A “side stitch,” medically known as exercise-related transient abdominal pain (ETAP), is a common discomfort experienced during physical activity. This sensation manifests as a sharp, cramping, or aching pain on the side of the abdomen, usually just below the ribs. While common among runners (approximately 70% annually), it can also occur during swimming, cycling, or horseback riding. ETAP is considered harmless and resolves on its own.
Understanding the Causes
The precise cause of side stitches remains unclear, but several theories aim to explain this common phenomenon. One theory suggests irritation of the parietal peritoneum, the lining of the abdominal and pelvic cavity. This irritation can arise from friction and movement within the torso during physical activity, particularly those involving repetitive jarring motions.
Another proposed mechanism involves stress on the visceral ligaments that connect abdominal organs, such as the stomach and spleen, to the diaphragm. When the stomach is full, the jarring motion of exercise may stretch or irritate these ligaments, leading to pain. Diaphragmatic fatigue or spasm is another factor, as this muscle is heavily involved in breathing during exercise.
Inadequate blood flow or oxygen to the diaphragm and surrounding abdominal muscles during intense exercise can contribute to cramps, as blood is redirected to working limb muscles. Consuming large meals, sugary drinks, or carbonated beverages too close to exercise can irritate the abdominal lining or diaphragm, increasing the likelihood of a stitch. Shallow breathing patterns during physical activity are also a contributing factor. Individuals with poorer posture may be more susceptible to side stitches.
Preventing and Relieving a Stitch
Implementing strategies can help reduce the likelihood of experiencing a side stitch. A proper warm-up, involving 5 to 10 minutes of light activity and stretching, can prepare the body for exercise and promote optimal breathing. Gradually increasing exercise intensity, rather than starting too quickly, allows the body to adjust and prevent overwhelming the abdominal muscles and diaphragm.
Focusing on deep, diaphragmatic breathing during exercise, instead of shallow chest breathing, can improve oxygen delivery and reduce strain. Avoid large meals or sugary and carbonated beverages for 1 to 2 hours before physical activity, as these can irritate the stomach and diaphragm. Staying hydrated throughout the day is beneficial, but consuming excessive amounts of water immediately before exercise may put pressure on the diaphragm. Strengthening core muscles can also improve posture and reduce strain on abdominal muscles, potentially lowering the incidence of stitches.
If a stitch occurs, slowing down or stopping the activity is often the most immediate and effective action. Applying gentle pressure to the affected area can help alleviate the pain. Stretching can also provide relief; try raising the arm on the side opposite the stitch overhead and bending gently away from the pain. Focusing on slow, deep belly breaths can help relax the muscles and improve oxygen flow. Bending forward at the waist might also offer some relief.
When to Be Concerned
Side stitches are a harmless and temporary discomfort that resolves quickly with rest or simple relief techniques. However, medical attention is warranted in some instances. Seek professional advice if the pain is severe or excruciating, or if it persists and does not subside even after stopping physical activity. Also seek advice if the stitch is accompanied by other symptoms such as fever, nausea, vomiting, dizziness, shortness of breath, or chest pain. If stitches occur frequently without clear triggers or during non-strenuous activity, consult a healthcare provider to rule out any underlying conditions.