A “side stitch,” formally known as exercise-related transient abdominal pain (ETAP), is a common, sharp discomfort experienced in the side, often just beneath the rib cage, during physical activity. This sensation frequently affects individuals engaged in sports involving repetitive torso movement, such as running. While bothersome, ETAP is generally considered harmless and does not typically indicate a serious underlying health issue. Up to 70% of runners report experiencing this pain annually.
Common Causes of Side Stitches
The precise cause of side stitches remains unclear, but several theories explain this common phenomenon. One widely discussed idea suggests that the diaphragm muscle, which plays a central role in breathing, can spasm. This muscle can become fatigued or overworked, similar to other muscles, leading to cramps and pain.
Another perspective proposes that side stitches arise from stress on the ligaments connecting abdominal organs, such as the liver, to the diaphragm. During activities like running, the jolting motion combined with labored breathing might strain these connections, potentially causing irritation or spasms. Some research also indicates that irritation of the parietal peritoneum, a membrane lining the abdominal cavity, could be a factor.
Breathing patterns also contribute to side stitches. Shallow or irregular breathing, particularly chest breathing rather than deep belly breathing, can reduce oxygen supply to muscles and place extra stress on the diaphragm and its surrounding ligaments. This can lead to muscle fatigue and cramping.
What someone eats and drinks before exercise can also play a role. Consuming large meals, especially those high in fat or sugar, or sugary beverages too close to a run, can divert blood flow to the digestive system and away from the diaphragm. This reduced blood supply can contribute to cramping. Poor posture, specifically slouching or hunching, has been linked to side stitches.
Preventing Side Stitches
Proactive strategies can help minimize side stitches. A proper warm-up, including dynamic stretches and a gradual increase in intensity, prepares the body for exercise by getting blood flowing to muscles. This gradual preparation helps prevent the body from being “shocked” by sudden exertion.
Consistent hydration is beneficial, but avoid consuming large quantities of fluids immediately before a run. Sipping water in smaller amounts is recommended. Similarly, pre-run nutrition should focus on light, easily digestible meals, avoiding heavy, fatty, or overly sugary foods for one to three hours before exercise.
Breathing techniques significantly influence the risk of side stitches. Practicing deep belly breathing, where the abdomen expands with each inhale, helps ensure the diaphragm works efficiently and receives adequate oxygen. Rhythmic breathing, such as exhaling on alternating footfalls, can also reduce stress on the diaphragm and its associated ligaments. Developing core strength through exercises like planks and glute bridges can provide better support for the diaphragm and abdominal muscles.
Relieving a Side Stitch
When a side stitch occurs, several immediate steps can help alleviate discomfort. Reducing the intensity of your activity, such as slowing down to a walk or stopping altogether, is often the first and most effective measure.
Focusing on deep, controlled breathing can also provide relief. Taking slow, deep breaths, pushing air fully out, helps muscles relax. Some find it helpful to forcefully exhale through pursed lips. Stretching the affected area can ease cramping; for instance, raise the arm on the side opposite the pain and gently bend away from the stitch.
Applying gentle pressure to the painful area, just under the ribs, while taking deep breaths may also help. As the pain subsides, gradually walk it out before resuming a run. If the stitch is particularly intense, a brief break from activity to focus on these relief techniques is necessary.
When to Consult a Doctor
While side stitches are typically benign and resolve on their own, certain symptoms warrant medical attention. Seek professional advice if the pain persists for several hours after stopping activity or occurs even when you are not exercising.
Consult a doctor if the side stitch is accompanied by other concerning symptoms, including fever, dizziness, nausea, vomiting, or shortness of breath. Pain that radiates to other areas, such as the chest or shoulder, should also prompt a medical evaluation.
Recurrent or severe side stitches that are debilitating despite consistent prevention and relief efforts may also benefit from a doctor’s assessment. While side stitches are common, these additional symptoms or persistent pain suggest a need to rule out other possible conditions.