What Causes Side Stitches? Prevention and Relief While Running

That sharp, stabbing pain in your side during running or exercise—the dreaded side stitch. It can stop you in your tracks. Here's what causes it and how to make it go away.

What Is a Side Stitch?

A side stitch (exercise-related transient abdominal pain, or ETAP) is:

• Sharp or stabbing pain in the side of the abdomen
• Usually just below the ribs
• More common on the right side
• Occurs during exercise, especially running
• Goes away when you stop

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What Causes Side Stitches?

The exact cause isn't fully understood, but leading theories include:

1. Diaphragm Stress

Theory: The diaphragm (breathing muscle) becomes stressed or cramped during exercise.

Why it happens:

• Bouncing movements stress the diaphragm's attachments
• Irregular breathing patterns
• The liver (on the right) pulls on the diaphragm

2. Ligament Stress

Theory: Ligaments connecting the diaphragm to internal organs are stressed by jarring movements.

Why running causes it:

• Repeated impact
• Organs bouncing with each stride
• More common with faster paces

3. Irritation of the Peritoneum

Theory: The membrane lining the abdominal cavity becomes irritated by friction during movement.

Why it happens:

• Reduced lubrication between membrane layers
• Movement creates friction
• May explain food/fluid connection

4. Spinal Involvement

Theory: Referred pain from the thoracic spine or intercostal muscles.

Why it happens:

• Posture during running
• Muscle imbalances
• Spinal joint irritation

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Risk Factors

You're more likely to get a side stitch if you:

• Eat or drink too close to exercise
• Consume high-fat or high-fiber foods before running
• Drink concentrated fluids (sugary drinks)
• Are less conditioned (beginners get more stitches)
• Run at a faster pace than usual
• Are young (declines with age)
• Don't warm up adequately

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How to Relieve a Side Stitch

During Exercise

1. Slow Down

• Reduce pace significantly
• Walk if needed
• Often resolves quickly with reduced intensity

2. Breathe Deeply

• Take slow, deep belly breaths
• Exhale fully
• Focus on rhythmic breathing

3. Press and Release

• Press your fingers into the painful area
• Apply pressure while bending slightly toward the pain
• Release and repeat

4. Change Breathing Pattern

• If stitch is on right, exhale when left foot strikes
• If stitch is on left, exhale when right foot strikes
• This may reduce stress on the diaphragm

5. Stretch

• Raise arm on the affected side
• Lean away from the pain
• Hold 30 seconds

6. Bend Forward

• While standing, bend forward slightly
• Push on the affected area
• Can help release the cramp

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How to Prevent Side Stitches

Pre-Exercise Eating

Timing:

• Avoid large meals 2-3 hours before exercise
• Small snacks: 30-60 minutes before
• Allow more time for high-fat or high-fiber foods

What to avoid before running:

• Large meals
• High-fat foods
• High-fiber foods
• Concentrated sugary drinks
• Foods that cause you GI distress

Hydration Strategy

Good practices:

• Drink water, not concentrated drinks, close to exercise
• Small, frequent sips during exercise
• Avoid gulping large amounts

Avoid:

• Drinking large volumes right before running
• Hypertonic (very sugary) beverages during exercise

Warm Up Properly

Benefits:

• Prepares the diaphragm and breathing muscles
• Reduces shock to the system
• Allows gradual increase in intensity

Include:

• 5-10 minutes of easy movement
• Gradual buildup to target pace
• Some deep breathing exercises

Strengthen Your Core

Why it helps:

• Better support for internal organs
• Improved posture during running
• May reduce stress on diaphragm attachments

Exercises:

• Planks
• Dead bugs
• Bird-dogs
• Breathing exercises with core engagement

Improve Your Fitness

The good news:

• Side stitches become less frequent as fitness improves
• Your body adapts to the stress
• Experienced runners rarely get them

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Breathing Techniques

Belly Breathing

• Breathe into your belly, not just chest
• Diaphragm moves more efficiently
• Practice during easy runs

Rhythmic Breathing

• Time breathing to footstrike
• Common patterns: 3:2 or 2:1 (inhale:exhale steps)
• Consistency may help prevent stitches

Full Exhale

• Focus on complete exhales
• Don't hold breath
• Prevents diaphragm from staying contracted

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When It's Not a Side Stitch

See a doctor if:

• Pain persists after exercise ends
• Pain is severe or different from usual stitch
• Accompanied by other symptoms (nausea, dizziness, etc.)
• Pain is in the chest (could be cardiac)
• Occurs at rest, not just during exercise

Other possibilities:

• Muscle strain
• Rib stress fracture
• GI issues
• Gallbladder problems (if on right side)
• Cardiac issues (if left-sided or chest pain)

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Quick Reference

| Situation | Action | |-----------|--------| | Stitch during run | Slow down, deep breaths, press on area | | Frequent stitches | Review pre-exercise eating, warm up longer | | Beginner runner | Expect some stitches, they'll decrease with fitness | | Severe or unusual pain | Stop and evaluate, see doctor if concerning |

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Key Takeaway

Side stitches are common, usually harmless, and become less frequent as you get fitter. Prevention focuses on what and when you eat before exercise, staying hydrated (but not overly full), and warming up properly. When one strikes, slow down, breathe deeply, and apply pressure to the area. If pain persists after stopping or is unusually severe, get it checked out.