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What's Causing These Side Stitches?

injury pain Nov 30, 2020

Most of us have experienced it: that debilitating, instantly crippling pain underneath the rib cage that can bring your run — or race — to a screeching, disappointing halt.


Side stitches are common, affecting around 70 percent of runners each year, but the shared experience of a side stitch probably doesn’t make you hate them any less.


Generally described as a stabbing, localized pain on either the right or left side of the abdomen, side stitches can happen to anyone, but they tend to mostly affect beginning runners or those stepping up their pace or distance.


That makes sense when you think about what a side stitch actually is — a spasming of the diaphragm, which is the large muscle below the lungs that helps the lungs expand so you can breathe. Although there isn’t definitive evidence as to what causes side stitches, there are plenty of theories.


5 possible reasons side stitches occur


1) Eating or drinking too close to a run


Many side stitches seem to be associated with nutrition and hydration — specifically, eating a large meal or drinking juice or a sugary sports drink right before a run. That may be because the stomach is full and knocking against the diaphragm as it expands and contracts. It also may be because blood flow is diverted from the diaphragm to the stomach to help with digestion.


2) Overstretched ligaments


Another potential cause of side stitches is excessive stretching of the ligaments that extend from the diaphragm to the internal organs, which can occur during a high-intensity run and result in a spasm.


3) Poor running form


If you’re running hunched over, it’s almost impossible for you to take deep breaths, meaning you’re probably taking quick, shallow breaths that don’t provide adequate oxygen to the diaphragm — sometimes leading it to spasm.


4) A skipped warm-up


Shallow breathing can also lead to a side stitch if you go right into a speed workout without warming up beforehand. It’s just one more reason why stretching and starting with a brisk walk or easy run before getting into tempo or interval work is so important.


5) Weak core muscles


Side stitches often affect new runners because they haven’t strengthened their core muscles enough yet to help stabilize the body so they can run efficiently. When you run, you strengthen your muscles, including the diaphragm, but adding in workouts to strengthen the core muscles will keep you from getting side stitches down the road.


What you can do about side stitches


There are ways to combat side stitches when you’re out on a run, but they’re not one-size-fits-all, meaning you have to experiment to see what works for you. Here are some common side stitch fixes:


  • Run through the side stitch.


Despite how painful they are, side stitches don’t cause long-term damage, meaning you can run through them. Eventually, they will go away.


  • Push through the pain (literally).


Press your fingertips into the spot on your abdomen where the pain is while exhaling forcefully. Repeat this a few times. It decreases the blood flow to the area momentarily, which allows the muscles to relax.


  • Take deep breaths.


Breathe in deeply and exhale slowly. Repeat. You can also try switching up your breathing pattern.


  • Stretch it out.


Raise the arm on the affected side of your body and lean toward the opposite side.


  • Take a walk.


You can try to stop and walk for a bit to see if the side stitch subsides, but, unfortunately, the stitch could come back when you start running again.


Long-term prevention


Getting rid of side stitches when they occur is one thing, but keeping them from recurring is even more important.


Here are some things you can do:


  • Watch what you eat and drink before a run.


Reduce what you eat or drink before a run, especially foods and drinks with high sugar concentrations. If side stitches persist, keep a log of what you’re taking in and when before you head out the door. Foods high in fat and fiber, for instance, take longer to digest and should be avoided one to two hours before a run.


  • Pay attention to your running form.


Make sure you’re running upright with your shoulders back so your diaphragm can expand and you can take deep breaths.


  • Don’t forget to stretch and warm up before a run.


Stretching and warming up are critical in injury prevention, but they’re also helpful in preparing the muscles and lungs for the work to come.


  • Strengthen your core.


Weave strength training into your running routine to build up strong diaphragm and abdominal muscles, which will make them less likely to fatigue and less likely to cramp. A stronger core will also help you run more efficiently and reduce your injury risk.


Now get out there and run your life.



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