Dealing With Side Stitch Pain While Running

woman holding stomach cramp during a run


During a run (or most exercise), a sharp pain in your side known as a stitch can bring you up short. If you've ever experienced a side stitch—medically known as exercise-related transient abdominal pain (ETAP)—you know just how distracting and uncomfortable it can be.

A 2015 study estimated that as many as 70% of runners had experienced a stitch in the previous year. Additionally, about one in five race participants are likely to get a stitch.

Fortunately, ETAP is not a medical emergency—or even a reason to see a doctor. The causes of side stitches are not well understood, but most people can deal with one if it happens and keep on running.

What Is a Stitch?

The overriding symptom of a stitch is localized pain on one side of the abdomen, usually just below the rib cage. In older people, stitches occur on the right side twice as often as on the left. The opposite is true of younger runners.

Studies show that people describe ETAP in different ways: sharp or stabbing, if severe, or like a muscle cramp or pulling sensation when less intense.

Although side stitches have been studied, researchers still aren't sure why they happen. While there are many possibilities, most of them are based on anecdotal evidence. Reasons you might get a side stitch include:

  • Curvature of the spine (scoliosis): One study found a link between ETAP and increased curvature of the spine.
  • Drinking sweet beverages: Some research has shown that consuming sugary drinks before exercise increases the likelihood of stitches.
  • Going for a run too soon after eating: Runners sometimes notice they're more likely to get a stitch if they're still full from a pre-workout meal or snack.
  • Not warming up before a run: Runners sometimes report that they seem more likely to get a side stitch if they start running without warming up.
  • Shallow breathing: Theoretically, some experts have attributed side stitches to improper breathing while running.

Several popular hypotheses about what causes side stitches have not panned one. For example, one theory posited that drinking water or a sports drink while running can lead to ETAP, but this does not seem to be the case.

Stitches also are often attributed to muscle cramps, but at least one small study found there was no difference in electrical activity in the muscles when someone was experiencing ETAP.

How to Stop a Stitch

There's no shortage of tips for stopping a side stitch. While they might not work for everyone, none of them are harmful—and at least one of them might do the trick for you.

The next time a stitch threatens to ruin your run, here is a sequence of steps to try before you throw in the towel:

  1. Gently push your fingers into the area where you feel pain. This should help relieve it to some degree.
  2. Next, try altering your breathing pattern: Take a deep breath in as quickly as you can—this will force your diaphragm down. Hold your breath for a couple of seconds, then forcibly exhale through pursed lips.
  3. Try changing your breathing/striding pattern. If you always exhale when your right foot strikes the ground, try exhaling with the left foot strike.
  4. Try stretching the area. If you have a side stitch on your left side, raise your left arm up over your head and lean toward the right side. This will help open up the muscles in the area of the stitch.
  5. If all else fails, slow down to a brisk walk and concentrate on deep breathing. When the stitch goes away, go back to running.

Risk Factors and Prevention

You might find that preventing a stitch is easier than making one go away. While the exact causes may not be well understood, there are a handful of known risk factors associated with ETAP.

  • Age: Oddly enough, younger runners are more likely to get side stitches than are older folks. When older runners do develop ETAP, they tend to rate the pain (on a scale of one to 10), as less severe.
  • Eating and drinking before a run: Ingesting food or beverages before a run can increase the risk of stitch and certain types of food and drink seem to be more highly associated with ETAP. It might help to avoid eating or drinking anything high in sugar or fat, fruits and fruit juices, and dairy products.
  • High-intensity exercise: Working too hard, such as going all out during a race, might make you more likely to get a stitch.
  • Low fitness level
  • Not warming up
  • Running in cold weather

There are known risk factors for getting a stitch while you're running. Here are some dos and don'ts to keep in mind if you want to avoid one.

  • Stick to plain water for pre-hydration: Skip sugar-laden beverages, including sports drinks and especially carbonated ones.

  • Regulate your breathing. Breathing is the most effective way to prevent side stitches. Inhale and exhale through your mouth, breathing deeply from your belly and not your chest to take in more air.

  • Incorporate yoga into your fitness routine. The practice will help you to learn how to breathe correctly.

  • Eating within one hour of heading out for a run.

  • Hit the ground running. Always warm up: Start with some dynamic stretches and a five-minute walk or jog to get blood pumping to your muscles before you run.

  • Run outside when it's very cold if you're not dressed for it. This can make it hard to take in deep lungfuls of frigid air. Before going for a cold-weather run, put on a neck warmer or wrap a scarf around your neck and breathe through that.

  • Run hunched over. It's tougher to take in deep breaths with hunched posture. Focus on maintaining good posture and proper running form.

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Article Sources
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