Sharp pain in the upper right abdomen during a run is often mistakenly attributed to the liver, given its location. However, this discomfort is rarely a liver issue. It’s typically a benign, temporary “side stitch,” a common occurrence for runners that usually resolves on its own.
Common Reasons for Upper Abdominal Pain During Running
Exercise-Related Transient Abdominal Pain (ETAP), or a side stitch, is a common cause of upper abdominal pain during running. This localized pain is often felt along the lower rib cage but can occur anywhere in the abdomen. While its precise cause is unknown, one theory suggests it results from irritation of the parietal peritoneum, the membrane lining the abdominal cavity. This irritation may arise from repetitive movements, especially when the stomach is full. The pain can range from a sharp, stabbing sensation to a cramping or aching feeling. About 70% of runners experience a side stitch annually.
The diaphragm, a muscle separating the chest and abdomen, is crucial for breathing. Irregular or shallow breathing during intense running can strain or spasm the diaphragm. This increased workload, especially for less experienced runners, or reduced blood flow (diaphragmatic ischemia) can contribute to discomfort.
Gastrointestinal issues also cause upper abdominal discomfort. Running’s physical stress can alter esophageal motility, worsening reflux and nausea. Eating too close to exercise, especially high-fiber, high-fat, or high-fructose meals, delays gastric emptying and causes discomfort. Dehydration further exacerbates these issues, hindering digestion and increasing the risk of nausea, abdominal pain, and diarrhea.
Muscular issues, such as oblique muscle strain (also called side strain), can cause upper right abdominal pain. These muscles, located on the sides of the abdomen, are involved in bending, twisting, and breathing. A strain, from overstretching or tearing, leads to localized pain, tenderness, and swelling, worsening with torso movements or deep breathing.
When to Seek Medical Attention
While most upper abdominal pain during running is temporary, certain symptoms warrant medical evaluation. Seek attention for persistent or worsening pain that doesn’t resolve with rest, intensifies over time, or becomes chronic even when not exercising.
Accompanying symptoms requiring medical attention include fever, jaundice, dark urine, or pale stools. Unexplained weight loss, severe nausea or vomiting, or significant abdominal swelling also suggest a serious issue. Pain radiating to other areas, like the shoulder or back, could indicate conditions beyond a side stitch.
Rarely, conditions affecting upper right abdominal organs can cause pain mistaken for exercise discomfort. These include gallbladder disorders like gallstones or inflammation (cholecystitis), which cause pain after fatty meals and may worsen with activity. Kidney stones can also cause radiating pain. Less common conditions like liver inflammation or enlargement might also cause pain in this region.
Strategies for Pain Prevention and Management
A proper warm-up before running helps prevent upper abdominal pain by preparing muscles and stimulating blood flow. A gradual warm-up with light cardio and dynamic torso stretches enhances flexibility and reduces spasms. A cool-down with gentle stretching aids recovery and helps the body transition.
Effective breathing prevents side stitches and diaphragmatic discomfort. Diaphragmatic or “belly” breathing, where the abdomen expands with each inhale, ensures adequate oxygen and prevents shallow breathing. Maintaining a steady, rhythmic pattern, like exhaling as a foot strikes the ground, synchronizes breathing with movement and reduces strain.
Proper hydration and nutrition timing are beneficial. Staying well-hydrated before and during runs prevents dehydration, which can worsen GI symptoms and affect muscle function. Avoid large meals or sugary drinks 2-4 hours before a run to prevent stomach distension and reduce abdominal friction. Choose easily digestible foods and lower-carb fluids (4-8%) during exercise to prevent GI distress.
Gradually increasing running intensity allows the body to adapt, reducing sudden pain. Avoid abrupt speed bursts, especially early in a run, to prevent overexertion of the diaphragm and abdominal muscles. Building mileage and intensity over time strengthens the body and improves tolerance.
Developing core strength supports the abdominal area and diaphragm. Exercises targeting abdominal and back muscles improve stability, reducing mechanical stress on the parietal peritoneum and ligaments during running. A strong core also contributes to better posture and efficient running mechanics.
If pain develops during a run, immediate strategies can provide relief. Slowing down or walking helps alleviate discomfort. Changing breathing patterns, like taking deep breaths, can relax the diaphragm. Gently pressing the painful area while bending forward may also offer temporary relief.