In today’s post, we’re going to be talking about how to prevent a side stitch when running.
I’m sure at some point you’ll have experienced a side stitch in your running career.
You’re running. You’re in the last quarter of the marathon. But then, suddenly, you feel a sharp pain in your side. It seems to get worse and worse with every breath. It is an attack of the side stitch!
It’s not life-threatening, it’s not a serious injury, but it can be really painful and can also put some people off running altogether.
If you’ve never experienced the potentially debilitating and sometimes very painful feeling of a side stitch or side cramp, then count yourself very lucky.
But if you have, there is some good news because there are actually steps that you can take to avoid picking one up in the future.
Let’s dive right into it…
How To Prevent A Side Stitch When Running
Let’s start by explaining the science behind what a stitch is and why you get it…
What Is A Side Stitch
In the medical world, it’s often referred to as Exercise Related Transient Abdominal Pain (ETAP), but you’ve probably more likely heard the term used as side stitch, side cramp, side pain, and apparently even a sticker.
Although this can be a really annoying pain that’s experienced by a lot of people who exercise, it isn’t actually an injury even though it’s estimated that around 70 percent of people who run regularly have experienced this at some point.
But it’s thought that actually amateur runners or people who are new to running are more likely to experience a side stitch than someone who is more experienced.
So basically, the side stitch is thought to be an internal type of cramp or spasm of the diaphragm felt by some runners.
That’s why you can experience pain underneath the ribs, sometimes right in the abdomen, in your shoulder, and in both sides although research shows that actually it’s most commonly found on the right-hand side of the abdomen.
Side Stitch Through History
A stitch is a pain that’s been referenced throughout history all the way back to the first century.
The Roman author and philosopher Pliny the Elder called it “a painful cramp” and recommended injecting the urine of a she-goat into the ears to help with the pain. Not sure how much that’s going to help you on a 5k run though.
Shakespeare even referenced stitches in his work as a threat. So in the Tempest, Prospero says “Tonight thou shalt have cramps, side stitches that shall pen thy breath up.”
So, if stitches have been around for centuries, then do we know what they are and what causes them?
What Causes A Side Stitch
There is still limited research into what actually causes a stitch, which means that there isn’t really a definitive answer to this. But there is a leading candidate among the theories and we’re going to run through some of those now…
It could be anything from eating and drinking too much, doing too many sit-ups, riding a bike in a poor position, or even having a lopsided running gait.
But one thing that is quite common is the diaphragm. It’s thought that a reduced blood flow to the diaphragm can cause this pain.
It is also thought that it could be irritation and therefore inflammation of the membrane lining between the diaphragm and the abdomen. So when there’s a lot of jostling up and down, this causes friction which then results in that side stitch type of pain.
Also, when you eat too much without a reasonable gap before exercise, running can cause a jolting to the organs that are trying to digest the food, which can put a strain on the diaphragm.
Another diaphragm base theory is that side stitches can be caused by something called Diaphragmatic Ischemia which, in simple terms, means that your diaphragm isn’t getting in a blood supply to it.
The diaphragm is connected to the intercostal muscles, which can explain the side pain, and is also connected to your shoulder, which can explain why some people experience stitch pain up in their shoulder as well.
However, this theory has also been debunked as people can often experience side stitches doing activities that don’t typically make you heavily out of breath like motor racing and horse riding.
Another theory was to do with the spleen. The spleen expands during exercise as the heart rate increases and pulls in blood cells from other areas of the body potentially causing pain elsewhere.
This theory was also ruled out though as it can’t explain pain in areas of the abdomen and the shoulder.
Another theory looks at the role that the liver can play in having side stitches. So with the organ sitting on the right-hand side of your body and anecdotally more side stitches happening on that side of the body, it was thought that it might be down to something to do with the liver.
However, lots of people experience side stitches right across their abdomen, which then means that this theory actually isn’t correct either.
Median Arcuate Ligament Syndrome
This syndrome is a condition where the median arcuate ligament is pushing too tightly on the celiac artery which is responsible for delivering blood flow to the stomach, the liver, and other organs.
Again though, the stumbling block here is it can’t explain abdominal pain in other areas.
Cramping Of The Abdominal Masculature
A lot of people describe the pain from a side stitch as similar to that of muscle cramps. However, recent studies have looked at the behavior of muscles during stitches and cramps and found that there was no muscle cramping during the side stitch.
Aggravation Of The Spinal Nerve
This one relates to poor posture and can explain a lot of stitch pain. Running sometimes aggravates the intercostal nerves, but it can’t explain the link between running and a stitch after eating.
After all that, the current thoughts behind the cause of a side stitch comes from research from Callister and Morton and that is an irritation of the parietal peritoneum.
The parietal peritoneum is the lining of the pelvic and abdominal cavities. It sits as two layers with liquid between it. So, it’s thought that a side stitch occurs when that system fails and the liquid is lost therefore causing the pain.
It’s also connected to the phrenic nerve which connects to the shoulder, which can explain why some people feel pain in the tip of their shoulder when they get a stitch.
So this theory does cover all of the bases when it comes to the areas of pain that people feel when they get a stitch. However, that said, researchers are still not a hundred percent certain that this is the cause of a side stitch.
So, when we’re out on a run, even if we’ve done everything that we think possible to try and prevent getting one, we still end up with a stitch.
But what’s the best way to deal with one when it strikes?
How To Prevent And Treat A Side Stitch When Running
Despite there being more research recently into the causes of side stitches, the exact reason behind them is still uncertain, which means that it’s not exactly clear the exact prevention measures that you can take and precautions in order to not get one.
Everyone has different ways of dealing with a side stitch when they get them and they can also last for varying amounts of time as well.
While some people say that they only experienced them for a couple of minutes at a time, others have reported feeling the after-effects of a side stitch for several days after as well.
Apparently, the quickest way to ease a stitch is to put upward pressure on the area underneath your ribs, but there’s no clear explanation as to why that works.
What To Eat Before A Run
This is very much a personal preference, but it’s a good idea to avoid having too much in the way of fatty foods or foods that are high in fiber as these will sit in your stomach for much longer.
We did a pretty cool expert round-up post where 27 expert runners shared their race-day breakfast ideas. Make sure you check that out as well.
Give Your Stomach Enough Time To Digest
There are dietary measures which you need to put in place before going for your run.
Avoid eating or drinking excessively beforehand. Then, allow two to three hours between eating and the start gun, which will allow the food to empty from your stomach and prevent it from bouncing around.
But it really is a matter of personal preference and how quickly your stomach can digest something, although you’ll soon find out through experimentation.
This isn’t to say that you’re definitely going to get a stitch especially if you’re going to be eating on the run, which is something that you might be considering doing if you’re training for longer distances like marathons or ultras, but it is worth bearing in mind when you’re going to eat and how much you’re going to eat when factoring in when you’re going to be doing your runs.
Also, try to avoid hypertonic compounds. Simply, this is food and drink that takes a long time to be absorbed into the body and takes water out of cells making you feel more dehydrated.
These generally include drinks that have high amounts of sugar or salt and even things like corn syrup. It’s much better to have an isotonic sports drink which works alongside the body’s fluids and nutrients.
Try to be well hydrated before the start of the event and during the event. If you want to take in fluid and food, just take small, frequent portions of those to prevent the stomach from expanding too much and potentially causing a stitch.
So fluids also need to be considered as dehydration can lead to a stitch, but also in the opposite direction of having too much fluid sloshing around.
Again, when it comes to drinks, it’s a good idea to try and avoid highly concentrated drinks and anything that’s too high in sugar, especially fruit juices as these take longer to empty from the stomach and eventually might also cause a stitch.
So try to have a sports beverage with a little bit of sodium in it.
Usually throughout your run, as you’re sweating and you’re losing that sodium, that can cause a little bit of cramping or a little bit of side stitching.
Another thing that people try to do is have a banana at the beginning of the day. Some people believe that trying to have that little bit of extra potassium will help to prevent the stitch because it’s believed that an electrolyte imbalance can cause that side stitch.
Related: Best Electrolytes for Runners
Improve Your Core Strength
It is recommended that improving your core strength can help you avoid getting stitches not to mention potentially reducing your risk of injury.
A 2014 study of 50 runners found that stronger trunk muscles and larger resting transversus abdominis size result in less pain from ETAP.
So it’s a good idea to work on strengthening your core muscles, the muscles of your lower back, and your abdomen. Building some core exercises into your weekly workout routine is a great place to start.
And while you’re doing that, you want to make sure you’re doing plenty of stretches for this area too so that the movement can be nice and smooth when you’re running.
Talking about stretching…
You can actually stretch it out mid-run when the stitch appears. You can actually just use your hands and grab the area so you’re changing the stimulus, and you can even double that up with a bend-over.
Or, what I find works for me is to stretch your arms up above your head and even add in a bit of a side bend. There’s no evidence behind either of these, but you’ll probably find that at least one of them will help.
According to a physiotherapist, if it comes on, squeeze your side as this has been shown to be a good preventative measure. If that’s not working, then slow down your running pace. Control your breathing and see if that helps.
The final thing to do is to stop altogether. Stretch, either by lifting your arm up over the head and bending to one side, or bending forward and reaching to the floor, touch your toes and see if that helps.
Another thing you can try to do is pull over to the side and try to stretch on that side of the stitch where it’s happening and really take a deep breath and breathe into that side of the stitch.
Try to keep walking and keep moving and eventually, it should go away.
Breathing & Cadence
It’s a good idea to think about your breathing and try to generally slow it down. So, really focus on your inhalation and your exhalation making them really nice and deep and therefore using the full movement of your diaphragm.
Another suggested method is actually taking a deep breath. Hold your breath momentarily and then rapidly exhale, which is going to change that pattern.
And talking of changing patterns, it’s worth considering your running cadence. The idea is to try and speed that up or slow it down or just change it up a little bit.
There are lots of people who would recommend a rhythmic breathing pattern where if you had a stitch on your right-hand side, you’d aim to exhale as soon as your left foot struck the ground. But it’s hard to prove if it really helps.
Think The Pain Away
This one is very much mind over matter. As you experience that side stitch pain, think of anything but the pain that you’re experiencing. The length of a stitch can vary for so many people, but the longer you think of something else, it might just go away.
Improve Your Posture
Another good prevention method and one that actually has the added benefit of helping you to run faster is improving your posture while you’re running.
Breathing And Foot Strike
I personally find this to be leaning more toward the myth end of the spectrum.
Most people tend to land on their right foot when they exhale. But what happens with that is with your liver being on the right side of your body, it puts pressure on your liver, so it will actually pull on your diaphragm and that can cause a side stitch.
Advocates of this method say when you’re landing on your left side, try to exhale forcefully and see if that helps over a little bit of time.
It’s worth noting at this point that none of these theories are scientifically proven to get rid of a stitch, but they’ve worked for lots of people in the past. Ultimately, you need to find out what works for you and you’re only going to find out unless you try.
There’s still no denying that a stitch is one of the most annoying common running-related pains. But it’s even more frustrating because no one seems to be able to put their finger on the exact reason why or when you get one in the first place, although there are several theories out there.
As we said before, Shakespeare wrote about stitches in his writing and so there have been many years of speculation about what’s behind them.
Talking about myths, some people say meditating is the best way to get rid of a stitch provided you’re able to meditate and run at the same of course.
So obviously, there is sadly no magic answer for preventing or even effectively treating this performance-limiting pain called side stitch.
But if you do address all of the things we’ve talked about like changing your food habits, making sure you’ve always had a good warmup, and also improving your cardiovascular fitness, these should all add up and hopefully reduce or prevent you from getting a side stitch in the future.
So there you have it. These were some of the best techniques we could find related to how to prevent a side stitch when running.
Hopefully, this article has helped to ease some of your stitch-related questions. Do you often get stitches when you’re out on a run? Have you given any of these a try? Or, maybe you’ve got your own magic way of getting rid of a side stitch that we haven’t mentioned?
Leave us a comment below and tell us about your experiences.