Why do you get a side stitch while running?
A side stitch is a sharp, stabbing, or cramp-like pain that usually occurs during running or another activity involving repeated movement of the upper body. The pain is often located beneath the ribs on the right or left side and may be intense enough to make you slow down or stop.
⠀
The phenomenon is often called exercise-related transient abdominal pain. Its exact cause is not fully understood, but the pain appears to be associated with irritation of the peritoneum, tension in tissues and ligaments around the abdominal cavity, posture, breathing patterns, and food or fluid intake before exercise.
⠀
Side stitches are common during running
A side stitch can occur during several types of activity, but it is particularly common during running. Running involves repeated impacts, rhythmic movement, and rotation of the upper body.
⠀
These movements may affect tissues and organs inside the abdominal cavity. At the same time, the diaphragm and other breathing muscles work harder as exercise intensity increases.
⠀
Side stitches are also common during:
⠀
• Swimming
• Horse riding
• Basketball
• Football
• Aerobics
• Fast walking
• Activities involving substantial upper-body movement
⠀
Children, adolescents, and younger adults report side stitches more frequently than older people, although they can occur at any age.
⠀
The pain is often located beneath the ribs
A side stitch usually occurs along the side of the abdomen, directly beneath the ribcage. The pain may develop on either the right or left side.
⠀
It is often described as:
⠀
• Sharp
• Stabbing
• Cramp-like
• Aching
• Localised and clearly defined
• Worse during a deep breath
⠀
Some people also experience pain at the tip of the shoulder. This may occur because irritation near the diaphragm affects nerves that refer signals to the shoulder area.
⠀
Irritation of the peritoneum is one possible explanation
One of the most widely accepted explanations is that a side stitch is caused by irritation of the peritoneum. The peritoneum is a thin membrane that lines the inside of the abdominal cavity and covers the outer surface of many organs.
⠀
The peritoneum consists of layers that normally glide smoothly against each other. During activity, repeated movement, friction, or stretching may irritate this tissue.
⠀
The irritation may become stronger when:
⠀
• The stomach is full
• The upper body moves substantially
• The body is bent forwards
• Breathing is heavy
• The activity involves repeated impacts
• The abdominal wall provides limited stability
⠀
The peritoneum is highly sensitive to pain and may therefore produce a sharp and clearly localised sensation.
⠀
Food and fluid intake before exercise may increase the risk
Some people experience side stitches more often when they have eaten or drunk a large amount shortly before exercising. A full stomach may increase the load and movement within the abdominal cavity.
⠀
Large amounts of fluid or sugary drinks in particular may be associated with an increased risk.
⠀
Possible triggers include:
⠀
• Large meals close to the session
• Drinking a large amount immediately before starting
• Concentrated sports drinks
• Fruit juice
• Very fatty foods
• Foods that digest slowly
⠀
This does not mean that you should exercise without energy or fluids. Timing, quantity, and composition may be more important than whether you eat or drink at all.
⠀
Sugary drinks may be a clear trigger
Drinks with a high concentration of carbohydrates may make side stitches more likely in some people. This may happen because the fluid remains in the stomach for longer and affects movement and pressure inside the abdominal cavity.
⠀
Common examples include:
⠀
• Soft drinks
• Concentrated sports drinks
• Energy drinks
• Juice
• Sweetened fruit drinks
• Large quantities of sugary beverages
⠀
Water often appears to carry a lower risk than highly concentrated drinks, although drinking a large amount of water immediately before running may also feel uncomfortable.
⠀
Small amounts consumed gradually are usually better tolerated than drinking a large volume at once.
⠀
The diaphragm has been proposed as a cause
The diaphragm is the main muscle used for breathing. During running, it works hard to draw air into the lungs.
⠀
In the past, a side stitch was often explained as a cramp or reduced blood supply to the diaphragm. However, this explanation does not fit all observations equally well.
⠀
A side stitch may occur:
⠀
• At relatively low exercise intensity
• In people with good cardiovascular fitness
• During activities with limited breathing demands
• In the lower parts of the abdomen
• After eating, even without maximal effort
⠀
The diaphragm may still be involved in some cases, particularly when the pain is located high beneath the ribs and is affected by breathing.
⠀
The organs move during running
With every running step, the body moves up and down. The organs inside the abdominal cavity move with it.
⠀
The liver, stomach, and other organs are attached by connective tissue and ligaments. Repeated pulling forces may create tension in these structures.
⠀
This has been proposed as one explanation for why the pain often occurs on the right side, where the liver is located.
⠀
However, side stitches also occur on the left side and in the lower abdomen. Tension in the tissues supporting the organs therefore probably explains only part of the phenomenon.
⠀
Posture may influence side stitches
People who run with the upper body bent forwards or with increased rounding of the thoracic spine may be more prone to side stitches. A collapsed posture may increase pressure inside the abdominal cavity and alter the load on the peritoneum.
⠀
A side stitch may be more likely if you:
⠀
• Run with the upper body leaning markedly forwards
• Collapse through the torso as you become tired
• Have limited control around the abdomen and pelvis
• Run with substantial upper-body rotation
• Have stiffness in the thoracic spine
⠀
An upright and relaxed running posture may reduce symptoms in some people.
⠀
Abdominal and upper-body stability may play a role
The abdominal muscles help control the upper body and limit unnecessary movement within the abdominal cavity.
⠀
If control is reduced, tissues and organs may move more during running. This could potentially increase tension and irritation.
⠀
This does not mean that people who experience side stitches necessarily have weak abdominal muscles. Better endurance and control in the upper body may nevertheless reduce symptoms for some.
⠀
Relevant exercises may include:
⠀
• Plank
• Side plank
• Dead bug
• Pallof press
• Farmer’s walk
• Controlled running-specific strength training
⠀
The aim should be good control and breathing rather than keeping the abdominal muscles maximally tense at all times.
⠀
Breathing patterns may affect the pain
A side stitch often becomes more noticeable during a deep breath. As the diaphragm moves downwards, it may increase stretching and pressure around the painful area.
⠀
Rapid and shallow breathing may also make the upper body more tense.
⠀
Some people experience less pain when they:
⠀
• Breathe more calmly
• Empty the lungs effectively
• Reduce their pace
• Focus on a long exhalation
• Avoid holding their breath
• Relax their shoulders
⠀
There are also theories that the rhythm between breathing and foot strike affects the load, but the evidence is not conclusive.
⠀
Why do beginners often experience more side stitches?
Side stitches appear to be more common among people who are less accustomed to the activity. A beginner may have less control over pace, breathing, and posture.
⠀
During unfamiliar running, a person may also:
⠀
• Start too quickly
• Breathe irregularly
• Tense the upper body
• Have lower endurance in the supporting muscles
• Eat too close to the session
• Make large increases in training volume
⠀
As the body becomes more accustomed to running, side stitches may occur less frequently.
⠀
Good fitness does not provide complete protection. Experienced runners may also develop a side stitch.
⠀
Why do children get side stitches so often?
Children and adolescents report side stitches more frequently than adults. The reason is not fully understood.
⠀
Possible explanations include:
⠀
• Less experience with controlling exercise intensity
• Starting at a higher intensity
• Eating or drinking close to activity
• Less developed control of the upper body
• Differences in body composition
• Greater tissue mobility
⠀
A side stitch in a child is usually harmless if it occurs during activity and disappears quickly when the child rests.
⠀
Repeated severe abdominal pain that also occurs without activity should be assessed for other causes.
⠀
Why does a side stitch appear suddenly?
A side stitch may develop quickly even when the beginning of the session feels comfortable. This may happen because the load gradually increases.
⠀
After a few minutes:
⠀
• Breathing may become heavier
• Posture may change
• The upper body may become more tense
• The abdomen and organs may move more
• Fatigue may reduce stability
• Intensity may pass an individual threshold
⠀
The pain may therefore appear suddenly even though the process has been building gradually.
⠀
What should you do when you get a side stitch?
A side stitch usually improves when the exercise load is reduced.
⠀
You can try to:
⠀
• Slow down
• Walk for a short period
• Breathe slowly and deeply
• Apply pressure to the painful area
• Bend the upper body slightly forwards
• Exhale forcefully
• Relax the shoulders and abdomen
⠀
Some people find that gently tightening the abdominal muscles while breathing in a controlled way is helpful.
⠀
The most important step is to reduce the movement that is provoking the pain.
⠀
Pressure against the area may provide relief
Many people press their hand or fingers against the painful area. This may reduce movement of the abdominal wall and provide a competing sensory signal.
⠀
Pressure may also make it easier to support the area while breathing.
⠀
A common method is to:
⠀
• Reduce your pace
• Press your hand gently against the painful area
• Bend slightly forwards
• Breathe in deeply
• Exhale slowly and forcefully
⠀
The pain often gradually decreases within a few minutes.
⠀
Focusing on the exhalation may help
A long and controlled exhalation may reduce upper-body tension and improve breathing rhythm.
⠀
If you are hyperventilating or breathing very shallowly, it may be more difficult to relax.
⠀
Try to:
⠀
• Breathe calmly through the nose or mouth
• Exhale for longer than you inhale
• Lower your shoulders
• Avoid pushing the abdomen forcefully outwards
• Reduce your pace until breathing is controlled
⠀
No breathing technique is guaranteed to stop a side stitch, but controlled breathing may make the pain easier to manage.
⠀
Should you stop completely?
It is usually unnecessary to end the entire session if the pain improves quickly when you reduce the intensity.
⠀
You can often begin running slowly again when:
⠀
• The pain has clearly decreased
• You can breathe deeply without sharp pain
• Your posture feels normal
• You do not have nausea or other symptoms
⠀
If the pain returns immediately, it may be better to stop or walk for the remainder of the session.
⠀
There is rarely any benefit to pushing through severe pain.
⠀
How can side stitches be prevented?
Side stitches cannot always be prevented, but several measures may reduce the risk.
⠀
Practical advice includes:
⠀
• Avoid large meals immediately before running
• Limit large amounts of fluid immediately before starting
• Be cautious with concentrated sugary drinks
• Begin the session at an easy pace
• Increase intensity gradually
• Train upper-body stability and endurance
• Maintain an upright running posture
• Breathe evenly and with control
• Adjust food intake according to your own experience
⠀
People respond differently. It may be helpful to note what you ate, drank, and did before sessions in which a side stitch occurred.
⠀
How long should you wait after a meal?
There is no single timing rule that suits everyone. The size and composition of the meal are important.
⠀
A small and light meal is often better tolerated close to activity than a large meal containing substantial amounts of fat.
⠀
Many people benefit from:
⠀
• Waiting longer after large meals
• Choosing easily digestible food before exercise
• Avoiding very fatty and high-fibre foods immediately before running
• Drinking regularly earlier in the day
• Avoiding filling the stomach immediately before starting
⠀
You do not necessarily need to wait several hours after every meal. The aim is to find a routine that provides energy without causing discomfort.
⠀
A warm-up may reduce the risk
A gradual warm-up gives the body time to adapt its breathing, circulation, and movement.
⠀
If you go directly from rest to a fast pace, the demands increase quickly.
⠀
A simple warm-up may include:
⠀
• Fast walking
• Easy jogging
• Gradually increasing the pace
• Dynamic movements
• A few short, controlled accelerations
⠀
A warm-up does not necessarily eliminate side stitches, but it may reduce the sudden transition that triggers symptoms in some people.
⠀
Can strength training help?
There is no strong evidence that one specific strength exercise prevents side stitches. Better control and endurance in the upper body may nevertheless be useful.
⠀
Training may focus on:
⠀
• The abdominal muscles
• The back muscles
• Hip and pelvic control
• Breathing under load
• Upright posture
• Rotational control
⠀
Strength training should be combined with gradual adaptation to the activity itself.
⠀
You primarily become better able to tolerate running by running regularly with appropriate progression.
⠀
Is a side stitch dangerous?
A side stitch is usually harmless when it:
⠀
• Occurs during activity
• Is located beneath the ribs or along the side
• Improves when the pace is reduced
• Disappears shortly after stopping
• Is not accompanied by other serious symptoms
⠀
The pain may be intense, but it usually does not mean that an organ has been damaged.
⠀
A side stitch does not normally cause permanent injury.
⠀
When could the abdominal pain have another cause?
Not all pain during running is a side stitch. Abdominal pain can have many causes.
⠀
Other possibilities include:
⠀
• Muscle strain
• Gastrointestinal problems
• Gallstones
• Kidney stones
• Appendicitis
• A hernia
• Pelvic or gynaecological pain
• Heart or lung disease
• Pain originating from the ribs or back
⠀
The location, duration, and accompanying symptoms are important for distinguishing between these conditions.
⠀
When should the pain be assessed by a healthcare professional?
Contact a healthcare professional if the pain:
⠀
• Does not disappear after the activity stops
• Also occurs at rest
• Gradually becomes worse
• Is extremely severe and unusual
• Is accompanied by fever
• Occurs together with vomiting
• Causes breathing difficulties or chest pain
• Is accompanied by blood in the urine or stool
• Occurs after an injury
• Remains clearly tender to touch for a prolonged period
⠀
Pain that always occurs in the same location and becomes increasingly pronounced over time should also be investigated.
⠀
Common misconceptions
A side stitch is not necessarily caused by poor fitness. Well-trained people can also experience it.
⠀
The diaphragm is not necessarily cramping. Several mechanisms may be involved, and irritation of the peritoneum is a central theory.
⠀
A side stitch does not mean that the liver or spleen has been damaged. The pain is usually temporary.
⠀
You do not always need to stop completely. Reducing your pace and controlling your breathing may be enough.
⠀
Drinking a large amount of water immediately before starting does not prevent a side stitch. Large amounts of fluid may actually increase the risk for some people.
⠀
Summary
A side stitch is a temporary abdominal pain that commonly occurs during running and other activities involving repeated movement of the upper body. The exact cause is not fully understood, but irritation of the peritoneum, movement within the abdominal cavity, posture, breathing, and food or fluid intake before exercise appear to play a role. The pain is usually harmless and resolves when the pace is reduced or the activity is stopped. Calm breathing, pressure against the area, and slight forward bending may provide relief. The risk may be reduced by avoiding large meals and substantial amounts of concentrated drinks immediately before exercise, beginning at an easy pace, and gradually adapting the body to the activity. Pain that persists after exercise or occurs with other symptoms should be assessed more carefully.
⠀
Sources
• Morton DP, Callister R. Exercise-related transient abdominal pain (ETAP). Sports Medicine. 2015;45(1):23–35.
• Morton DP, Callister R. Factors influencing exercise-related transient abdominal pain. Medicine & Science in Sports & Exercise. 2002;34(5):745–749.
• Morton DP, Aragon-Vargas LF, 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.
⠀
