Have you ever been feeling great when suddenly you’re struck with a side stitch while running?
These pesky pains can be a real nuisance, disrupting your workout or even causing you to slow down or stop moving altogether. Fortunately, understanding what may cause side stitches and how to prevent them can help you stay on track with your fitness goals.
What Is a Side Stitch?
A side stitch, medically referred to as exercise-related transient abdominal pain (ETAP), is a sharp, stabbing pain felt under the lower edge of the ribcage, usually on the right side. However, it can occur on the left side or even both sides simultaneously. These pains are often present during physical activities such as running, swimming or cycling, particularly when engaging in vigorous exercise after eating.
Side cramps can:
- Disrupt your pace and rhythm during a session
- Cause discomfort and distraction
- Hinder performance
- Stop or slow you down
- Distract you focus
- Impact overall enjoyment
In short, you just want to avoid side stitches if you’re a runner who values feeling good and running well!
What Causes a Side Stitch While Running?
While the exact cause of side stitches isn’t entirely clear, there are several theories:
Diaphragm Spasm or Cramp
One prevailing theory involves spasms or cramps in the diaphragm or the surrounding muscles. During exercise, particularly those involving repetitive movements like running, the diaphragm undergoes continuous contractions to facilitate breathing. Intense or sudden movements may lead to muscle fatigue or cramping, resulting in the familiar sharp pain.
Irritation of Abdominal Ligaments
Another hypothesis suggests that side stitches may stem from irritation of the ligaments that support the organs inside your body. As the body moves during exercise — especially high-impact movements — these ligaments may experience stress or strain, leading to pain or discomfort.
According to this theory, the pain of a side cramp may be exacerbated by movements that cause the organs to tug on these ligaments, triggering a painful response.
Eating a Large Meal Before Exercise
Indulging in a hefty meal shortly before exercise can spell trouble for your gut and your workout. A full stomach can impede diaphragmatic movement and increase the risk of side stitches. Large meals require significant digestive energy, diverting blood flow away from working muscles to aid digestion. Reduced blood flow results in less oxygen available to your working muscles.
Dehydration
Inadequate hydration can also contribute to the onset of side cramps. When your body is dehydrated, muscles may be more prone to cramping and spasms, including those in the diaphragm.
Additionally, dehydration can affect electrolyte balance, which is crucial for proper muscle function. Ensuring proper hydration before, during and after exercise can help reduce the risk of side stitches.
Poor Breathing Technique
Improper breathing techniques during a workout can exacerbate the risk of side stitches. Shallow breathing from the chest, rather than deep breaths from the diaphragm, may contribute to muscle tension and fatigue. Focusing on proper breathing mechanics can help alleviate strain on the diaphragm and reduce the likelihood of experiencing side stitches.
Drinking Too Much Before a Workout
Hydrating is crucial for optimal performance, but there’s a fine line. Consuming excessive fluids right before exercise can backfire and lead to side cramps. Downing large volumes of liquid can distend the stomach, putting pressure on the diaphragm and surrounding organs.
To avoid this potential trigger, aim to hydrate steadily throughout the day rather than chugging large amounts right before a training session.
Lower Age
Some research studies have inked age to side stitches, with younger individuals more prone to experiencing them. These results could be a result of factors such as less developed core strength, less efficient breathing techniques or simply a lack of experience in managing discomfort during exercise. However, some researchers believe it may be due to a sedentary lifestyle being more common for older adults.
Workout Intensity
While pushing your limits can yield impressive results, ramping up the intensity of your workouts too quickly can also invite side stitches. Intense exercise places additional strain on the body, including the diaphragm and abdominal muscles. Gradually increasing the intensity of your workouts allows your body to adapt and reduces the chance of experiencing discomfort or cramping.
Poor Posture
Maintaining proper posture during exercise is essential for optimal biomechanics and muscle function. Poor posture — such as slouching or hunching over — can compress the organs, restricting movement and increasing the risk of side cramps. Your diaphragm needs space to move properly so give it that space while running!
Lower Fitness Level
Individuals with lower levels of fitness may find themselves more susceptible to discomfort, as their bodies may not be as efficient at managing the demands of exercise just yet. Weak core muscles, in particular, can contribute to poor posture and compromised breathing mechanics, increasing the likelihood of experiencing discomfort during a training session.
Gradually building up strength and endurance through consistent exercise can reduce the occurrence of this pain over time. You can get started with our comprehensive core workout for runners.
Side Stitch Remedies
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While getting a side stitch while running can be uncomfortable, the good news is that you can take steps to prevent them from ruining your workout.
Watch What You Eat
Avoid eating large meals or heavy, greasy foods within two hours of exercising. Rather, go for lighter, easily digestible snacks or meals if you need some fuel before your workout. You should eat larger meals 3-4 hours before a session and snacks 1-3 hours before.
Some great pre-workout options include:
- Whole grain toast with almond butter and banana slices
- Greek yogurt with berries and a drizzle of honey
- Oatmeal topped with nuts, seeds and fruit
- Smoothie made with spinach, banana, protein powder and almond milk
- Quinoa salad with mixed vegetables and grilled chicken
- Brown rice bowl with grilled salmon and steamed broccoli
- Veggie omelet made with eggs, spinach, bell peppers and feta cheese
For more guidance on nutrition for runners, download our complimentary Q&A with a Registered Dietitian here.
Stay Hydrated
Make sure to drink plenty of water throughout the day, especially before and during your workout. On average, aim for 15.5 cups of water for men and 11.5 cups of water for women daily. This number includes other fluid sources such as tea, coffee, vegetables and fruits.
Warm-Up Properly
Take the time to warm up your muscles before jumping into intense exercise. A proper warm-up can prepare your body for the demands of your workout and may reduce the likelihood of experiencing side stitches.
Our Standard Warm-up Routine takes about 10 minutes to complete and can be done virtually anywhere:
This routine includes a variety of dynamic flexibility and strength exercises to metabolically prime your body for running.
Gradually Increase Intensity
If you’re new to exercise or trying a more intense workout, ease into it gradually. Sudden increases in intensity can put extra strain on your muscles and increase the risk of side stitches.
Avoid High-Sugar Drinks Before
Sugary beverages, such as sodas, energy drinks and fruit juices, can spike your blood sugar levels, leading to rapid digestion and absorption of carbohydrates. This sudden influx of sugars can result in bloating gas and discomfort. That can put extra stress on your diaphragm, potentially leading to a side stitch while running.
Improve Your Breathing Technique
Pay attention to your breathing while exercising. Try to take deep, rhythmic breaths from your diaphragm rather than shallow breaths from your chest. Some people find that exhaling forcefully when the foot on the side of the stitch pain strikes the ground can alleviate the discomfort.
Follow these instructions to improve your breathing while running:
- Inhale deeply through your nose
- Exhale fully through your mouth
- Coordinate your breath with your movement
- Maintain a steady rhythm
- Engage your core
- Avoid shallow breathing from your chest
- Aim for smooth, controlled breaths
- Exhale during the most exertive part of the movement
- Focus on maintaining relaxed shoulders and jaw
Stretch Your Abdominal Muscles
Add stretches that target your abdominal muscles into your pre- and post-workout routine. This can improve flexibility and reduce cramping.
Press the Area
While it may seem counterintuitive, pressing on the painful area during a side stitch can sometimes provide relief. This technique, known as trigger point pressure, involves applying gentle pressure to the affected area to release tension.
Focus on Posture
Avoid slouching or compromising your running form during a run or cycle. Focus on standing tall with your shoulders back and engage your core muscles to support proper alignment and minimize strain.
You can download our Form Cues Guide for a list of my favorite cues and when to use them.
Listen to Your Body
If you start to feel a side stitch coming on, slow down your pace or take a short break to allow the pain to subside. Pushing through the pain can make it worse and may lead to injury.
While side stitches can be frustrating, they’re usually harmless and you can often prevent them with some simple lifestyle adjustments.
Smash Your Next Workout Pain-Free
While researchers aren’t entirely sure what causes this sensation during exercise, you can still take measures to prevent it. Whether you avoid large meals, hydrate properly or take it easy, you can minimize the risk of these uncomfortable interruptions.
Remember, consistency and mindfulness are key, so listen to your body, make adjustments as needed and smash your next session.
And if you’re prone to running injuries, get our best advice here!
This article was written by Mia Barnes. She is a freelance health and wellness writer with expertise in fitness and healthy living. Mia is also the Founder and Editor-in-Chief of Body+Mind Magazine.
