Side Stitches: How to Treat, Cure & Prevent a Stitch

Side Stitches: How to Treat, Cure & Prevent a Stitch

Side stitches commonly occur during physical exercise, so if you’re a runner or someone who engages in prolonged physical activities then chances are you’ve felt the familiar ache of a stitch on either side of your abdomen.

Stitches, or exercise-related transient abdominal pain (ETAP), are somewhat of a mystery as there is no precise or proven cause and there are multiple different theories surrounding the topic.

Side stitches can range from a dull ache in your abdominal cavity or cramping feeling to a sharp, stabbing pain or pulling sensation below one’s rib cage on either side of the body.


Are side stiches caused by a spasm in the diaphragm


Some say that stitches are the result of a spasm in the diaphragm due to the increased stress of exercise, while others theorize that they are caused by increased blood flow to your internal organs, like your spleen and liver.

This could cause temporary hepatomegaly or portal hypertension which restricts blood flow to the rest of the body and thus causes some abdominal pain around the liver.

While those are two of the most common theories surrounding what causes stitches, there are many more so keep reading to find out more about the causes, prevention tips and treatments of side stitches as well as what to do when you do get one.

If you'd like to understand the science behind a side stitch then a study (Authored by Morton DP, Callister R) that was published in the Journal of Science and Medicine in Sport is a fascinating read. You can read it by clicking here.

What causes side stitches?


Side stitches when running may be the result of a diaphragm spasm which, like any muscle, can fatigue during exercise.

If your diaphragm is not used to the extra stress of exercise or if you’re pushing yourself too hard, you are more likely to experience a side stitch.

People new to running, or any other cardio activity, are more likely to get side stitches because their bodies aren’t used to prolonged aerobic activity.

Another leading theory is that as your rate increases during exercise it forces more red blood cells into the liver, which can cause temporary live enlargement (hepatomegaly) or high blood pressure around the liver and portal vein (portal hypertension).

These conditions can restrict the blood flow from the liver to the portal vein and therefore slow down the blood flow to the rest of the body. This is why many people will feel a side stitch on their right-hand side around the liver.

Your breathing patterns could also be what is causing the discomfort. Shallow breathing could also cause side stitches as you need to breathe deeper when you run so that your muscles get enough oxygen.

One of the most well-known causes of side stitches is eating a big meal or drinking a sugary sports drink before you go for a run or do some prolonged form of exercise.


How to prevent side stitches


There are 4 things you can do to prevent a side stitch while running:

  1. Warm-up properly
  2. Breathe deeper
  3. Eat properly before your run
  4. Add strength training to your training regime

Let's dig into each of these in a bit more detail...


Warm-up properly

It is always important to make sure you warm up your muscles before you do any sort of exercise. Going from 0 to 100 with no warm-up causes irregular breathing and puts a lot of strain on your muscles. Warming up helps to get your muscles ready to go so that you can exercise for longer without getting a side stitch or cramping.

What is causing your abdominal pain when you run?

Pro Tip: If you've ever experienced a side stitch while running (and most of us have) this is what is causing it and how to deal with it during a run...

Can't Listen now? Read the full transcript

We're going to be chatting about stitches today with regards to running. We've all had them at some stage and they're not pleasant. We've got the coach with us, Lindsey Parry, Lindsey, welcome back. Nice to touch base once again.

Very good to touch base. I hope we're talking about stitches of the abdominal kind rather than the medical kind from falling while you run.


What is a side stitch and what causes them?


Absolutely. That is exactly what we are chatting about. Lindsey, let's sort of give a sort of overview of stitches as a whole. We get lots of questions in, people saying I get stitches and what do I do about it? We'll touch on that in this chat as well. But what is a stitch and what causes it?

That's actually probably the most difficult question you've ever asked me on the podcast. We're not 100% sure of what causes stitches. Part of that is because they are also quite non site specific. So some people get stitches up around the collarbone or just under the collarbone area, other people get it kind of in the mid abdominal region, between the rib, and then I guess the most common stitch is the one that you get just underneath the diaphragm, or in the upper abdominals. So it is a cramp, that's the one thing we know.

So what the actual stitch is, is when either your diaphragm or your intercostal muscles have gone into to cramp. A little bit harder to talk about the stitch that people kind of get that's just under the collarbone, it is also a cramp, but it almost feels more like there's a pocket of air that's stuck in there or something like that. So because it is muscular in nature, in other words, it's a muscle that's gone into spasm, we then look at the things that can potentially affect it. So when it's in the intercostals, or more around the rib area, we tend to look at breathing as the culprit.

When it's in the abdominal area, or just below the diaphragm or in the stomach, then the culprit normally is the diaphragm itself. So there would be some looking at breathing but also how full is your stomach. So have you drunk too much, did you eat too much before you ran, is there like an excessive tugging of the stomach on the diaphragm, which then leads the diaphragm to go into spasm while it's breathing in and out.


How to deal with a side stitch


So definitely, because it's cramping and it's often related to the diaphragm or the intercostal muscles, changing you're breathing, slowing it down, deeper slower breath, that can help. Often applying pressure to the area now that's particularly useful when it's in the diaphragm area, that often when you actually apply a pressure to that muscle with your fingers or the palm of your hand, that reduces the cramping and it definitely reduces the severity of the cramping. People kind of hunch over and turn over and that sort of serves the similar kind of purpose in that it's putting pressure on the muscle and it's perhaps easier and more comfortable to run just by applying that pressure.

Certainly walking often reduces the cramping and in that instance where walking does reduce the cramping then I do feel that often changing the breathing pattern, but in particular, just not taking in fluids for a while so that you can just let your stomach settle down does definitely help. And when you start running again, start running at a slightly lower intensity so that bouncing of the stomach isn't quite as big, but also that the breathing or respiratory drive doesn't just suddenly push up.

Then obviously concentrate on just slower breathing and breathing in deeper in and out. You can also try, particularly with the diaphragm stitch, you can try the belly breathe, so in other words, as you breathe, use your stomach to go in and out. That also then can help those muscles just to relax and to stop that cramp from continuing.

Breathe deeper

Make sure you breathe deeply when you exercise so that you get enough oxygen to your muscles. Your muscles need oxygen to work properly so shallow breathing can cause your muscles to fatigue quicker and cramp up. Inhaling deeply and exhaling fully while running can help to prevent side stitches from occurring.


Eat properly before your run

What you eat and how long you wait in between eating and exercising both contribute to you your chances of getting a side stitch. If you’re still digesting some food when you start your exercise, less blood flows to the diaphragm which can cause spasms.

Certain foods take longer to digest so should be avoided before you exercise or head out on your run. So don’t eat food that is high in fat or fibre and avoid sugary drinks or sports drinks as well.

If you are unsure about which foods are more likely to trigger stitches, you can keep a log of what you eat and drink before your runs and then track when you get stitches so that you can recognize which food is a possible trigger.


Strength training

Incorporating strength work into your training can also help to prevent cramps as it helps to strengthen your core muscles and diaphragm which makes them more resistant to fatigue and cramping (Our free strength training progam is perfect to include as part of your training).

Do you want to shave 10 minutes off your marathon PB?

You can run faster with our FREE running strength training programme that you can do once a week, at home and with no expensive gym equipment needed.


Included in the programme:

 Detailed descriptions of each exercise so you know how to do them

 Number of repetitions for each exercise so that you avoid overtraining & injury

 Short videos showing you EXACTLY what to do (Number 6 will turn you into the "Marathon Slayer" so that you don't hit the wall and implode later in the race)

What to do when a side stitch strikes during a run


There are a few things you can do during a run if a side stitch should develop.

Slow down

When you get a side stitch while running or exercising then slow down and walk until the pain goes away. Putting your hand over the area and breathing deeply will help to alleviate the pain as well.


Stretching your abdominal muscles by reaching up with one hand while bending to the side of the stitch can help get your blood flowing and stretch out any cramping muscles that may be causing the side stitch.


If you get a stitch, try concentrating on your breathing and make sure you breathe in deeply and exhale fully. This will help increase the oxygen levels in your muscles so that they can function normally.

Can you continue running with a side stitch?


While it is recommended to slow down to a walk if you experience a side stitch, you can continue to run with a stitch. Side stitches can range from a mild ache to a painful, sharp, stabbing sensation so whether you want to carry on running with a side stitch is dependent on you and how much pain you’re in.

If the pain is mild you can continue running but you should try to focus on your breathing and get into a pattern of deep breathing while you run so that you get enough oxygen to your muscles which will help to ease the stitch.

If you experience a more sharp and painful side stitch, it is recommended that you slow your pace down to a walk or a jog if you don’t want to walk, until the pain subsides.


Can a side stitch do permanent damage?


Side stitches do not cause any permanent damage to your body, muscles or organs. They are a temporary condition caused by changes in blood flow, blood pressure or spasms in the diaphragm and they usually only last a few minutes.

Once your blood flow normalizes and your muscles start functioning normally again, you stitch will go away and you can continue to run or exercise as you please.

While stitches may be a nuisance, they are ultimately harmless and will not cause any permanent damage.

If you have severe side pain accompanied by a fever and abdominal swelling, go and see a medical professional immediately as those are symptoms of something more serious.

What are you training for?

Simply click on any of the images below to access our running training programmes.