Do you ever feel a sharp, stabbing pain in your side during your run? Then you’re not alone. Side stitches are very common among runners—affecting 7 out of 10 people, from beginner runners to serious marathoners. But what is a side stitch cramp in running? How do I prevent them?
What is a side stitch?
Anyone who exercises vigorously can experience some kind of cramps or muscle pain. But a side stitch (also known as the exercise-related transient abdominal pain or ETAP for short) is not your typical cramp.
A side stitch is a sharp pain that you feel on the side of your abdomen. It can feel like someone is stabbing you with a knife—and in some cases, it can be so uncomfortable that you’ll stop mid-run just to catch your breath.
A side stitch is typically felt below the rib cage and is typically on the right side. Sometimes it is accompanied by pain in the shoulder tip.
Sometimes the side stitch can feel like a slight cramp, but on average, it is moderate or painful enough to affect performance until it goes away. But luckily, the pain is not permanent: usually, it goes away shortly after you stop running.
What causes side stitches when you run?
While side stitches are very common, it wasn’t thoroughly researched until about 15 years ago. Even now, sports medicine experts offer different theories on why it happens.
Muscle spasms in the diaphragm
Gasping for breath during your run? As you reach higher speeds or exercise for longer durations, your respiratory system has to work harder to provide oxygen. That taxes the diaphragm, which is the main muscle used for breathing.
But when the diaphragm is forced to expand and contract beyond what it’s used to, there’s bound to be some muscle pain and spasms—experienced as a sharp pain in the area of the lower ribcage, where the diaphragm is located.
Irritation of the parietal peritoneum
The abdomen has a thin lining called the parietal peritoneum. It has two layers: the first is found along the abdominal wall, and encloses the diaphragm, while the second protects the internal organs.
Normally, there’s a small space between the two layers. But in some conditions—like when your stomach expands after a big meal, or you hunch when you run—the layers can rub against each other. That friction is what causes the side stitch.
Running can put both vertical and rotational stress on the spinal column, because of the way our torso as we stride. This can lead to a sharp, localized pain along the sides of our sides and back.
That’s why this type of pain typically occurs in any sport that significantly involves the torso, such as running, horseback riding, and swimming.
Related: Why Do Runners Get Cramps?
How can you prevent a side stitch when running?
When you get a side stitch, there’s not much you can do except to stop and take a break until the pain subsides. So, the best thing you can do is to prevent it from happening in the first place.
Don’t eat a heavy meal before you run
Since side stitches are associated with an expanded abdomen, then you want to avoid starting your run with a full stomach. Aside from a large meal, limit ingredients that make you bloat, or large amounts of water.
On average, it’s enough to wait an hour after a meal. But if you’re prone to side stitches, you may want to limit consumption up to three hours before your workout. You can, however, have a light pre-workout snack and some sips of water—hydration is still important, but aim to drink throughout your exercise rather than loading up right before.
Don’t eat something that’s high in sugar and fat
Very sweet or oily food can irritate your abdominal lining and increase gastrointestinal (GI) activity, so it increases the risk of getting a side stitch. It may take up to four hours for your body’s GI levels to go back to normal, so plan your workout accordingly.
Warm-up and slowly increase speed
One of the most common mistakes that runners make that can lead to side stitches is to skip the warm-up or suddenly ramp up your speed. Your body needs time to get used to the increased oxygen demands.
Always begin with stretching and a slow pace, then gradually build up to your desired speed. This is especially important for new runners.
Take deep belly breaths
Short, shallow breaths don’t take in a lot of oxygen, so your diaphragm has to work harder and faster to meet your body’s requirements as you run. So, one of the most important skills you need to learn as a runner is how to do deep chest breathing—so it comes naturally to you, even when you’re pushing your body past its limits.
When you feel yourself gasping for breath, or taking shallow breaths just to keep up, take a break and allow your breathing to return to normal.
Mind your posture
Poor posture, such as hunching over as you run, compresses your abdominal muscles and can lead to the irritation of the parietal peritoneum. It can also aggravate spinal stress, another factor in getting a side stitch.
As you run, imagine your spine being pulled by a string. Keep your shoulders relaxed, and tighten your core muscles to provide additional support.
Are side stitches a sign of something I should worry about?
Side stitches are generally not a sign of a serious medical condition, as long as it doesn’t happen every time you exercise, go away after you rest, and are not accompanied by other symptoms like diarrhea, constipation, or other problems with the gastrointestinal tract.
But even if it’s not a medical problem, it doesn’t mean that you should ignore it. It may be your body’s way of telling you that you need to adjust your pace, spend more time on your warm-up, or pay more attention to your posture.
You can also try to revisit your pre-workout meals to see if you are sensitive to any food. Change some of your snacks, or wait longer before your workout, to see if it makes a difference.
In this way, your side stitches can help you learn what your body needs to have a more effective run.
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