Dealing With Side Stitch Pain

woman holding stomach cramp during a run

Verywell

Whether you're out running or doing any form of exercise, an all-too-familiar sharp pain in your side can stop you in your tracks. If you've ever experienced a side stitch—also known as a muscle stitch or exercise-related transient abdominal pain (ETAP)—you know just how distracting and uncomfortable it can be.

Side stitches are common during many forms of exercise, particularly running. In fact, a 2015 study estimated that as many as 70% of runners had experienced a stitch in the previous year. Additionally, about one in five race participants are likely to get a stitch.?????

Fortunately, ETAP is not a medical emergency—or even a reason to see a doctor. The causes of side stitches are not yet fully understood, but most people can deal with one if it happens. Learn how to get rid of a side stitch so you can keep moving without the discomfort.

What Is a Stitch?

You may have experienced a side stitch (also called a side cramp, side sticker, or side ache) at one time or another during exercise.?The main symptom of a stitch is localized pain on one side of the abdomen. This sudden sharp or stabbing pain is usually felt on the?right lower abdominals just below the ribs. It is especially common among runners and swimmers. In older runners, stitches usually occur on the right side twice as often as on the left.????? The opposite is true of younger runners.

While age appears to play a role in ETAP—with older adults less prone to side stitches than children, adolescents, or younger adults—a person's sex or?body mass index?does not. Just about anyone of any shape, size, or ability can get a side stitch from many different types of physical activity.

Research shows that people describe ETAP in different ways, depending on the level of pain: sharp or stabbing if severe, or like a muscle cramp or pulling sensation when less intense.???? While the exact causes may not be well understood, there are a handful of known risk factors associated with ETAP.?????

  • Age: Younger runners are more likely to get side stitches than older adults. But when older runners do develop ETAP, they tend to rate the pain as less severe.
  • Eating and drinking before a run: Ingesting food or beverages before a run can increase the risk of getting a stitch. Certain types of food and drink seem to be more associated with ETAP, particularly those that are higher in sugar or fat, some fruits and fruit juices, and dairy products.
  • Low fitness level: Those who are new to exercise may experience cramps like side stitches if they're still working on developing and strengthening their abdominal muscles.
  • High-intensity exercise: Conversely, exercising too hard despite your level of fitness could make you more likely to get a stitch, especially if you're not warmed up.
  • Not warming up: A proper warm-up gets oxygen flowing through your body, which can help prevent a stitch, particularly in runners.
  • Running in cold weather: Some people find it harder to run in cold weather since the chilly air can cause the diaphragm to spasm. If you're unable to breathe deeply, you may be subjected to a cramp or stitch.

Causes of Side Stiches

Although side stitches have been well-studied, researchers still aren't entirely sure why they happen.??? While there are many possibilities, most of them are based on anecdotal evidence. Reasons you might get a side stitch may include:

  • The curvature of the spine (scoliosis): One study found a link between ETAP and increased curvature of the spine.??
  • Drinking sweet beverages: Some research has shown that consuming sugary drinks before exercise increases the likelihood of stitches.??
  • Going for a run too soon after eating: Runners sometimes notice they're more likely to get a stitch if they're still full from a pre-workout meal or snack.
  • Not warming up before a run: Runners sometimes report that they are more likely to get a side stitch if they start running without warming up.
  • Shallow breathing: Not breathing properly while running has been attributed to side stitches.??

Stitches also are often attributed to muscle cramps, but at least one study has shown no significant difference in electrical activity in the muscles when a subject was experiencing ETAP.???

While there is no definitive explanation as to the cause of a side stitch, researchers have proposed two possible theories to explain the phenomenon: dietary-related causes and physiology-related causes.

Diet

Whether you're an exerciser or runner, what you eat and drink during and prior to a work out matters. Research has shown that the foods eaten before exercise are the predominant causes of ETAP.???? Interestingly, the volume of food eaten seems to have less of an effect than either the timing of a meal or the types of food eaten, however.

A study published in 2015 in Sports Medicine found that the consumption of juices or beverages high in carbohydrates (11% concentration or greater) just before or during exercise increased the risk of a side stitch.???? Additionally, some studies have suggested that drinking fruit juice or high-carbohydrate sports drinks before and during exercise can lead to ETAP.???? By contrast, people who consumed water or low-carb sports drinks experienced fewer side stitches, according to the research.

Physiology

Exercise itself is not necessarily a risk factor for side stitches. ETAP is usually caused by repetitive movements in which the torso is repeatedly extended, which occurs during certain types of physical activity.???? This could explain why side stitches can affect horse riders or off-track racers whose upper bodies are placed in upright positions under rapid, repetitive stress. The structures of the body affected by this stress include:

  • Diaphragm: the muscle layer situated between the abdominal cavity and lungs
  • Lumbar spine: an area located on the lower back
  • Parietal peritoneum: the soft lining of the abdomen and pelvic cavity that surrounds most of the internal organs
  • Peritoneal ligaments: the connective tissues that hold the internal organs in place

It is possible that the friction between tissue layers and the stretching of ligaments and muscles could trigger spasms and inflame the sensitive nerve endings of the spine and parietal peritoneum in the abdomen.

As for runners, some anecdotal theories posit that exhaling on the right foot exerts greater pressure on the liver (which is also situated on the right just under the ribs). According to the theory, this may cause the diaphragm to lift at the same time that the liver drops, potentially triggering ETAP—though there is insufficient evidence to support this claim.

How to Get Rid of a Side Stitch

There's no shortage of tips for stopping a side stitch. While they might not work for everyone, none of them are harmful—and at least one of them might do the trick for you.????? The next time a stitch threatens to thwart your exercise, here is a sequence of steps to try before you throw in the towel:

  1. Gently push your fingers into the area where you feel pain on the right side of your belly. This should help relieve it to some degree.
  2. Alter your breathing pattern: Take a deep breath in as quickly as you can—this will force your diaphragm down. Hold your breath for a couple of seconds, then forcibly exhale through pursed lips.
  3. Try changing your breathing/striding pattern. If you always exhale when your right foot strikes the ground, try exhaling with the left foot strike.
  4. Try stretching the area. If you have a side stitch on your left side, raise your left arm up over your head and lean toward the right side. This will help open up the muscles in the area of the stitch.
  5. If all else fails, slow down to a brisk walk and concentrate on deep breathing. When the stitch goes away, you can resume activity.

If you develop a side stitch while you're exercising you should stop the activity immediately and take steps to alleviate the discomfort. If you continue to experience pain, call your doctor.

How to Prevent a Side Stich

There are known risk factors for getting a stitch while you're running and exercising.???? Fortunately, by taking a few precautions, you might find that preventing a stitch can be easier than making one go away. While some risk factors cannot be controlled such as age or the weather, there are some helpful dos and don'ts you can keep in mind.

Do's
  • Drink only water before a workout


    Always warm-up


    Regulate breathing


    Try yoga


Don'ts
  • Eating within one hour of a workout

  • Run hunched over

  • Skip cold-weather gear

  • Do too much, too fast

Know How to Fuel Up

Skip the high-carb sugary beverages, including sports drinks, and just drink plain water for pre-hydration. Be sure to eat appropriately, too. Avoid heavy meals just before exercise, especially foods high in protein that can take longer to digest.?While you're training, sip rather than chug fluids and avoid drinks with high concentrations of acid, added sugar (carbohydrate), or sodium.

Regulate Breathing

Get oxygen flowing through your body before you ramp up your exercise. Regulating your breathing is one of the most effective ways to avoid a stitch. Simply inhale through your nose and exhale through your mouth, breathing deeply from your belly and not your chest to take in more air.

If you're running, change your stride-breathing pattern. Most runners follow a two-to-one breathing pattern, taking one full breath for every two full strides. Consciously changing that pattern every now and then may reduce the stress placed on the abdomen and torso.

Strengthen Your Core

Incorporate yoga into your fitness routine. The practice will help you to learn how to breathe correctly. Breathing techniques in yoga focus on deep belly breathing. Learn to?breathe with your diaphragm?by extending your belly during inhalations and pulling in your belly during exhalation.

Certain yoga postures can strengthen your abdominal muscles. Incorporate?core strengthening?into your training,??? including planks, side planks, and V-sits.

Practice Good Form

Always warm up first: Start with some dynamic stretches and a 5- to 10-minute walk or jog to get the blood pumping to your muscles before you run. Make sure you avoid hunching over, which will also allow you to breathe more deeply. Focus on maintaining good posture and proper running form.

Dress for the Weather

If it's very cold outside and you're not dressed for it, you will likely find that it's hard to take in deep lungfuls of frigid air. Before going for a cold-weather walk or run, put on a neck warmer, snood, or wrap a scarf around your neck and lightly over your mouth and nose and breathe in and out through that.

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