What Are Side Stitches and What Can Runners Do about Them?

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When you run, lots of things can go wrong: you can get injured, you can get tired, and you might end up dehydrated or depleted from lack of enough food. How about side stitches, however, and the incredible discomfort they can cause to runners?

What are side stitches, who runs the risk of getting them, and how bad can stitch pain get? Reported by many runners as a sharp pain in the side of their abdomen, side stitches can be anything from a short pang to much worse, stabbing pain that can ruin your run or your race.

What Causes Side Stitches?

As we’ve mentioned, a side stitch is known as exercise-related transient abdominal pain and occurs in your stomach during running or physical effort. While stitch pain is often sudden and can go away as quickly as it starts, it can also develop into a longer, dull ache where it can end up inhibiting your range of motion and disrupting your run.

There is no clear cause for side stitches. In fact, studies point to various different reasons for them developing from a movement of blood to the diaphragm, to irritations in the stomach lining… there are many reasons why you could get a stitch. Some scientists consider them to be linked to irritation in the pelvic cavity, while finally some link the stitch to muscle pain. 

Sometimes, stitches are accompanied by shoulder tip pain – a strange connection, but one that’s been made to when the abdominal wall lining is irritated and causes pain to occur in different areas of the body.

Overall, athletes and scientists agree on the following situations where side stitches occur:

  • After eating a large meal or a meal taken too close to the physical activity
  • After drinking too much of a sugary sports drink
  • From irregular shallow breathing that causes the diaphragm muscles to become irritated
  • During a longer run, as a result of the jarring motion of running continuously at the same time as breathing in and out, leading to ligaments that extend from the diaphragm to the internal organs to be too stretched out and not have enough time to relax

When are you more likely to get a side stitch?

There are a couple of scenarios when runners report getting a side stitch more often. These involve shallow or irregular breathing, especially at the start of a run or when running fast and running too soon after eating or having too big a meal before running.

Breathing related stitches 

If you don’t warm up properly before your run, getting your heart rate up and your respiratory muscles ready to put up with the increased intensity and volume of work, you may get a stitch caused by shallow breathing. According to physiotherapists and coaches, running too fast too quickly can put unnecessary strain on your body before it’s had a chance to adjust, leading to compensations and misplaced demand on the body.

Also, in connection with breathing, the main culprit to cause a stitch is shallow or “chest breathing.” This occurs when you take short, shallow breaths as opposed to deep breathing. The muscles may not receive enough oxygen, getting fatigued quicker, leading to cramps, especially in the abdominal muscles. You can control this by slowing down and taking a few deep breaths, until you feel your stitch subsiding.

Stitches linked to food intake

Meals high in fat or drinks with a lot of added sugar have been linked to the occurrence of side stitches during runs, especially if they are consumed less than one hour before exercise. Runners should avoid a big meal before intense workouts, as this activates the GI (gastro-intestinal) system and makes less oxygen available to the diaphragm. In turn, a stitch will develop in your diaphragm muscles.

It is always a good idea to ensure you have adequate nutrition before a run, however, you should ensure that you are consuming easy to digest snacks and drinks, to allow your body time to process the food, get the nutrients it needs from it, and not be hindered during the run.

What should you do if you get a side stitch during a run?

Even if you’ve done all the right things and have been consistently training in a progressive manner so you arrive well rested and prepared before a race or a big event, a side stitch can still occur. Instead of allowing it to ruin your run or your race, here are a few tips and breathing techniques to help you overcome it when it does:

  • Slow down your pace – either just run a little slower, or slow down to a fast walk and take some deep breaths until the tension or pain subsides
  • Practice deep abdominal breathing. This means a few deep, belly breaths, counting a few seconds on your in breath and a few seconds on your out breath
  • Add an arm and/or ab stretch. Lift your arms overhead when you breathe in, then slowly release as you breathe out. Keep your arms aloft for a few seconds to allow your abdominal muscles to stretch out
  • If you feel a stitch coming on but it’s not fully developed, you might be able to stop it in its tracks by pushing on it. This requires you to stop completely, locate the painful spot and push on it as you inhale, then push even harder as you exhale. Doing this a few times can be helpful against an incoming stitch

Tips for stitch free running

To enjoy running without side stitches, here are a few general tips:

  • Always do a proper warm-up before you run, including dynamic stretches to get your muscles warmed up
  • Work on deep breathing and a good breathing pattern that prevents you taking short, shallow breaths
  • When you plan to go for a run, avoid big or heavy meals and sugary drinks at least 2 hours beforehand
  • Avoid going too hard, too soon. Use a progressive training plan so you don’t overload yourself by running too often or too hard when you’re not at the right fitness levels
  • Develop core abdominal muscles to prevent muscular pain. Ensure you have exercises targeting your core muscles in your strength training program

Studies on muscle cramps and endurance athletes have sometimes pointed to the consumption of pickles or pickle juice to relieve stitch pain and sudden cramping. Brigham Young University researchers showed pickle juice to relieve cramps 45% faster than drinking water, but this is a matter of personal preference as well as circumstances. While this does work for some, it might not have anything to do with side stitches, as we’ve seen that stitches come about from breathing and from a heavy meal more so than from muscular specific pain.

Avoid stitch pain and improve your breathing patterns when running

Most athletes, from elite to casual runners, will experience a side stitch every now and then. Stitches come about most often when you’ve had a heavy meal too close to your run, when you’ve had sugary sports drinks, or when you’re breathing too shallowly and not adopting a regular breathing pattern. 

However, a side stitch doesn’t need to ruin your run. You can adopt an active set of stretches during the run, breathe deeply and try to press on the painful area. With some fast walking or a slower pace coupled with deep breaths, the pain should go away. Once it does, ensure you stick to a regular breathing pattern to avoid it coming on again. 

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