The sharp pain that strikes the side of the abdomen during a run is often mistakenly described as “liver pain” due to its location beneath the right rib cage. However, this discomfort is rarely an issue with the liver itself. This exercise-related sensation is typically a benign, temporary condition signaling a physiological reaction to the stress of running. Understanding the true nature of this pain and its underlying triggers can help runners manage it effectively.
Side Stitch or Actual Organ Pain
The majority of pain experienced in the side during exercise is formally known as Exercise-induced Transient Abdominal Pain (ETAP), or a side stitch. This pain is generally sharp or stabbing, or a milder cramping or aching sensation, most commonly felt on the right side of the upper abdomen, just below the ribs. The transient nature of a side stitch—coming on during exercise and resolving shortly after stopping—distinguishes it from more serious issues.
True liver pain is typically a dull, persistent ache not solely triggered by physical activity. The liver lacks many pain receptors, so discomfort often relates to the stretching of the thin capsule surrounding the organ. Actual organ pain, such as issues with the liver or gallbladder, presents with systemic symptoms like persistent nausea, jaundice, or pain that continues long after the run is over.
Common Triggers While Running
The cause of a side stitch involves irritation of the parietal peritoneum, the sensitive membrane lining the abdominal cavity. The repetitive jarring motion of running likely creates friction between the abdominal organs and this lining, especially during torso movement. This irritation is often exacerbated when the stomach or intestines are full, which increases pressure and friction within the abdominal cavity.
Improper timing of food and fluid intake is a common trigger for ETAP. Consuming large meals, foods high in fat or fiber, or sugary, hypertonic drinks one to two hours before a run increases the likelihood of a side stitch. These items take longer to digest, diverting blood flow to the digestive system instead of the muscles, including the diaphragm.
Shallow, rapid chest breathing, rather than deep abdominal breathing, contributes to side stitches. The diaphragm, the primary breathing muscle, can spasm or become ischemic (experience reduced blood flow) when overworked or not fully engaged. Shallow breaths restrict the full descent of the diaphragm, limiting the relaxation of ligaments connecting abdominal organs to the muscle. Poor running posture, such as slouching, further restricts the space for the diaphragm to move, compounding stress on the upper abdominal area.
Techniques for Immediate Relief
When a side stitch strikes, the most effective immediate action is to slow the pace, often by reducing the run to a brisk walk or a complete stop. This reduction in intensity lessens the jarring impact and allows the diaphragm to recover from repetitive stress. Runners should then focus on deep, controlled, diaphragmatic breathing to help relax the cramped muscle.
Relief can be found by exhaling forcefully through pursed lips, which engages the deep abdominal muscles and may release the diaphragm spasm. Runners also find relief by pressing their fingers firmly into the painful area, just under the ribs, while simultaneously bending forward at the torso. Stretching the affected side by raising the arm over the head and gently bending away from the pain is also helpful.
Changing the breathing pattern can also provide relief, specifically by exhaling on the foot strike opposite the side of the pain. Since the liver is on the right side, exhaling when the left foot hits the ground may prevent repeated stress on the diaphragm’s ligaments. Once the pain subsides, a runner can gradually increase their pace, continuing to focus on deep, rhythmic breathing.
Warning Signs That Require Medical Attention
While a side stitch is benign, pain in the abdomen that persists or is accompanied by other symptoms warrants medical evaluation. Persistent pain that does not resolve within minutes of stopping exercise or that lasts for several hours is a red flag. Abdominal pain accompanied by a fever, unexplained weight loss, or persistent vomiting should prompt a consultation with a healthcare provider.
Pain that radiates significantly to the back, shoulder, or chest may indicate an issue beyond a simple muscle cramp, potentially involving the kidneys, gallbladder, or even the heart. The presence of blood in the urine or stool, yellowing of the skin or eyes (jaundice), or severe tenderness when touching the abdomen are all signs that the pain may be related to a serious underlying condition. Seeking professional advice is necessary to rule out conditions such as gallstones or kidney stones.