If you’ve ever been sidelined by a side stitch, you’re in good company.
Research suggests that approximately 70 percent of runners experience this phenomenon in a year. Also known as exercise-related transient abdominal pain (ETAP), a stitch is localized pain felt on one side of your abdomen.
When mild, stitches are typically more similar to cramping and aching. But when severe, runners describe the pain as sharp and stabbing.
Even if your stitch is mild, you’re probably wondering why it happens, how to make it stop, and what you can do to prevent it from happening in the first place.
Here’s everything you need to know about how to avoid a side stitch when running.
Puzzled as to why stitches happen in the first place? So are the experts. Here are some possibilities.
Muscle spasm
“The jury is still out on the exact cause of a side stitch, but one thought is that it is a spasm in the diaphragm,” said physical therapist Ryan Hill, doctor of physical therapy and co-founder of The Stride Shop.
“The diaphragm is the primary muscle we use to breathe, and if it is asked to do more work than it’s used to, then it will revolt,” Hill said.
This can include expanding and contracting quicker than normal or stretching beyond its usual limits. This most frequently happens with less experienced runners.
Parietal peritoneum irritation
Sensation in this membrane is linked to the phrenic nerve. When the parietal peritoneum is irritated by movements in the abdominal wall, pain sensations in this nerve become increasingly noticeable.
Stress on the spine
Another possible explanation, Hill says, is that the pain is a response to increased stress on the spine.
“Both the vertical and rotational components of running can place increased stress on the spinal column, and this increased stress can then show up as sharp, localized pain in the side,” Hill explained.
Side stitches are well known to runners. But other activities, such as horse riding and swimming, can also produce these painful aches. In general, any activity that involves considerable torso movement can trigger a stitch.
Anyone can get a side stitch while running or performing activities that require considerable torso movement.
That said, some activities are more likely to trigger stitches or make it more likely to get one while running.
Skipping your warmup
Dr. Alexis Colvin, orthopedic sports medicine surgeon at Mount Sinai, puts it this way: If you have weak core muscles or don’t do a proper warmup before heading out on a run, you’re potentially at higher risk of getting side stitches during a workout.
Dietary choices
Eating a heavy meal high in fat or drinking beverages high in sugar less than 1 or 2 hours before running may also lead to side stitches.
“Eating a large meal before a run will activate the GI system, which means less oxygen will be available to the diaphragm. And if the diaphragm isn’t getting the resources it needs, then that lack of oxygen will feel like a stitch in the side,” Hill said.
Ramping up your workout too quickly
Physical therapist and running coach Natalie Niemczyk, DPT, CSCS, adds that doing too much too soon is another common trigger of side stitches.
“Running too far or too fast before your body has been able to adequately adjust leads to compensations and misplaced demand on the body,” Niemczyk said. This can result in pain and discomfort in the abdomen.
Shallow or chest breathing
Finally, shallow or chest breathing may contribute to a side stitch.
“This happens when you take short breaths rather than deep, belly breaths,” Niemczyk continued.
When you take short, shallow breaths, your muscles may not receive enough oxygen and become fatigued more easily during a run, leading to cramps associated with a side stitch.
Shallow breaths may also put more stress on the muscles and ligaments around the diaphragm, causing nearby muscles to work harder to compensate for this added stress from the lack of movement of the diaphragm.
Here are some tips to help you stop a side stitch in its tracks:
Slow down
When you’re running, the goal is to keep moving.
That’s why the first strategy you try should be slowing your pace and changing the cadence of your breathing, Colvin says.
Practice belly breathing
Belly breathing, aka diaphragmatic breathing, requires you to slow down and bring focus to your breath.
When you get a side stitch, pause your exercise and take a few belly breaths. Inhale and exhale fully and deeply.
Stretch your arms and your abs
Stretch your arms overhead and then over to the side of the stitch. Hold this position for 30 seconds.
You may need to do this a few times to get relief.
Push on the stitch
If you feel a stitch coming on, stop running and step out of the way.
Locate the stitch and place your hand in the location where you feel the stitch coming on. Push on the area while inhaling. Each time you exhale, push a little deeper into the painful spot.
If you want to keep moving, you can do this while walking.
Now that you know what a side stitch is and how to stop it, it’s time to go over strategies to prevent them from happening in the first place.
Warm up
Do a proper warmup before running that involves dynamic movements to stimulate blood flow and prep the muscles to work.
Niemczyk recommends a warmup that includes reaching activities and rotating your trunk to prepare the tissues surrounding the diaphragm.
Breathe
Colvin reminds runners to fully inhale and fully exhale during activity.
Eat right
Avoid trigger foods and drinks before working out.
This includes avoiding heavy meals or drinking large quantities of fluids 1 to 2 hours before a run, as well as limiting or avoiding drinks with highly processed sugar content.
Go slow
If you’re new to running or returning from a hiatus, make sure to avoid big leaps in distance or intensity in your exercise before your body adequately adjusts to the demand.
Consider following a training plan geared toward your current fitness level.
Concentrate on your core
Having a strong core and being able to effectively activate your abdominal muscles while running may reduce stitches.
A
Hill agrees and says one of the best things you can do to prevent side stitches is to strengthen your core muscles. Here are four of his favorite exercises:
- glute bridge
- bird dog
- loaded carry
- Palloff press
If you’re experiencing symptoms similar to a stitch, but you’re not exercising or experiencing other symptoms along with a stitch, it might be time to call your doctor.
According to Colvin, you should seek medical attention for the following symptoms:
- you have pain without exercise
- the pain lasts for several hours
- your abdomen is very tender to touch
These symptoms may indicate that you’re experiencing a condition that needs medical attention, such as:
- internal injury or bleeding
- hiatal hernia
- gallbladder problems
- phrenic nerve damage
- pancreatitis
- diaphragmatic endometriosis (in women only)
- early symptoms of a heart attack
Side stitches are a common phenomenon for runners. While many people will get through an episode with a few deep breaths or stretches, some will need to stop exercising to alleviate the pain.
See your doctor if you’re experiencing side stitch pain at rest or you have other symptoms along with a side stitch.
Experiencing the pain of a stitch when you’re not running could be a sign of something more serious, such as a hiatal hernia, an injury, or a condition that affects the internal organs around the diaphragm area.
To help prevent side stitches from happening in the first place, avoid large meals or extra fluid before running, enhance your core strength, ease into your training plan, and remember to take deep breaths.