The side stitch while running is truly a crazy-annoying injury that appears out of nowhere! Almost every runner out there has experienced it at some time or another.
Who hasn’t felt that shooting pain in their side?
Who hasn’t had to fall short of their running goal because of it?
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 over the course of a year, approximately 70% of runners experience side stitches while running.
The good news is that there are precautions that you can take to ensure that your next run won’t be sidelined by side stitches.
In this article, we will provide you with everything you need to know about side stitches, including:
- What Is A Side Stitch?
- What Causes A Side Stitch?
- Side Stitch: Symptoms And Diagnosis
- How To Effectively Treat A Side Stitch
- How To Get Rid Of Side Stitches While Running
- 4 Exercises To Help Prevent A Side Stitch While Running
Let’s take a nice deep breath and get into it!
What is a side stitch?
The technical term for a side stitch is, exercise-related transient abdominal pain or ETAP.
It is an acute, localized pain, most commonly appearing on the mid to upper right side of the abdomen, and can occur during or after exercise. In less severe cases, you can expect an aching or cramping sensation.
ETAP is especially prevalent in running due to the repetitive movement of the torso.
What causes a side stitch?
Unfortunately, no one the exact cause of side stitches. Researchers and scientists continue to study the causes – but in the meantime, they’ve got a few theories.
The most frequently discussed causal factors are:
#1: Irritation of the Parietal Membrane
According to a comprehensive review in 2015, most experts believe that friction and subsequent irritation are to blame.
There are two layers of membrane that line your abdominal cavity. The parietal and parietal peritoneum. They are separated by a lubricating fluid which allows the membranes to move against each other.
It is thought that the membrane corset which wraps around your abdominal area (parietal peritoneum) gets inflamed during exercise as a result of friction between the abdominal contents and the stomach lining.
Friction will occur when the gap between the membranes decreases, and this may be caused by the pressure of a full stomach or a reduction in the lubricating fluid.
A stitch may also be felt in the shoulder due to the lining’s attachment to the phrenic nerve, which refers pain to the shoulder region.
#2: Mechanical Causes – Visceral Ligament Stress
Running produces a lot of force that the body has to absorb. As the body jostles, the visceral ligaments of the diaphragm are subject to mechanical stress due to the movement of the internal organs.
Although this theory captures many of the characteristics of ETAP, it doesn’t explain why pain can be felt in the lower abdomen or why pain can arise in activities that involve less mechanical stress, such as swimming.
#3: Lack Of Blood Supply To The Diaphragm
The theory goes: when we run, the muscles involved in respiration and the muscles involved in limb locomotion are in competition with each other for adequate blood flow. As a result, the diaphragm gets fatigued.
However, the diaphragm has to work hard when we run to keep up with the increased rate of respiration. Therefore, it is unlikely that it is starved of blood flow during this time. Quite the opposite, in fact.
#4: Psychological Causes
Due to the incongruent relationship between cause and effect, a recent study analyzed the correlation between ETAP and other factors such as anxiety, stress, and sleep dysfunction.
It found there to be a moderate correlation between psychological factors and ETAP frequency, although there is more research needed.
#5: Other causes…
Other possible but less likely causes are:
Aggravation of the spinal nerves, gastrointestinal disturbances, muscular cramps, bloating, caecal slap syndrome, and diaphragmatic ischemia.
The likelihood is that there are several overlapping causes and competing risk factors rather than one single, simple explanation.
Side stitch: Symptoms and Diagnosis
Side stitches can feel different for different people. When diagnosing a side stitch, it is important to rule out other pathologies that may be exhibiting similar symptoms.
Abdominal pain in runners can have many differential diagnoses, such as muscle cramps, stomach ulcers, costochondritis, gastritis, median arcuate ligament syndrome, and more.
Check with your doctor if you are unsure, as this article is not designed to replace medical advice.
The symptoms that you are likely to experience are:
- Sharp, localized pain on the mid to upper right-hand side of the abdomen (this is not to say you can’t feel it elsewhere). The pain is predominantly lateral.
- The pain dissipates soon after you stop running
- The pain is more likely to be a dull ache in less severe cases.
- The pain is consistent.
how to effectively treat a side stitch
As the exact cause is unknown, the strategies aimed at managing a side stitch are somewhat anecdotal yet still effective.
It should be noted that there is a decreased frequency of side stitch prevalence in more experienced and older runners. This is thought to be due to the acknowledgment and avoidance of precipitating factors.
There are plenty of ways to preemptively avoid getting a side stitch, such as nutrient timing, breathwork, and training methodology.
The tips below are for those who are suffering from ETAP. If you can down a sugary drink alongside a big burger and head straight out the door without a second thought, then you do you!
#1: Nutrient Timing
As a general rule, avoid consuming large amounts of fluid or food within a 2-hour timeframe before a run. When you do consume food or water, try to consume it in small, regular frequencies rather than one large serving.
We always recommend hydrating before (and often during) your run, but there’s a better approach than gulping down water right before you speed off: drink plenty of water over a longer period before you run.
Be mindful of what you drink too. Try to consume drinks that have a lower carbohydrate profile as they are absorbed faster, thus reducing the volume in the gut.
The National Library of Medicine advises you to avoid “reconstituted fruit juices and beverages high in carbohydrate content.”
If you run in the evening or 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
When it comes to food, the same principles apply. Avoid eating a large meal before running; in particular, avoid food that is high in fat, as it will take longer for it to empty from the intestines.
Proper breathing technique is a great way to reduce the onset of ETAP. If you are running too fast, slow down. Otherwise, you will be unable to control your respiration rate.
When you are running, keep your breath calm, measured, and controlled. Try to adopt a deep and rhythmic breathing pattern.
Try to include exercises that are designed to encourage abdominal breathing rather than upper chest breathing.
For a more specific tool, check out our article on How To Breathe When Running.
#3: Training Methodology
Excessive high-intensity training can put high-stress loads on your intercostal muscles, be sure to include adequate volumes of low-effort running in your training.
If the soreness from a side stitch lasts for a couple of days, you can decrease the number of miles you are running and do other forms of cardio instead. Consider cross-training activities, such as cycling, that put less stress on the torso.
Be sure to rest – perhaps with an active rest day – and give your body a chance to recover.
Make sure to warm up before you head out on your run; in particular, exercises that target thoracic rotation will help keep the torso mobile.
Be sure to include plenty of core stability work in your training, too; we’ll provide a few exercises for you to try at the bottom of the article.
How to get rid of side stitches while running
There are several ways to combat side stitches during a run.
- 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 lie down or sit unless the pain is intense. Instead, take a few minutes to walk and assess whether you can continue your workout.
- Rehydrate. Are you dehydrated? Drink some water ASAP, but not too much all at once.
- Stretch. 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 relax. Many runners find relief by taking some deep breaths with their bellies and slowly exhaling. You can also try pursed-lip breathing.
- Gently massaging the painful area by pressing your fingers into the muscles can also help.
- You can also bend forward to stretch the diaphragm
4 Exercises to help prevent a side stitch
There is a solid foundation of evidence to show the positive benefits of improving functional core stability for those suffering from ETAP.
Here are 4 exercises you can try!
#1: Thoracic Rotations
Thoracic rotations will help mobilize your spine and neck while opening up your chest.
Repeat 15-20 times on each side.
A plank is a great compound exercise that will help improve your core strength and stability.
If you are new to the exercise, try 10-15 seconds and repeat 3 times. Work your way up to 60 seconds!
#3: Side Plank
Similar to the plank, the side plank is a great compound core exercise. This time the force is focused more on the obliques and lateral portion of the abdominals.
Try 10-15 seconds and repeat 3 times. Work your way up to 60 seconds!
#4: Oblique Twists
Oblique twists are a slightly more advanced and highly effective exercise for strengthening the abdominal muscles.
Try 15-30 repetitions, repeating for 3 sets.
We hope all of our tips and tricks help you get rid of those side stitches so you can enjoy all of your running sessions.
For more of our running ailment guides, check out:
Runner’s Knee Explained: How To Diagnose and Treat It
Iliotibial Band Syndrome For Runners: Diagnosis, Symptoms, and Treatment