Painful Side Stitches: Why They Occur, and How to Prevent Them

Few things can ruin a nice run like a side stitch. You’re going along, you’ve got your rhythm, and you’re making good time, when suddenly the pain grips you, throwing everything off.

You have to slow down and go through the motions of trying to get rid of it. You try deep breathing, squeezing the painful area and stretching your side. If you’re lucky, it will subside, and you can get back to where you were, but many times a side stitch will force you to stop and walk it out before you can get back to your jog. It’s time to prevent these irritating pains from messing with your workout.

What Is a Side Stitch?

A side stitch is a sudden sharp pain in your side that occurs while you’re exercising, most often while running. It usually happens just below the rib cage and feels like a bad muscle cramp or a stabbing, knife-like pain.

Also called a side cramp, side sticker or side ache, a side stitch is medically termed an “exercise-related transient abdominal pain (ETAP),” which is just a fancy way of saying “a temporary pain in the abdomen that occurs during exercise.”

Although it can occur on either side, it’s more common on the right. Studies have indicated that right-side pain is up to twice as common as left side pain, although left-side pain may be more prevalent among younger exercisers.

In a 2005 study, researchers surveyed about 850 participants (76 percent runners, 24 percent walkers) after they’d completed a 14-kilometer City to Surf community-run. About 27 percent of them suffered an ETAP during the event, with the condition reported more frequently by runners (30 percent) than walkers (16 percent).

Nearly half (46 percent) suffered from right-side pain, while almost a quarter (23 percent) suffered from left-side pain. The exercisers also stated that the pain was detrimental to their performance.

Fortunately, ETAPs are harmless. They do not indicate any serious health issue, nor do they threaten to cause lasting injury. They are annoying, however, and since they often occur in the same area during future workouts, they can be a detriment to your exercise and weight-loss goals.

What Causes a Side Stitch?

As to what causes a side stitch, there doesn’t seem to be any clear answer. We do know, however, that certain factors seem to increase the risk:

  • Age: They seem to be more common in younger people, with cases dropping off as people get older.
  • Twisting exercises: Side stitches appear to be more common in types of exercise that involve twisting the upper body, like running, swimming and horseback riding.
  • Eating and drinking: Side stitches seem to be triggered by eating and drinking before exercise, particularly foods and beverages high in sugar.

Scientists thought at first that the diaphragm was to blame and that not enough blood was getting into this organ, causing a cramp-like pain, but studies have failed to find evidence supporting this theory.

It could be that the jolting movements that occur during exercise stress the ligaments in the abdomen, but then that wouldn’t be the case in swimming where the movements are smoother. Posture or problems with gait or form could be to blame as could friction, irritation or inflammation in the abdominal wall.

One thing we do know is a side stitch is not a muscle cramp. It may feel like one, but studies measuring skeletal muscle activity have revealed that the muscles are not involved when a side stitch is present. This is valuable information as it lets us know that doing the things that we might normally do to fix a muscle cramp, such as “stretching” it out, are unlikely to help relieve a side stitch.

Unfortunately, no one theory seems to explain all side stitches, which causes another problem — without knowing exactly what’s causing the pain, we also don’t know exactly how to fix it.

8 Ways to Prevent a Side Stitch

Once you’ve experienced a side stitch, you certainly don’t want to experience another one. As noted above, it’s not exactly clear what causes them, but there are some things you can do to increase your odds of avoiding the pain.

1. Avoid High-sugar Foods and Beverages at Least 90 Minutes Before Exercise

Studies have indicated that consuming a lot of sugar before exercise can increase the risk of stitches. Even so-called “exercise” drinks can be high in sugar and may cause pain later on. Sugary drinks reduce the rate at which the stomach empties its contents into the intestines, which can lead to bloating and friction.

You may also want to be careful about your fluid intake in general. One study found that drinking fluids before exercise were associated with side stitches. Fruit juices were the worst offenders while water and sports drinks had less of an effect.

2. Avoid Heavy Meals at Least 2 Hours Before Exercising

Foods that are high in fat and fiber take longer to digest, so it’s best to avoid them before a workout. The process of digestion diverts blood flow to the stomach, leaving less for the diaphragm and other surrounding organs.

Foods and fluids in the stomach also increase the weight of the organ, which can strain the ligaments in the abdomen. Either of these conditions could lead to a side stitch, so it’s best to exercise on an empty or near-empty stomach.

3. Breathe Deeply

If your breathing is too shallow while you’re exercising, the muscles, ligaments, diaphragm and the rest of the body can end up short on oxygen. Shallow breathing also tends to correlate with tension in the body. That could lead to a side stitch.

Take a few deep breaths before you start your workout. Then, think about breathing faster and exhaling each time fully. If you’re running, inhale for two steps and exhale for one, for example, to make sure you’re getting enough air. Feel free to vary this pattern now and then to reduce stress on the abdomen and torso. Controlling your breathing in this way is often effective at preventing a side stitch from developing.

4. Warm Up First

If you blast into your workout and accelerate your heart rate quickly, it can cause irregular breathing, which again can lead to pain. Be sure to warm up for a few minutes first. Spend a few minutes brisk walking before running, walk slowly before a fast walk or do an easy float for a few laps before swimming all out.

5. Shore Up Your Core Muscles

One of the factors that seem to be involved in creating side stitches is excess movement in the upper body, particularly rotational movements in the trunk. If your core muscles are strong, they will help reduce those movements and provide better support to your stomach, diaphragm and other organs. Strengthen these muscles with front and side planks.

6. Check Your Form

Poor posture while exercising has been indicated as a possible factor in causing side pain, particularly if your spine is curved. In one study, those with “kyphosis,” which is a “humpback” type curve to the spine, were more at risk for ETAP.

Have a workout partner check your form, and then correct anything that’s not quite right. You want to keep your spine straight when running. Think about aligning your neck with your spine.

7. Dress for Cold Weather

There is some evidence that exercising in cold weather can increase the risk of side stitches. It’s more difficult to take in full breaths when the air is frigid. Make sure you’re dressed for the temperature and put on a neck warmer or a scarf and breathe through that material to help reduce the risk of pain.

8. Practice Yoga

Yoga, more than almost any other exercise, focuses on breathing and can teach you to breathe deeply and regularly. Practicing yoga trains your body to breathe in a way that is conducive to preventing side pain. That training can then benefit your other workouts as well.

5 Ways to Stop a Side Stitch Once It Starts

If all your preventative measures don’t work and you still end up with a side stitch, try these methods to more quickly get rid of it.

1. Slow Down

This is always the best first step and is often required because the pain will naturally slow you down. While proceeding at the slower pace, bend forward, place your hand on the painful area and push inward and upward. Tighten your core muscles and exhale. If this doesn’t work within a minute or two, try another method.

2. Tighten Your Belt

Performing the following series of movements is helpful for many athletes. First, contract your abdominal muscles, then modify your breathing (creating more of a rhythm). Then, tighten the belt (core muscles) around your abdomen. Often, the side stitch will disappear quickly.

3. Make Your Steps Match Your Breathing

If your stitch is on the right side and you normally exhale when your right foot strikes the ground, switch it up — exhale on the left. If your stitch is on the left side, do the opposite.

4. Breathe in the Opposite Way

Usually, when we inhale, the stomach distends outward, and when we exhale, the stomach contracts. If you have a stitch, try reversing this pattern. While you’re moving at a slower pace, take deep breaths in and out, pushing the air out more forcefully on the exhale while distending the stomach and drawing it in faster on the inhale while contracting the stomach.

5. Stop and Breathe

If none of these methods work to relieve the pain, stop, walk and massage the area while taking slow deep breaths. Wait until the pain subsides, then start again.

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