Side Stitches: Why They Happen and How to Prevent Them

Published on March 12 by Matt

A side stitch, or exercise-related transient abdominal pain (ETAP), is a sharp or cramping pain that typically occurs on one side of the abdomen, just below the ribs. It’s a common issue for runners, often striking during long or intense runs. While side stitches are generally harmless, they can disrupt training and races if they persist.

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Why Runners Get Side Stitches

1. Diaphragm Stress from Heavy Breathing

Running requires sustained and rhythmic breathing, and if the diaphragm (the primary breathing muscle) becomes fatigued or irritated, it can spasm—leading to a stitch.

2. Poor Breathing Technique

Shallow or irregular breathing fails to provide the diaphragm with enough oxygen, making it more susceptible to cramps.

3. Eating or Drinking Too Close to a Run

Consuming a large meal, dairy, or sugary sports drinks shortly before running can increase the likelihood of a side stitch. The digestive system competes with the diaphragm for blood flow, leading to discomfort.

4. Weak Core Muscles

A weak core reduces overall stability and forces the diaphragm to work harder during running. Poor posture due to core weakness can also contribute to side stitches.

5. Running Posture & Gait

Slouching forward or overstriding can compress the diaphragm and reduce its ability to expand freely, increasing the chance of a stitch.

6. Lack of a Proper Warm-Up

Jumping into high-intensity running without a warm-up can shock the muscles, including the diaphragm, making a stitch more likely.

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How Runners Can Get Rid of a Side Stitch Mid-Run

If a side stitch strikes during your run, try these strategies for quick relief:

1. Slow Down and Control Your Breathing

• Reduce your pace to a jog or walk.
• Breathe deeply from your diaphragm rather than taking shallow breaths.
• Try the "2:2 breathing pattern"—inhale for two steps, exhale for two steps.

2. Exhale on the Opposite Footstrike

• If the stitch is on your right side, time your exhale when your left foot hits the ground (and vice versa).
• This technique reduces stress on the diaphragm.

3. Stretch the Affected Side

• Raise your arms overhead and gently lean away from the painful side.
• Alternatively, bend forward slightly while taking slow, deep breaths.

4. Apply Pressure

• Press your fingers into the stitch area and hold for 10–15 seconds while breathing deeply.
• Gradually release the pressure and continue running at a slower pace.

5. Adjust Your Posture

• Keep your torso upright with shoulders relaxed.
• Avoid slouching forward, which can compress your diaphragm.

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How Runners Can Prevent Side Stitches

1. Improve Breathing Technique

• Practice deep belly breathing instead of shallow chest breathing.
• Try breathing drills such as "diaphragmatic breathing":
  • Lie on your back, place one hand on your chest and one on your stomach, and inhale deeply so your stomach rises while your chest stays still.

2. Strengthen Your Core

A strong core supports proper running form and reduces strain on the diaphragm. Include these exercises in your routine:

• Planks
• Russian twists
• Bicycle crunches
• Hanging leg raises

3. Avoid Eating Right Before Running

• Wait at least 1.5–2 hours after a meal before running.
• Avoid high-fat, dairy-heavy, or sugary foods before a run.
• If you need fuel, opt for a small snack like a banana or toast with peanut butter.

4. Warm Up Properly

• Jog lightly for 5–10 minutes before starting your main run.
• Include dynamic stretches like side bends and arm swings to loosen up your core and diaphragm.

5. Maintain Good Running Form

• Keep an upright posture with a slight forward lean.
• Relax your shoulders and avoid hunching.
• Run with a natural stride, avoiding overstriding.

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When to Seek Medical Attention

While side stitches are common and harmless, see a doctor if:

• The pain persists even after stopping exercise.
• The pain is severe and different from a normal stitch.
• You experience vomiting, dizziness, or shortness of breath.

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