Stitches when running: What causes it and how to prevent it

A stitch (or ‘side-stitch’) is something that almost all athletes will have had the misfortune to experience at one time or another.

What is a stitch?

It’s characterised as a sharp or stabbing pain localised in the lower abdominal region on one side just below the ribs, but it can also be referred up to the tip of the shoulder in some cases.

While it’s not thought of as a ‘serious’ health issue it can wreak havoc on performance if it occurs during a race or hard training session, as, for a period of time, it can genuinely leave you doubled over and unable to maintain a high intensity for quite some time.

The frequency of stitches varies amongst different sports. However, sports that require the torso to be held in an extended postural position for a prolonged period of time and involve repetitive movements of the trunk are more susceptible to stitches.

Running is the most provocative, closely followed by swimming, but cycling has a low incidence due to the relatively flexed torso position and little movement.

What causes a stitch when running?

A stitch is most common when running but it can sometimes occur also when biking or swimming. For a long time, it was blamed on a lack of blood flow to the diaphragm causing it to cramp or spasm.

However, this theory has largely fallen out of fashion as the diaphragm has to work hard when respiration rate increases during exercise so is highly unlikely to be genuinely starved of blood flow in this state.

A couple of other theories have emerged in recent years suggesting that the pain could emanate from ligaments holding the diaphragm as these are put under mechanical stress during exercise due to the up and down motion of internal organs.

This seems very possible during running but maybe less so during swimming or biking where movement of the organs is way less pronounced.

The other theory is that the peritoneum (the lining inside the abdominal cavity) gets irritated by something during exercise causing the pain. This is most plausible when it occurs soon after eating so it may be that there are a couple of over lapping causes rather than a single, simple explanation for why a stitch happens in every single case.

How can you prevent a stitch?

Whatever the root cause there’s no silver bullet for preventing or fixing a stitch once it occurs but there are a few strategies that are most definitely worth trying if it is something you find yourself having to deal with:

  • Don’t eat too soon before exercise
  • If, for energy reasons, you have to eat in the immediate pre-exercise window minimise the volume of food and drink consumed (avoiding fiber in particular as it’s slow to digest) by going for low to moderate amounts of simple carbohydrate based foods or drinks
  • Start off slowly and build the intensity of exercise up through the session to give your body time to properly warm up
  • Try to be mindful of breathing deeply and regularly to maintain relaxation in the diaphragm and abdomen
  • Make sure your training includes workouts of sufficient intensity to accurately replicate and prepare your body for the demands of your intended race pace

How do you get rid of a stitch?

  • Slow your pace
  • Breathe deeply and focus on exhaling fully
  • Raise your arms above your head to stretch your abdominal region
  • ‘Tense’ your stomach muscles to stabilize your core area

As you become fitter and used to running consistently, this may help decrease the risk of contracting a stitch as your body will be more adapted to the physiological demands. And do exercises that focus on improving the range of movement in the torso and encourage spinal alignment.

This may help to enhance breathing mechanics and prevent excessive rotation when running. Exercises that target the deep abdominal muscles, such as the transverse abdominus, may help support the abdominal organs.

Also, exercises tailored towards developing dynamic trunk stability to improve the efficiency of the body to absorb rotational forces.

Experimenting with different approaches will help you understand what works for your own body, and could prevent future, unwelcome, side abdominal pain.

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