Everything You Need to Know About Side Stitches
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 conducted among 848 participants in a 14K race in Australia. The results of the study were published in a 2005 issue of the Journal of Science and Medicine in Sport.
How It Happens
Dr. Lewis Maharam, writing in Runner’s World, says that side stitches are likely to be 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, he or she stretches these ligaments, and that 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.
The truth is that 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.
Side Stitches by the Numbers
Percentage of runners and walkers who experienced side stitches in the Australian study mentioned above
Percentage of those people who felt pain on the right side
Age below which side stitches were more common.
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 previously, 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 effect.
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 experience pain.
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.
- A temporary stabbing pain on the lower right side of your abdomen.
- The pain subsides almost immediately after exercise stops.
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 competition.
- 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. Examples include 1/2 deli sandwich and a sports drink, 2-4 fig bars and a sports drink, or a granola bar and a sports drink. 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 abdominal muscles.
- 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.
Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.
- Bob Calvin, MS, RD, CSCS, performance nutritionist at Athletes' Performance
- Runner’s World, July 29, 2008
- Journal of Science and Medicine in Sport
- Gatorade Sports Science Institute
- Prevention Fitness