The side stitch while running: a crazy-annoying injury that every runner out there has experienced and agonized over.
Who hasn’t felt that shooting pain in the side?
Who hasn’t had to fall short of their running goal because of it?
It seems like they come out of nowhere.
You’re out enjoying your run, and then it happens.
You feel like someone is punching you in the side or that your body is revolting.
Side stitches can make it difficult to breathe, and the pain can be bad enough that you can’t continue your run.
If you’ve ever experienced this dreaded running issue, then you’re not alone.
Research shows that approximately 70% of runners experience side stitches while running.
The good news is you can take some precautions to ensure that your next run won’t be sidelined by side stitches.
Here’s everything you need to know about side stitches – including how to prevent them, treat them, and beat them.
Why You Get a Side Stitch While Running
Dr. Patrick Griffith, a Physical Therapist and writer with myrateam.com, explains the cause behind side stitches.
“Side stitches or aches are commonly caused due to irritation/inflammation in the abdominal or pelvic cavity due to repetitive movements. This is why runners commonly report feeling a side ache with prolonged or intense workouts.
Common reasons why this irritation occurs is an imbalance in electrolyte levels such as too much salt or not enough water in the system which causes the abdominal lining to become irritated. This imbalance usually quickly resolves itself once running stops and the abdominal cavity becomes less irritated.”
The inflammation is caused by the rush of blood to your abdomen when you begin running.
It happens if you are a new runner, or if you’re coming back after a break from the sport.
You may also not be taking very deep breaths, which causes your diaphragm muscles to fatigue very quickly.
Side stitches can also be caused by eating or drinking too much before a run, especially unhealthy, sugary foods and drinks. The National Library of Medicine advises you to avoid “reconstituted fruit juices, and beverages high in carbohydrate content.”
We always recommend hydrating before (and often during) your run, but there’s a better approach then gulping down water right before you speed off: drink plenty of water over a period of time before you run.
- If you run at night, this is easy to do. Just keep water on hand throughout the day and make sure you drink regularly.
- If you run in the morning, drink a large glass as soon as you wake up, then have a few sips here and there until you start the run. It’s much better to delay your run by 30 minutes while you stretch and hydrate, than to chug the water and hit the road right away.
- Related: Hydration Guide for Runners
What Exactly is a Side Stitch?
The technical term for a side stitch is exercise-related transient abdominal pain, or ETAP.
That is just another way of saying that a concentrated and localized area of your abdominals is feeling that sharp pain.
This is usually caused by the muscles in your diaphragm spasming, and it is primarily due to what you eat or drink before your run (i.e. too heavy on the levels of salt or sugar).
This leads to tension and spasms in the muscles and ligaments that are attached to your diaphragm.
Additional Causes of Side Stitches
Unfortunately, no one knows what exactly causes side stitches. Researchers and scientists continue to study the causes – but in the meantime, they’ve got a few theories.
When you breathe, oxygen flows into your lungs, causing them to expand, then release the air. When you run, even more oxygen goes into the lungs and the muscle over-extends. That could be the cause of the pain.
As you run, the foot repeatedly hits the pavement over and over. When the foot hits the pavement at the same time you exhale, it might strain the diaphragm, causing it to spasm.
The continual bouncing up and down can create a forceful impact on your ligaments. As the body jostles, the ligaments and organs have additional work to do with all the extra pressure.
This is the two-layered lining of your abdominal and pelvic cavities. Normally, there is fluid between these two layers of lining to keep them from scraping together. When you eat a large meal or when you’re dehydrated, there is less fluid between those two layers, causing them to scrape together and leads to pain.
Side Stitch Symptoms
Side stitches can feel different for different people.
For most runners, they occur on the right side of the body.
Some runners feel a stitch as a sharp pain, almost as if someone is stabbing them.
Others report a cramping feeling or a dull ache.
A side stitch may also feel like someone is pulling on your muscles.
They tend to dissipate once you stop running and walk them off.
Preventing Side Stitches
Dr. Griffith offers a solution to avoid the side stitch while running.
“Runners should make sure to increase their training volume and intensity conservatively. Runners should also avoid eating a large meal or excessive salt/sugar prior to activity which can cause abdominal lining irritation. Also practicing nasal breathing can be helpful to reduce excessive abdominal breathing which can also be a culprit in causing side stitches.”
Here are some foods you’ll want to avoid before you run:
- Heavy, high-fat foods before your run.
- Foods that are very high in fiber can also irritate your gut and should be avoided.
- Avoid drinking too much before a run.
- Limit yourself to water, and don’t get so full that you can feel the liquids sloshing around in your stomach.
Other Factors to Keep in Mind
Practicing good posture is another excellent way to prevent side stitches.
Runners whose spines are rounded have a higher chance of developing this condition.
Most of us struggle to maintain good posture because of our jobs, so take time during the day to straighten your spine and roll your shoulders back.
Doing back strengthening exercises at the gym, like rows and flies, can also help keep your posture in check.
As Dr. Griffith suggested, another way to prevent side stitches is to warm up slowly and practice your breathing while you run. Instead of taking off, walk for a few minutes to get your body prepped for your workout.
Then focus on deep breathing – ensuring you use your entire lung capacity. Use a technique like the 2:2 method.
This will keep your breathing regular and prevent muscle spasms.
Treating Side Stitches for Runners
There are several ways to combat side stitches, from during a run to before you even put your shoes on.
- Take a Break. If you experience a side stitch while running, it’s time to take a walk break. If you force yourself to power through, you will probably just hurt more! You don’t need to lay down or sit unless the pain is very bad. Instead, take a few minutes to walk and assess whether you can continue your workout.
- Rehydrate and Stretch. Are you dehydrated? Drink some water ASAP. Does it feel better to stretch? You may find it helps to raise the arm on the same side of the pain and then stretch your torso in both directions. This will give the irritated muscles a chance to relax and can help the pain go away.
- Breathe and Massage. Many runners find relief by taking some deep breaths with their belly and slowly exhaling. Gently massaging the painful area by pressing your fingers into the muscles can also help. You can bend forward as you massage to ease the tension in your muscles.
- Mix Up Your Plan. Another great way to treat side stitches in runners is to reevaluate your training plan. If you have a big race coming up or are training for a long-distance run, then you may have taken on an intense plan. As a result, you bit off a little more than you can chew. If so, you can decrease the number of miles you are running and do other forms of cardio instead. This will help increase your fitness without causing painful side stitches. (It will also ensure that you can finish a workout!) Focus on shorter, more intense runs, like track workouts. Side stitches usually happen on longer runs, so keeping your workouts short can keep them at bay.
- See Your PT. If you find that your side stitches are a chronic problem, then see a physical therapist. They can help correct any imbalances in your body that may be causing poor form when you run. They can also help improve your posture and strengthen your abdomen and back.
Fortunately, side stitches are usually not serious and will go away after a few minutes.
However, they can really put a dampener on your run, so they should be avoided!
Make sure you are hydrating and fuelling properly before your runs and spend time stretching and strengthening your core and back.
If you get a side stitch, don’t panic.
Take a rest – perhaps with an active rest day – and give your body a chance to recover.
Trying to push through a side stitch will not help.
Give your body a break and take a deep breath.
You will live to run again!
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