Side Stitches

Contributed by Dr. Steven T. Devor – Director of Performance Physiology for MIT and OhioHealth, and Associate Professor of Exercise Physiology, Department of Human Sciences, and Department of Physiology and Cell Biology, The Ohio State University

Everyone that consistently runs, especially those just getting started in the sport, will at some point have to contend with the pain of a “side-stitch”. And when this happens you will be forced to slow your pace and try to eliminate the discomfort. The majority of the time a side stitch cramp occurs on the upper right side of the abdomen, in the general vicinity of where your liver is found. Interestingly, other endurance athletes, for example cyclists and cross-country skiers, rarely experience this sort of pain. This is likely related to both the continual up and down motion and more severe ground impact that is unique to running. It is not entirely clear what exactly causes the cramp like pain of a side stitch, but there are two quite plausible reasons why these cramps occur.

The first possibility is related to the fact that the liver, stomach, and spleen are all attached to the diaphragm muscle by ligaments, and the liver is heaviest of all the organs in the abdominal area. The diaphragm is a large, flat muscle located just above the stomach that permits inhalation as it contracts, and exhalation as it relaxes. During running these organs bounce up and down repeatedly and create downward force on the diaphragm. The repeated downward force and general jarring of the organs can result in the stomach-area cramp known as the side stitch.

One proven method to avoid the potential for the “jarring mechanism” to cause a side stitch is to not begin your run at an extremely fast pace. Do a gentle warm up first. If you immediately transition from standing or walking slowly to fast running, the sudden change of pace, increased ground impact, and associated up and down motion may indeed result in a side stitch.

The second possible cause of the side stitch is related to the depth of breathing. Shallow breathing, almost a panting type of breathing, results in less oxygen being delivered to the working skeletal muscles. And the diaphragm is certainly one of the muscles that requires oxygen to function. If your breathing is not deep enough during running, the diaphragm can cramp. When doing any type of exercise, running included, it is important to focus on deep breathing. My suggestion to determine if you are deep breathing is to put your hand on your stomach, if you are deeply breathing from your lower lungs your stomach will rise and fall.

Experienced runners are naturally more adept at deep breathing. Accordingly, the potential for the “shallow breathing mechanism” to cause a side stitch is much more common in those just beginning to run. However, being nervous can play a role here as well. Many endurance athletes, both beginners and experienced, can become nervous about a workout or a race and begin to breathe in a shallower pattern, and that may elicit the side stitch.

Through the years that I have worked with runners, I have noted a number of things that can either eliminate side stitches, or become effective ways to deal with them if they do occur. These strategies are listed below. However, what works for one person may not work for another. It is best to experiment with the remedies below and determine the best method or methods for yourself.   

1. When a side stitch cramp occurs on the right side, exhale when your left foot strikes the ground. This will transfer most of the jarring force away from the afflicted side allowing you to take the stress off of the diaphragm;
2. Stop running or walking and bend forward at the waist while tightening your abdominal muscles
3. Breathe deeply. This will help to stretch the diaphragm;
4. Stretch with your right arm extended above your head, lean to the left. Hold for approximately 10 - 20 seconds. Repeat the stretch with the left arm stretched upward;
5. Focus on your breathing pattern and exhale a few times through pursed lips;
6. Try changing your breathing pattern for approximately one minute while your running pace is slowed. For example, inhale one extra step then exhale one less step; and
7. Slow your pace of running or walking.