If you’re a runner, cyclist, or participate in endurance sports, the chances are that you’ve experienced a sharp, debilitating pain in your side that has forced you to slow down in training or during a race. Commonly known as a side stitch or side cramp, this symptom can occur on the right or left side of the abdomen and can range from a dull cramp to a stabbing pain. It is estimated that 70% of endurance athletes have experienced a side stitch in the last year. Luckily there are several strategies that you can implement before and during exercise to minimize the chances of getting a side stitch. This article will discuss the plausible causes of side stitches and provide practical solutions to stop them dead in their tracks.
No One Knows What EXACTLY Causes Side Stitches
Although the exact cause of side stitches has yet to be proven, there are two theories as to why they occur. Some experts think stitches are the result of a cramp in the diaphragm, perhaps due to ischemia (your diaphragm not getting enough blood). As you exercise, you increase pressure on your abdominal muscles and breathe rapidly, expanding your lungs. Those two actions create a dual pressure: a push up from the abdominals, and a push down from your lungs—with your diaphragm getting pinched in the middle. That pinch can cut off the flow of blood and oxygen, causing the cramp.
Just like other muscles in the body, when the diaphragm is put under too much stress it can fatigue and cramp. This is why you often see side stitches occur in beginner endurance athletes or those who increase their pace and distance
Another less supported theory is that the stitches are the result of irritation of the parietal peritoneum, the membrane that lines the abdominal wall and helps support your organs.
Now that we know the potential causes of side stitches let’s look at things you can do before, during, and after exercise to help prevent and stop them.
Before Endurance Exercise
- The last meal before endurance exercise should be consumed 2-3 hours beforehand and be low in fat and fiber. If your body is still digesting food by the time your workout rolls around, less blood will be flowing to the diaphragm, which can induce spasms/side stitches. The exception to this rule is if you need a gel or quick digesting carb to curb hunger before your run, ride, etc.
- Avoid drinks and juices high in sugar. Several studies have found these can contribute to stitches. Fruit juice seemed to cause them most often, while water and sports drinks had less of a negative impact.
- Warm-Up. Spend the first 10-15 minutes of your workout at an easy pace to promote blood flow to working muscles and optimal breathing patterns. Generally speaking, when you break a sweat your body is warmed up.
During Endurance Exercise
- Slow and steady. After a thorough warm-up don’t jump the gun by starting at a breakneck For example if you are running a threshold workout increase the pace 10 seconds faster every mile.
- Increase your breath. Taking shallow breaths does not efficiently supply oxygen to working muscles, including the diaphragm. Inhaling and exhaling fully and deeply can help reduce the occurrence of side stitches. Research shows that breathing "faster"—as in, inhale for two steps, exhale for one step—increases the depth of breath.
- Slow down and exhale to release the stitch.Slow your pace and exhale as the foot on the opposite side of the stitch strikes the ground. This doesn’t mean every time that foot hits the ground, but as you exhale, do so in sync with that opposite side. When you exhale, you use the muscles of your diaphragm. When this happens in unison with your foot striking the ground, the impact forces travel up the body and through your core and exacerbate the muscles in spasm creating that stitch. When you change the side of the landing forces to the opposite side, the tension causing the stitch releases.
- Give yourself a hand. Press with your hand on the painful area and relieve the pressure while breathing out.
- Stop and stretch. If the stitch still doesn’t go away after trying the above three methods, you may have to stop and stretch mid-workout. Take a long, deep breath and stretch your arms up to the sky. Next, bend at the waist toward the opposite side of the stitch with your arms extended above overhead. (If your stitch is on the right side, bend to the left.)
After Endurance Exercise
- Spend some time on your core. Allocate 10 minutes, two times a week to work on your abdominals and obliques. Research has demonstrated that a strong core can help prevent side stitches by reducing rotational movement in the trunk of the body.
- Stand Tall/Sit Straight. Focus on standing tall and sitting straight during the day. Avoid slumped positions where the shoulders and spine are “rolled” forward. Two studies have found that kyphosis (or “roundback”), a condition where the upper spine is more sharply curved than normal, is related to an increased risk of suffering from side
The Bottom Line On Side Stitches
Side stitches can be a pain in the ass (or more appropriately the side) for an endurance athlete during training and racing. Although the exact cause of side stitches is not known, there are several researched solutions that can help reduce or prevent them altogether. If you are still experiencing side stitches on a regular basis after trying the methods above, it may be time to see your doctor as there could be a problem with blood flow to your intestines.
- Morton, D.; Callister, R., Factors influencing exercise-related transient abdominal pain. Medicine & Science in Sports & Exercise 2002, 34 (5), 745-749.
2. Morton, D.; Callister, R., Spirometry measurements during an episode of exercise-related transient abdominal pain. International Journal of Sports Physiology and Performance 2006, 1 (4), 336-346.
3. Morton, D.; Callister, R., Characteristics and etiology of exercise-related transient abdominal pain. Medicine & Science in Sports & Exercise 2000, 32 (2), 432-438.
4. Morton, D.; Callister, R.; Richards, D., Epidemiology of exercise-related transient abdominal pain at the Sydney city to Surf community run. Journal of Science and Medicine in Sport 2005, 8 (2), 152-162.
5. Morton, D.; Aragón-vargas, L.; Callister, R., Effect of ingested fluid composition on exercise-related transient abdominal pain. International Journal of Sport Nutrition and Exercise Metabolism 2004, 14 (2), 197-208.
6. Morton, D.; Aune, T., Runner's stitch and the thoracic spine. British Journal of Sports Medicine 2004, 38, 240-243.
7. Muir, B., Exercise related transient abdominal pain: a case report and review of the literature. Journal of the Canadian Chiropractic Association 2009, 53 (4), 251-260.
8. Plunkett, B.; Hopkins, W., Investigation of the side pain "stitch" induced by running after fluid ingestion. Medicine & Science in Sports & Exercise 1999, 31 (8), 1169-1175.