Running - Knowledge

Side Stitch: Learn Ways to Ditch the Running Stitch

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Nothing can stop a runner right in the track like a nasty side stitch. Call it anything - side cramp, side ache, or a side sticker, the pain intensity remains the same. While a daily jog or going for a medal win, a side stitch is one of the worst running injuries a runner can encounter. But don’t worry because just like most of the running injuries, this too can also be avoided and taken care of!

Keep reading to know more about the stomach cramps while running aka the side stitch.

  • What is a Side Stitch
  • Who Gets Side Stitches
  • What Causes a Side Stitch
  • How Does a Side Stitch Develop
  • How to Prevent a Side Stitch
  • How to Overcome a Side Stitch

What is a Side Stitch

A Severe Side Cramp (source)

Technically 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 crops up while exercising.

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

We shall discuss everything on side stitch, including the remedies to deal (if you ever get one!).

Who Gets Side Stitches

Of all the athletes, the two 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. Thus, the individuals who are likely to experience side stitch are:

  • Young people

Side stitches are much likely to affect the young athletes than 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 prevalence and the 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 you are a well-conditioned individual and comply with all the ETAP prevention rules then you may be less likely to suffer a side stitch compared to the unfit.

What Causes a Side Stitch

Cause of Side Stitches
Side Stitch Occurs While Running (source)

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

Other theories claiming to be the cause of this distressing side stitch are – a blood flow increase to the liver or spleen, a simple stretching of the visceral ligaments caused by repeated vertical translation and jolting, shallow breathing, a poor blood circulation and low 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 widely accept irritation of the abdomen's lining against the abdominal wall as the true reason.

How Does a Side Stitch Develop

Although the apparent cause may be still unknown, the theory of inadequate blood circulation and low supply of oxygen to the diaphragm sounds like a plausible root cause.

In the breathing process, the diaphragm plays a crucial role. While running, our internal organs slightly shift with every step through shocks. The diaphragm also moves as we respire during running. As a result, a tension is created in the body leading to cramps in the diaphragm. Hence the side stitch.

Any of the above-mentioned causes could trigger a side stitch. We may not confirm a definite cause but we do have some insights on how to curb the pesky side stitch. Keep reading!

How to Prevent a Side Stitch

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 only estimated on theories?

Well, one can only hope! Below are some tips on preventing a side stitch, check out!

  1. Small bites before running

    Avoid stuffing yourself up with too much food and fluids before a run. Eat well prior to at least two hours of exercise. Foods that are rich in fat and fiber takes a longer time to digest. Understand what to eat before running and give your body time for proper digestion before sprinting off!
  2. Do the stretching

    All physical activities demand good stretching exercises. They relax the muscles and increases blood flow. We are sure you are aware of that but do you understand what type of stretching workout will help with side cramps?
    Here’s a simple stretching exercise routine – First, bend your body sideways at the waist and extend both arms, do it for 15 seconds on each side.
  3. Warm-up well!

    It is advisable that you do not hit 20mph immediately after putting on those running shoes. You got to work it up slowly. Invest in a good warm up session because skipping it leads to sore muscle and irregular, rapid breathing patterns that can make you groan in pain on the roadside within few minutes of starting out.
  4. Regulate your Breathing Patterns

    As a runner, you should learn to regulate your breathing patterns. Since shallow breathing could be one of the many causes of ETAP, hence learning the proper techniques while training is given attention to. Most athletes, including swimmers, practice the two-to-one stride-breathing pattern, meaning take one full breath for every two full strides and exhale for the same. Doing this will not only prevent side stitch but also promote better oxygen flow.
    Breathing Patterns


  5. Strengthen your core

    It is found that well-trained, strong core muscles can fight a side stitch. Perform 10 minutes of ab exercises like planks and donkey kicks (three times a week) or practice yoga and Pilates daily to have strong abs and minimise the likelihood of a side stitch.
  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.
  7. Promote diaphragmatic (belly) breathing

    Since a majority of the experts believe that stress in the diaphragm could be a plausible reason of side stitch, hence learning to fix it could be helpful. Lying on the back, place a book or any 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 train you to breathe properly using the diaphragm instead of chest muscles.
  8. Correct a spinal dysfunction

    Aside from following the above tips, you can also visit a chiropractor or a physical therapist who can help you with spinal problems.

How to Overcome a Side Stitch

Take a Break from the Run (source)

In spite of following all the precaution rules, if you still find yourself twitched up in pain mid-run then follow the tips for acute side stitch for instant relief.

  • Slow down and Exhale

As you feel that pinching pain on the side, slow down your pace and exhale as the foot on the opposite side of the side stitch 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

And as you slow down the pace, bring it down to a walk. The idea is to take a break while adjusting the stitch before resuming the run.

  • Massage the Area

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

  • A quick Upper Body Workout

As you understand 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 until the pain alleviates.

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

Remember that adopting proper breathing techniques is one of the best ways to handle or restrain a running stitch. Avoid consuming large volumes of food and fluids before setting out to run and do not forget to stretch and warm up. A side stitch or ETAP is usually common in sports like running, swimming, and horse riding. This is because the upper body is massively involved in these sports, so it is recommended to take proper upper body training. Thus, build your core strength – 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. And this will only come with practice.

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

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