A sharp, often stabbing sensation beneath the ribs during physical activity is commonly known as a “stitch,” or Exercise-Related Transient Abdominal Pain (ETAP). This pain is highly common, especially among runners and swimmers. While temporarily debilitating, it is generally considered a benign condition that does not indicate serious harm and typically resolves quickly once exercise is slowed or stopped. Understanding immediate relief techniques and long-term prevention strategies can help you manage this unwelcome interference in your workout.
Immediate Techniques for Stopping the Pain
When a stitch begins, immediately slow your pace or stop the activity entirely to reduce jarring motion and muscular strain. The most effective way to counteract the pain is to focus on deep, controlled breathing to help relax the diaphragm muscle. Aim for diaphragmatic breathing: inhale deeply to expand the abdomen, and then exhale forcefully through pursed lips, almost like blowing out a candle.
Applying gentle but firm pressure directly to the area of the stitch with one or two fingers can help alleviate the cramping sensation. While pressing on the painful spot, try a specific stretching maneuver. Raise the arm on the side opposite the pain overhead and gently bend your torso toward the painful side. This motion stretches the muscles around the diaphragm and the abdominal wall, which can help release the spasm.
If you are running, coordinate your breathing rhythm with your foot strikes to equalize the forces placed on your torso. If the stitch is on your right side, for instance, exhale when your left foot hits the ground. This is thought to load the core musculature on the opposite side during the exhale. You can also try bracing your core muscles by tightening the abdominal area as if anticipating a light impact, which offers support to the internal organs.
Common Theories on Why Stitches Occur
The exact mechanism behind ETAP is not completely understood, but current research points to a few leading theories involving irritation and muscle fatigue. The most widely accepted explanation suggests the pain is caused by irritation of the parietal peritoneum, the sensitive membrane lining the abdominal cavity. This irritation results from the repetitive jolting movements of running, which cause friction between the membrane and the abdominal organs, especially if the stomach is full.
Another prominent theory focuses on diaphragmatic ischemia, a temporary reduction in blood flow to the diaphragm, the large muscle below the lungs responsible for breathing. During intense exercise, blood is shunted away from the diaphragm to the working limbs, potentially causing a cramp. The pain from a diaphragm spasm can sometimes be felt in the shoulder tip, a phenomenon known as referred pain, because the diaphragm shares nerve pathways with that area.
The pain may also be linked to stress on the ligaments connecting internal abdominal organs, such as the stomach and intestines, to the diaphragm. The constant up-and-down motion of the organs during exercise, particularly when combined with shallow breathing, is believed to pull on these ligaments, causing discomfort. These theories highlight that the pain is a localized muscular or connective tissue issue, not a sign of a larger systemic problem.
Pre-Exercise Strategies for Avoiding Stitches
Proactively managing nutrition and body mechanics before and during exercise can significantly reduce the likelihood of a stitch occurring. Avoid consuming large meals or high-volume fluids for at least two hours prior to starting a workout. Having undigested food in the stomach appears to increase tension and pressure on the abdominal lining, making irritation more likely.
Avoid highly concentrated sugary beverages, known as hypertonic drinks, immediately before and during exercise, as these have been shown to be provocative. Focus on staying well-hydrated throughout the day with small, consistent amounts of water. Beginning your workout with a proper warm-up that includes gentle stretching for five to ten minutes helps prepare the diaphragm and core musculature for the demands of the activity.
Incorporating core-strengthening exercises into your regular routine helps stabilize your torso and support the abdominal organs, minimizing strain on the ligaments. Exercises that improve posture, especially in the thoracic (mid-back) region, are also helpful, as a slouched position can restrict the diaphragm’s full range of motion. Gradually increasing the intensity and duration of your activity allows your body to adapt and build endurance in the necessary support muscles.
When Pain Under the Ribs Requires Medical Attention
While a typical stitch is temporary and benign discomfort, certain symptoms suggest the pain is not ETAP and warrants consultation with a healthcare professional. Seek medical advice if the pain is constant or persists long after you have stopped exercising. Pain accompanied by systemic symptoms, such as fever, chills, nausea, or vomiting, is also a sign that the issue is more than just a muscle cramp.
Pain distinctly different from the sharp, transient nature of a stitch, such as a dull ache that worsens with rest, may indicate a more serious underlying condition. If the pain is felt under the breastbone rather than the rib cage, is accompanied by difficulty breathing, or radiates to the left arm, it could signal a cardiac issue. Any pain in the rib area resulting from direct trauma or that prevents deep breathing should be evaluated by a doctor.