 seconds and your normal pace for two to three minutes. Due to the focus on timed running sessions, this type of workout is best on the treadmill; the next time you’re at the gym. The more you’re at it, you’ll find that these small bursts of sprinting will start to make your normal pace feel slow.
2. Tempo Runs
When running takes you outside, tempo runs are a great way to work on increasing your speed. During a tempo run, go faster than you normally would but at a pace that you can sustain for a longer period of time. During the run, you want to feel comfortable but challenged — you should be slightly out of breath, and holding a full conversation should be difficult (if not impossible). The idea behind a tempo run is to condition your body to perform past its lactate threshold (the point where it begins to fatigue); by doing so, the body is able to perform faster and at longer distances. When starting out, try a 10-minute tempo run, and over time, allow yourself to build up to 20 minutes; aim to incorporate a tempo run into your routine every seven to 10 days.
Given how slow you feel chugging up a hill, it may have you questioning why this makes for good speed training. But consider this: running uphill builds strength in your butt and legs while also improving lung health — all of which are essential for becoming a faster runner. To make hill running feel easier, focus on your breath, trying to match it evenly with your stride. Try a session of hill repeats outside, or the next time you’re at the gym. After a few rounds of hill training, running on flat ground will feel like a piece of cake.
While running is a great workout, the risk for running-related injuries increases as people seek that finish line. Taking care of one’s shins, knees, hips and back is critical to a runner’s overall health. Wearing supportive running shoes and taking a workout onto forgiving surfaces are tried-and-true practices for runners to reduce shock on the legs and body. Read on for the basics of the five most common running injuries.1. Shin splints. One of the most common injuries among runners is shin splints, a term given to any pain experienced at the front of the lower leg. Shin splints occur at the front inside of the shin bone and are caused by long-distance, high-impact running, inadequate footwear, an increase of training too quickly or running on hard surfaces—or a combination of all of these. However, it can be tough to gauge the severity of shin splints. The pain usually fades over the course of the exercise session or run, but it will most likely return after the activity and may even be worse.How to Prevent Shin Splits
- Before and after running, stretch the calf muscle and Achilles tendon to target the muscles of the lower leg.
- Engage the muscles of the back of the legs rather than place all of the impact on the shin and front-leg muscles.
- Don’t overstride. Keep your stride longer in back and shorter in front.
- Engage in strength-training exercises for the calf muscles.
- Warm up before increasing speed during a run.2. Runner’s knee. Runner’s knee results from the overuse of the knee and is commonly developed in novice runners as well as women. “To ensure muscles are not overworked, long-distance runners should make it a rule not to increase their distances more than 10 percent per week. One sign of runner’s knee is pain on the outside of the knee, which can become aggravated by running, especially downhill. Other symptoms are tender trigger points in the gluteal area, as well as tightness and pain during flexion or extension of the knee.How to Prevent Runner’s Knee
- Avoid aggressive runs, especially downhill.
- Strengthen the quadriceps muscle, as a weak quad is a common cause of the ailment.
- Because runner’s knee can be caused by tight hamstrings and calf muscles, be sure to stretch both of these muscles before and after running.
- Use insoles or heel pads during your run to reduce impact.3. Snapping hip. Snapping hip is a condition that results in an audible snapping or popping feeling around the hip joint when the hip is flexed and extended. This sensation can either be felt externally or internally. Athletes are at special risk for developing this syndrome as a result of the repetitive and physically demanding movements they do. With runners, snapping hip is attributed to extreme thickening of the tendons in the hip region. Pain can be reduced through rest and inactivity, but symptoms can last for an extended period of time, causing it to eventually become very painful.How to Prevent Snapping Hip
- Avoid running for an extended period of time to alleviate pain and prevent recurrence.
- Maintain good flexibility and strength by lightly stretching the muscles around the thigh, hip and pelvis.
- Before engaging in running again, have a specialist assess your running technique to determine if that is causing the ailment.4. Neck pain. Stress tends to accumulate in the neck area, and neck ailments in runners are common. As the neck balances a 10-pound head and compensates for deficiencies in imbalances in the arches of the feet or the curves of the back, the neck takes on a lot of physical burden, and for runners, sometimes the ailment is coupled with poor running form or tense muscles during the run.How to Prevent Neck Pain
- Take breaks when standing or sitting for a long period of time.
- Adjust your desk, chair and computer so that your computer monitor is at eye-level, your knees rest at a point slightly lower than hips, and you have chair armrests available for additional support.
- Slowly introduce yoga postures for neck and back pain to strengthen muscles.
- Concentrate on standing with correct posture. Keep your head centered over your spine, so gravity works with your neck rather than against it.5. Lower-back pain. Runners who already have lower-back problems may find that their ailments are worsened by the impact running places on their body. In some cases, lower-back pain can lead to sciatica, herniated disc or degenerative disc disease. Lower-back pain can develop after running too far a distance before properly warming up and can be experienced in muscular strains, spasms and pains.How to Prevent Lower-Back Pain
- Prior to a run, be sure to perform a thorough warm-up.
- Engage in gentle daily stretching that alleviates tight back muscles and loosens tight hamstrings.
- Do strength-training routines to condition and tone the core muscles of the back.
- Adjust your chair so that the positioning doesn’t strain the lower back.
Running may be challenging, but it is an activity humans were designed to do, and it’s something nearly everyone can enjoy if we allow time and patience for our bodies to adapt to the demands of the sport. But that doesn’t mean that proper running form will come naturally for you.
If you were to watch 10 different people run, you would notice that each one has a distinctive style. There is not one “correct” way to run. You should run the way that is most comfortable and efficient for you. However, you can still fine-tune your running technique, whether you’re an experienced runner or a walker who is ready to jump into running. Every runner should understand the basics like proper breathing, posture and foot strike. With proper form, you can help improve your performance and decrease your risk of running ailments and injuries.
Proper Running Posture
Just as you should maintain good posture when standing or sitting, maintaining a relaxed, upright posture while running is essential. Good posture will help release tension and reduce strain in the neck and shoulders, which can prevent muscle fatigue. The idea is to run in a relaxed manner with as little tension as possible. Follow these four proper posture principles to do just that.
- Hold your head high, centered between your shoulders, and your back straight. Imagine your body is hanging from a string that is attached to the top of your head. Do not lean your head too far forward; this can lead to fatigue and tightness in the neck, as well as the shoulders, back and even your hamstrings. While a backward lean is not as common, doing so puts greater tension on your back and legs, so avoid that, too.
- Focus your gaze approximately 30-40 yards in front of you. Looking down when running can lead to greater strain on the neck muscles and spine, which can lead to fatigue especially in the latter part of your run.
- Relax your jaw and neck. Holding too much tension in your face and neck can lead to tension in other parts of your body, making for an inefficient (and tiring) run.
- Keep your shoulders relaxed and parallel to the ground. Do not pull your shoulder blades together as this increases shoulder tension. Your shoulders should hang loosely with a slight forward roll for optimal relaxation. If your shoulders rise toward your ears or tense up during your run, drop your arms and loosely shake them out. Do this several times during your run.Breathing
Over time, each runner will discover a breathing technique that works best for him or her. As to whether you breathe through your nose, mouth, or a combination of the two, is a personal preference. Most runners find that mouth breathing provides the body with the greatest amount of oxygen.
Whatever technique you choose to use, make sure your breathing is relaxed and deep. It may take conscious effort in the beginning, but deep abdominal or “belly” breathing is ideal for running. Most of the time, we breath quickly and shallowly into our chests. This may work fine for daily living, when the body isn’t demanding a greater need for oxygen, but it’s an inefficient—and even stressful—way to breathe when exercising.
To practice belly breathing, lie flat on your back with a book on your abdomen. Slowly inhale as you watch the book rise, then lower the book by slowly exhaling. This takes focus, but overtime you will find it easier to do this type of breathing during your runs.
Side stitches (sharp, cramp-like pain in the trunk of the body) are quite common among new runners, and they can really put a damper on your workout. One cause of side stitches can be shallow, upper chest breathing. This is where belly breathing helps tremendously. By inhaling and then forcefully exhaling through pursed lips, you can very often help prevent the dreaded side stitch. Maintaining good posture, with your body in an upright position, also allows for better lung expansion, therefore permitting for greater delivery of oxygen to the muscles.