Every runner knows that feeling: you’re running along feeling on top of the world, when BAM! It feels like someone stuck a knife in your side. Typically in the lower ribcage area, a sharp pain appears out of nowhere that nearly doubles you over, makes breathing difficult, and running feel impossible. It’s the dreaded runners side stitch.
What Exactly IS a Side Stitch?
Medically referred to as exercise related transient abdominal pain (ETAP), the exact cause of a side stitch is still somewhat of a mystery. Dr. Lewis Maharam ,MD, FACSM, explains one theory behind the cause of a side stitch is due to pressure placed upon the diaphragm. While running, there is increased abdominal pressure pushing up on the diaphragm from below, while rapid breathing expands the lungs and puts pressure on the diaphragm from above. This pinching effect experienced on the diaphragm from pressure above and below shuts off the flow of blood and oxygen, and causes spasms, and as a result, the painful side stitches. Another possible theory is that over eating, or eating fatty foods before exercise may cause stress on the diaphragm. Poor posture, as well as dehydration are also thought to be possible causes of a side stitch.
And though side stitches often seem to be a common ailment among newbies, it turns out no runner is immune to the evil cramp. A study done by the Avondale Centre for Exercise Sciences shows that the occurrence of side stitches was unrelated to gender, body type, or running pace; though frequency of side stitches decreased with age. But the good news is: the study reports that individuals who trained more frequently reported less instances of experiencing side stitches.
Are Side Stitches Preventable?
Since the exact cause of a side stitch is unknown, it can’t exactly be prevented with 100% certainty. However, physicians and running coaches have numerous suggestions that may prevent the onset of a side stitch. Ensure that you are properly hydrated and avoiding large meals before a run. Begin your run with a proper warm up, and avoid over exerting yourself early during your run…if at all possible. Obviously this doesn’t apply to speed work day. Practice proper breathing techniques, such as belly breathing, and inhaling through the mouth (more examples in this Runner’s World article). Most experts agree that the frequency of side stitches decreases with experience, so proper endurance training will aid in prevention.
Once I Get a Side Stitch, How Can I Get Rid of It?
Good news! Even though they may feel like they last forever, the truth is side stitches typically do not last long. If you experience a runners side stitch, slow down and focus on your breathing. Deep, calm breaths help the spasms of the diaphragm subside, One technique to focus on your breathing is to exhale through pursed lips, as if you are blowing out a candle. Another common method is to exhale as the left foot strikes the ground, instead of the right foot, as this puts less strain on the diaphragm (source). Runner’s World recommends stretching: raise the arm of the same side in which you are experiencing the pain, and then lean to the opposite side. And last resort: walk. Get your breathing under control and relax. This too shall pass, and there is no shame in a brief walk break.
In conclusion: side stitches suck. And while the exact cause remains to be determined, taking preventative actions to avoid their onset, as well as practicing the tips mentioned above to help cure side stitches, may help lessen or altogether avoid the discomfort of a runner’s side stitch.