You’re two miles into a run and feeling good. Your stride is relaxed, your breathing is controlled, and those endorphins are ~flowing~.
All of a sudden, you’re hit with a sharp, stabbing sensation on the side of your torso, just below your ribs. Without even thinking, you slow your pace, desperate to get rid of the pain. You planned to run six miles today, but now all you can think about is how the hell you’re gonna make it home in one piece.
Nothing kiboshes an otherwise awesome workout like the dreaded side stitch.
Clinically called exercise-related transient abdominal pain (ETAP for short), the side stitch is “very common,” Sydney Lopez, a licensed athletic trainer with The Stone Clinic in San Francisco, tells SELF. An older survey of 965 athletes, published in 2000 in the journal Medicine & Science in Sports & Exercise, found that nearly 70% of runners and 75% of swimmers reported a side stitch in the past year.
But just because the side stitch is common doesn’t mean you need to suffer through it. Read on to learn what the hell causes side stitches, expert-backed tips for banishing them, and the red flags that warrant a chat with your doctor.
What exactly is a side stitch?
The side stitch is a sharp, localized pain that comes on during exercise and occurs in the abdomen, typically below the rib cage, according to Hunter Carter, an exercise physiologist at Hospital for Special Surgery in New York City. “A lot of people will describe it as sort of like a stabbing pain in the ribs,” Carter tells SELF. For many people, this sensation crops up on the right side of the body, he says.
A side stitch is different from other exercise-induced abdominal issues, such as muscle cramps (which feel more like tightness) and GI distress (which can include cramping accompanied by bloating, nausea, and/or a sudden urge to poop), Carter says.
Why do people get side stitches?
As for what causes the side stitch, “there is no one exact mechanism that is absolutely agreed upon,” Carter says. But the leading theory is that it happens when the parietal peritoneum (a layer of abdominal lining) gets irritated with repetitive movement, he says.
Runners who have a lot of vertical oscillation—meaning they bounce up and down a bunch as they stride—can be especially susceptible, Cater says. That’s because all that vigorous motion can jostle and aggravate the parietal peritoneum.
Repeatedly twisting your torso can also irk your parietal peritoneum, Carter adds. This motion is common in swimming, especially with freestyle and backstroke, which may explain why side stitches are common in that sport, he says. Excessive rotation can also occur during running if you don’t have good core control, he adds.
Another theory behind the side stitch is that it’s caused by diaphragmatic ischemia, which is a fancy term for reduced blood flow to the diaphragm, Carter says. Basically, when you’re exercising, your body shuttles blood away from the center of your body, where your diaphragm is housed, and towards your working muscles. This can really tucker out your diaphragm—which still needs to do its job of supporting respiration—and that fatigue may manifest as the pain of a side stitch.
Eating a big meal, drinking a large volume of liquid, and/or consuming certain foods or drinks directly before or during your workout may also contribute, Carter says. That’s because exercise diverts blood away from your intestines (and towards your working muscles, like we mentioned), which leaves things lingering in your GI tract undigested. The very presence of those foods and liquids jostling around can irritate your abdominal lining enough to bring on a side stitch, Carter explains.
What can you do to ease or prevent side stitches?
Side stitches have a way of sneaking up on you. But, while you usually can’t predict their arrival, you can typically bring them to a halt by toning down the intensity of your workout. “Backing off the pace reduces the mechanical stress on the abdomen and usually allows the pain to settle quickly,” Lopez explains. This could look like slowing your run to a slow jog or walk or taking a break at the side of the pool in between laps.
Taking a few slow, deep diaphragmatic breaths may also help, Lopez adds. “Focusing on deeper breathing can reduce strain on the diaphragm and help relax the abdominal region,” she says. Another hack: Press your fingers into the tender spot and bend slightly forward. This may reduce the pain by providing “a different feedback sensation at the point of irritation,” Lopez says.
Beyond that, maintaining good core activation throughout your workouts can reduce the chances of a side stitch coming on in the first place. “Abdominal bracing is going to help correct or prevent that abdominal lining from going through so much irritation,” Carter says. To help on this front, he gives the cue of knitting your ribs together and keeping them closed together (versus flared out), even as you inhale. With running specifically, he recommends leaning your torso slightly forward as you stride, since this posture can help recruit your core muscles.
Of course, being able to maintain good core engagement throughout your workouts requires a strong baseline level of abdominal strength, stability, and control. So if you feel like you’re lacking in that arena, Carter recommends weaving into your routine exercises such as the bear plank, side plank, and Palloff press. If side stitches are repeatedly sabotaging your workout, Carter suggests getting your form evaluated by a fitness professional. They may notice biomechanical errors that are possibly contributing—like too much vertical oscillation as you run, for example—and they could provide the guidance to help you fix them.
Lastly, because food and drink intake can trigger a side stitch, Lopez recommends avoiding eating large meals within one to three hours before running or other high-intensity exercise. Similarly, try to hydrate continuously throughout the day instead of chugging a bunch of water right before you break a sweat, Cater says.
Side stitch red flags
The side stitch can definitely be painful and annoying, especially when it sabotages your workout. But rest easy: “It is typically not dangerous,” Carter says.
Lopez agrees: “Most side stitches are harmless and resolve quickly once you slow down.”
That said, there are a few side stitch red flags that warrant a check in with a medical professional. These include having persistent or severe abdominal pain, especially if it occurs outside of a workout, gets worse over time, or crops up with other symptoms like nausea, dizziness, or chest pain, Lopez says. Same goes if you’ve taken all the steps to alleviate your side stitches—including having a fitness professional evaluate your form—but they keep happening, Carter says.
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