Runners Issue – The dreaded “Side Stitch”

Posted by Ian (Race Runner and Collector of Bling) on Thursday, August 15, 2019

What is the stitch?

This familiar runner affliction has a few common names – side stitch, stitch in the side, side ache, side cramp, side crampie, side sticker, muscle stitch, stomach cramp, subcostal pain, or simply the stitch. More technically it is known as exercise-related transient abdominal pain (ETAP).

It is normally a pain in either side of your abdomen below your ribs, this can vary from cramping, aching, pulling to a sharp stabbing pain. It is reported to be more common on the right-hand side of the body. Younger athletes are more likely to get a stitch than experienced ones but it can affect anyone who is exercising for longer periods.

The number of cases that are reported tends to drop off as people get older. It is also reported that activities that involve the upper body twisting, like swimming, running, and horseback riding the stitch is more common.

A study has shown that broken down by sport, swimmers reported having had ETAP the most, followed by runners, horseback riding, aerobics, basketball and cycling. It has also shown that the most common area for the stitch is the right middle third of the abdomen (just adjacent to the umbilicus) followed by the left middle third and then the umbilical area.

There has been no connection with BMI, gender or body type with how often the stitch occurs or its severity.

Around sixty to seventy percent of runners will experience the stitch every year.

What is your diaphragm?

The diaphragm is a sheet of muscle that extends across the bottom of the rib cage and plays an important role in your breathing.

What is the reason behind it?

This is where it gets interesting as there a few theories abound and no one seems to know the exact cause. So with no known accepted cause of the stitch, there is also no know standard cure to prevent or stop one from happening.

There a few popular theories as to what might cause the stitch.

Some studies show that a movement of blood to the diaphragm or muscles during physical activity can lead to a side stitch. Not enough blood and so, therefore, oxygen getting to the diaphragm causes the pain but this wouldn’t be the case with horse riding as breathing is not being overtaxed.

Other research shows that an irritation of the lining of the abdominal and pelvic cavity may be the cause. This irritation can occur during physical activity when there’s a lot of movement and friction in the torso. Once again this wouldn’t be the case with horse riding.

The most popular theory appears to be cramp or spasm in your diaphragm muscle. Just like any muscle it can cramp and tire when it is put under too much stress. This stress can come in the form of stepping up the pace or increasing your distance which is why it can also commonly afflict beginning runners who have not yet strengthened up this area. Shallow breathing can increase the cramping by not letting the diaphragm lower far enough for the ligaments to relax and this increases the chance of stress and spasm

Practical Help

You can try the following steps to help reduce your pain and resolve the side stitch:

Pre Run – Practical Help

Low Calcium, Magnesium or Potassium levels – Low levels of calcium or magnesium may predispose you to cramp. Low potassium levels can occasionally cause muscle cramp. See this article for more information by Medical Author: Melissa Conrad Stöppler, MD –

Core strengthening will also strengthen your weak diaphragm muscles helping them reduce the effects of fatigue and therefore less likely to cramp. A strong core will also help with your running overall.

Yoga – add some yoga to your exercise routine this will help you learn how to breathe correctly.

Eating just before your run may cause cramping. Don’t eat so close to going for a run or limit your intake before your run. If your body is still digesting your food it can allow your diaphragm to spasm. Studies have shown drinking fruit juices and other drinks that are high in sugar can also add to the occurrence of getting the stitch. Keep a food log of what you consume before you run and this might give you a key to what is triggering the stitch for you.

Hydrate before your run – being hydrated can lessen muscle cramps.

Stretching/ warming up can prevent or lessen the effects of a cramp. Spend some time Stretching/ warming up before you start into your run. This will allow you to start with a more regular breathing pattern rather than launching straight into the run.

During Your Run – Practical Help.

Slow down – take it easy for a while and allow the cramp to dissipate.

Take a break – walk – if slowing down isn’t helping slow right down to walk.

Stop – take a break for a few minutes – concentrate on your breathing.

Bending over forward – can help relieve the stitch.

Apply pressure – Press your hand on the painful area and release the pressure while breathing out. Conscious, deep breathing helps when trying this strategy.

Stretching – can relieve the stitch – Just lean your upper body to the side and stretch a little farther with each exhalation.

Deep Breathing – breathe deep and stretch your diaphragm. If your breathing is too shallow start inhaling and exhaling deeply and fully. Try inhaling for two steps, exhaling for one step— this increases the depth of breath.

Stay hydrated – during your run staying hydrated can help lessen the chances of getting the stitch.


If your side stitch doesn’t go away after several hours, even after you stop exercising, you may need to seek medical care. It may be the result of a more serious underlying medical condition. Best to check with your doctor to rule out any other gastrointestinal or abdominal problems unrelated to exercise.

Seek emergency medical help right away if you’re experiencing sharp, stabbing pain accompanied by a fever or swelling on the side of your abdomen.

Medical Disclaimer: Here at SweetCommute, we aren’t providing medical support or advice. This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians. Always, always seek professional medical health advice. Take care of your body and mind with the appropriate support.