The medical term for a side stitch is “exercise-related transient abdominal pain” and the words tell us as much about the condition as anyone knows.
Side stitches occur during physical exertion (usually running or walking briskly). They're transient. They affect the abdominal area to the right of the navel. And they hurt.
Beyond the basic definition, there's little consensus and no proof about the cause, cure or prevention. Much of what we know comes from a 2005 study published in a 2005 issue of the Journal of Science and Medicine in Sport.
How it Happens (Current Theories)
- Side stitches are caused by the pumping action of the legs putting pressure on the diaphragm from below, while rapid breathing expands the lungs and puts pressure on the diaphragm from above. This “dual pinching” effect shuts off the flow of blood and oxygen, and causes pain, cramps or both.
- Other researchers believe that side stitches are caused by
stretching the ligaments that extend from the diaphragm to the
liver. When a runner or walker pounds the surface while breathing in
and out these ligaments are stretched which causes the pain.
- A third theory is that eating a lot of food or fatty food, in
particular, before exercise may cause stress on the diaphragm.
No one knows for sure what causes the pain, but it's real and there are some things you may be able to do about it.
Who’s At Risk of Side Stitches?
Runners are more susceptible than walkers; women more likely to get
side stitches than men; younger people more than older exercisers;
and less conditioned runners more than well conditioned ones.
Again, in the Australian study mentioned above, the pain began to
develop equally during the first, middle, and latter part of the
race, so warming up or not warming up does not seem to have an
The amount of food eaten prior to exercise appears to make a person
more susceptible to side stitches. Runners who ate the most during
the two hours before the event were the ones most likely to
Almost 50 percent said that the pain occurred after they had ingested
water or a sports drink.
These findings were the result of just one study, so they must be considered in that context.
There is no treatment. Simply stop doing whatever causes the pain or stop and try some of the in-race suggestions below, then resume the activity after 1-2 minutes.
How to Avoid Side Stitches
There are many suggestions for avoiding side stitches, but what works for one person may or may not help another. Experiment with the ideas below, use the ones that work, and disregard the rest.
- Eat moderately-sized, low-fat meals 2-3 hours before practice or
- Stick to familiar foods that are easily digested. A small snack
about an hour before a workout or run is ok, but this snack should be
comprised mostly of carbohydrate and fluid, not fat.
- If all else fails, try different sources of pre-workout foods (energy
gels, sports drinks, bread, pasta, oatmeal, fruits) till you find
something you can tolerate without getting a pain in the side.
- Stop running or walking and bend forward, while tightening the
- Exhale through pursed lips (to focus on breathing pattern).
- Stretch (right arm extended upward, lean to the left, hold for 20-30 seconds, repeat with the left arm stretched upward).
- Breathe deeply (to stretch the diaphragm).
- Change breathing patterns while running, inhale one extra beat than when exhaling (inhale 1-2-3; exhale 1-2).
- Slow your pace of running or walking.
- Hydrate during your workouts with 7-10 ounces of water or a sports drink (Gatorade) every 10-15 minutes. These amounts and types of beverages will promote better fluid absorption compared to consumption of larger amounts of beverages such as fruit juices.