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Side Stitch: Causes, Symptoms, Treatment, and Prevention (Infographic too!)

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Nothing can stop a runner right on the track like a nasty side stitch. Call it anything - side cramp, side ache, or a side sticker, the intense pain remains and is hard to bear. Be it a daily jog or running a medal-winning race, a side stitch is one of the worst running injuries any runner can encounter. But just like most of the running injuries, this too can also be avoided and taken care of easily!

What is a Side Stitch

what is a side stitch?
A Severe Side Cramp (source)

A side stitch, in technical parlance, is referred to as Exercise-related Transient Abdominal Pain (ETAP).  A side stitch is an acute stabbing pain under the lower edge of the ribcage. It usually occurs while exercising.

No matter how well-prepared you are to run your marathon or jog a few rounds of the park, a side stitch is as unpredictable as the Scottish weather. And as a runner or an athlete, you may be looking for the answers related to side stitch queries.

We shall discuss everything on side stitch, including the remedial measures (if you ever get one!).

Who Gets Side Stitches?

Of all the athletes, two common types that often suffer a side stitch are runners and horseback riders. This could be due to the repetitive torso movement involved in both the activities. Further, the individuals who are likely to experience side stitch are:

  • Young people

Side stitches are much likely to affect the young athletes as compared to the elder ones. As reported in a study, 77 percent of active individuals under the age of 20 experienced ETAP (side stitch), as compared with only 40 percent of those over 40. Therefore, it could be assumed that the occurrence and severity of side stitches decrease with age.

  • Gender

A few studies reported that females have four times higher chances of experiencing side stitches than males.

However, if your body is well-conditioned and complies with all the ETAP prevention rules then you may be less likely to suffer a side stitch compared to the lesser fit.

What Causes a Side Stitch

What causes Side Stitches
Side Stitch Occurs While Running (source)

Although the exact reason for the occurrence of side stitch is yet to be proven,  Jordan Metzl, M.D., who is a Sports-medicine physician and the co-author of The Athlete's Book of Home Remedies, says that the most likely cause for a side stitch is a diaphragm spasm.

Another hypothesis says that this abdominal pain may result from the downward pull of the internal organs, liver, and stomach, on the diaphragm. However, this theory appears to be inconsistent to an extent, as swimmers, who hardly apply any downward force on their organs, have also complained of experiencing side stitches.

Other cause of this distressing side stitch are – a blood flow increase to the liver or spleen, a simple stretching of the visceral ligaments caused due to repetitive vertical translation and jolting, shallow breathing, a poor blood circulation and poor oxygen supply to the diaphragm, eating or drinking before running (exercise), bad posture, etc.

While some experts attribute the side cramps to a combination of various causes like - diaphragm spasms, lack of blood electrolytes, weak abdominal muscles, shallow breathing and gas traps in the large intestines, others tend to widely accept inflammation of the abdomen's lining against the abdominal wall as the true reason.

Breathing correctly does matter

How Does a Side Stitch Develop

Although the apparent cause or side stitch symptom may be still unknown, the theory that inadequate blood circulation and low supply of oxygen suffered by the diaphragm sounds like a probable root cause. In the breathing process, the diaphragm performs a crucial role. While running, our internal organs tend to move slightly with every step, through shocks. The diaphragm also moves when we respire while running. As a result, a tension is created in the body leading to cramps in the diaphragm. Hence occurs the side stitch.

We cannot always confirm a definite side stitch symptom but we do have some insights on how to curb the pesky side stitch.

How to Prevent a Side Stitch: 9 Ways to Stop the Pain

How to Prevent a Side Stitch
Hows to Prevent a Side Cramp (source)

Runners often wonder how to prevent cramps while running especially the inevitable diaphragm pain in the side. Other kinds of muscle cramps can be dealt with supporting gears and stretching the right way before a run. But how do you prevent a cramp whose root cause is estimated theories?

Well, one can only hope! Check out some tips below on preventing a side stitch.

Tip 1: Eat Wisely - Small bites before running

What you eat and when you eat plays a crucial role in the occurrence of side stitches. If your body is still digesting the food, it affects the blood flow which further induces spasms. Refrain from overeating and drinking excess fluids before a run. Eat well, at least, two hours prior to running and exercising. Foods that are rich in fat and fiber takes a longer time to digest. Understand what to eat before running and give your body sufficient time for proper digestion before sprinting off! Studies have proven that concentrated and fruit juices which are high in sugar can cause side stitches. Thus, skip fruit juice.

Livingit Tip:
Maintain a food diary especially for what you eat and drink before running. It will help you identify food triggers when you get a side stitch! 

Check out What to Eat before Running? Top Foods for Runners

Tip 2: Engage inadequate stretching

All physical activities demand good stretching exercises. They relax the muscles and increases blood flow.They act as effective warm-ups. You might be aware of it but you need to understand what type of stretching workouts help with side cramps?

Here’s a simple stretching exercise routine – First, bend your body sideways at the waist and extend both arms. Hold the position for 15 seconds on each side for effective stretching. Good stretches will improve the quality of your running and decrease the risk of side stitches. 

Case studies prove that correct stretches while bending forward, like stretching the stomach, contracting the abdominal muscles and deep breathing can help alleviate a side stitch. New runners need to build their endurance to avoid this condition. 

Know all about Essential Post Run Stretches after a Run

Tip 3: Warm-up thoroughly!

It is advisable not to hit 20mph immediately after putting on your running shoes. You got to work it up slowly. Invest time in a good warm-up session because skipping it can lead to sore muscles and irregular, rapid breathing patterns that can make you groan in pain during the run within a few minutes of starting out. Always begin with brisk walking and then head on for a good run.

Read on A Warm up Routine for Running Perfectly

Tip 4: Regulate your Breathing Patterns

As a runner, you should learn to regulate your breathing patterns. Shallow breathing or Chest breathing could be one of the many causes of ETAP, hence learning the proper techniques while training is a must. Most athletes, including swimmers, practice the two-to-one-stride-breathing pattern, which means inhaling one full breath for every two strides and exhaling for the same. Doing this will not only prevent side stitch but also promote better oxygen flow and help in better running.

Want to learn the correct pattern?

Check out How to Increase Lung Capacity: Learn these Effective Techniques

Regular breathing patterns
Breathing Patterns

Tip 5: Strengthen your core

It is found that well-trained, strong core muscles can fight a side stitch. Perform 10 minutes of core exercises every day. You could do ab exercises like planks and donkey kicks (three times a week) or practice yoga and Pilates daily to have a strong core and minimise the occurrence of a side stitch. A stronger core strengthens your muscles which in return helps you to run efficiently. Planks and side planks are a must for runners, especially the new runners to strengthen the muscle in the side stitch region.

Know all about Strength Training for Runners: 6 Effective Exercises You must Try!

Also, check Yoga for Runners: How Yoga Can Improve Your Running

Tip 6: Improve your posture

Poor posture alignment may also contribute to the occurrence of a side stitch. You can improve your posture by doing Pilates or yoga. This will strengthen your back and core muscles and help to prevent side cramps while running.

Read all about - Do you know the Correct Running Technique?

Tip 7: Promote diaphragmatic (belly) breathing.

Since a majority of the experts believe that stress in the diaphragm could be a plausible reason for a side stitch, learning to fix it could be of immense use. Lie on your back, place a book or an object that would provide bearable pressure on the abdomen. Now, inhale by pushing the stomach out and exhale by relaxing the abdominal muscles. Push the air out of the lungs with the help of the object’s weight. This exercise will help you train to breathe properly using the diaphragm instead of chest muscles.

Check out The Ultimate Guide on How to Breathe Properly While Running

Tip 8: Correct a spinal dysfunction

Apart from following the above-given tips, you also might visit a chiropractor or a physical therapist who can help your spinal problems. In a case study report in 2004, D. P. Morton and T. Aune (authors of several papers on running) described that 9 out of 18 runners whom they saw at their clinic, the pain from a side stitch occurred during a workout. They state that it could be readily reproduced by applying manual pressure to the upper spine vertebrae. In another report, they found that people who have a roundback or kyphosis (a condition in which the upper spine is sharply curved) have an increased risk of side stitches.

Tip 9: Salt Might Help

If you are in for a long distance run, you need to make up for the electrolytes lost. In such cases, carry salt tablets and carry on with running!

How to Overcome a Side Stitch - Treat it Correctly

How to overcome a side stitch
Take a Break from the Run (source)

In spite of ticking off all the precautionary measures, if you still find yourself twitched up in pain due to a side stitch, mid-run, then follow these tips for treatment and instant relief.

  • Slow down and Exhale properly.

As you feel that pinching pain on the side, slow down your pace and exhale properly. Simultaneously make sure, the foot, opposite to the side where the stitch has occurred hits the ground. For example, if the stitch is on the right side of your body, slow down and exhale as your left foot strikes the ground.

  • Shift a Gear Down.

Slow down your pace and bring it down to a walk. The idea here is to take a break while adjusting the stitch before you can resume the run.

  • Massage the area gently.

Next, massage the stitch by pushing it deeply with your fingers and blow out hard with your lips pursed. Relieve the pressure as you breathe out. Want to know all about massage?

Read - When and Why Should Runners Get a Deep Tissue Massage

  • A quick Upper Body Workout.

As you now realize that a muscle spasm in the diaphragm leads to stitch, do a quick exercise to relax the diaphragm and the abdominal cavity. Put your arms above your head while inhaling and gradually lean the upper body forward as you exhale. Let the arms dangle. Repeat the process until the pain alleviates.

Check out - How Upper Body Muscles Help in Running

  • Hydrate Yourself

Drink enough water within one hour of running or any kind of physical exercises. When the body is hydrated correctly, it reduces the chance of a spasm and side stitch!

Know all about Effective Hydration Tips for Runners

And that’s how you deal with the side stitch!

Remember, that adopting proper breathing techniques is the best ways to handle or restrain a running stitch. Avoid consuming large volumes of food and fluids before setting out to run. Never forget to stretch and warm up. A side stitch or ETAP is usually common in sports like running, swimming, and horse riding, because the upper body is massively involved in these sports. It is thus recommended to undergo proper upper body training and build the core strengths – your abdominal and diaphragm muscles. 

It might be shocking to know that some of us may have been breathing the wrong way all our lives (!) but yes using diaphragm muscles is the correct way to breathe. This will only develop with practice.

So, start practicing today, to run stitch-free tomorrow!

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