Painful Side Stitch When Running: Causes, Prevention, and Possible Cures

Oh!  My Aching Side.

Do you suffer from the ever-so-painful side sticth that grabs you at about mile two and hangs on until you’re done running? What causes it? What can you do to prevent it? One of my readers suffers from this rather common malady and asked me to help her find out why and figure out what she can do about it.

Memories of High School P.E. Class

I remember as a kid I would have to run the 100 yard dash once a year for the President’s Physical Fitness Challenge in P.E. class.  After running as hard as I could for 100 yards I would have this stabbing pain in my side.  I can clearly recall what the pain felt like and I’m thankful that I haven’t been struck with it since taking up running a few years ago. Since grade school P.E. class I’ve never suffered from ‘side stitch’, so the challenge of researching the causes and possible solutions has been interesting for me.

Below is a list of what my research has turned up as probable causes.  Also listed are possible solutions.  You might think that all of these ‘possibilities’ don’t sound like much help.  If you suffer from ‘side stitch’ you want to know how to get it to stop now never to return.  Unfortunately, it’s not that easy and even running coaches have different ideas as to how to prevent it or stop it when it strikes.

Flickr photo by Rennett Stowe

What Is Exercise-related Transient Abdominal Pain:

Exercise-related Transient Abdominal Pain is most common among runners and swimmers.  It typically occurs on the right side right and is well-localized below the rib cage.  Some people experience ETAP on the left side.  ETBP has not been found to be related to body mass index or gender.  It is far less common in older athletes.


Most of the research agrees that the side stitches are caused by a cramp or spasm in the diaphragm. There are a variety of reasons why these spasms occur.  Some of them are:

1.  Exhaling During Foot Strike – Exhaling at the same time the foot lands in a stride causes the liver to pull downward at exactly the same time the diaphragm is at its highest point in the torso.  This tugging and strain could result in a spasm.

2. Decreased Blood Flow – During exercise there is decreased blood flow to the diaphragm.  The lack of blood could trigger a spasm.

3.  Trapped Air In The Lungs – During exercise, air goes into the lungs more easily than it goes out.  The extra air may press on the diaphragm causing it to cramp.

4.  Diet – Some research shows that eating too close to running or swimming, or intolerance to wheat or daily products may cause a reaction.

5. Weak Core Muscles – Weak abdominal muscles allow the internal organs to move around more when running which can exacerbate the problem.

6.  Lack of Aerobic Conditioning – During cardio exercise when you get winded you have a tendency to take shorter, shallow breaths.  Shallow breathing doesn’t  allow the diaphragm to relax fully causing a chain reaction and painful stitch.

Prevention Techniques:

1.  Foot Strike – Most side stitches occur on the right side. Notice if you land on your right or left foot each time you exhale.  If you consistently landing on the right foot while releasing the breath, it can cause a strain on the ligaments between the liver and diaphragm and create friction between the two.  If you suffer from pain on the left side, try to put your right foot down as you exhale.

2.  Breathe Deeply – Try to avoid shallow breathing.  Breathe deeply and slowly so that the belly expands and contracts.  If you find it difficult to take deeper breathes, you may need to work on pace or add walk/run intervals and work up slowly to your desired speed.

3.  Grunt Exhale – Making a grunting sound while you exhale will help release excess air from the lungs.

4.  Diet – Avoid eating a large meal two to three hours before running or swimming.  An empty stomach makes you lighter and reduces the strain on the ligaments.  You also don’t run the risk of having the stomach busy digesting food, taking blood flow away from the other organs, while you’re exercising. Avoiding dairy products and fruit juices beforehand may also help.

5.  Incorporate Core Exercises – Building a strong carrier for your internal organs will diminish the jarring and friction on the liver and diaphragm.  Doing a 10 minute core workout two to three times a week will strengthen your abdominals and help improve your overall running speed.

6.  Add Speed Drills – While this may sound counter-intuitive to #2, it is a way to improve your overall cardiovascular conditioning which can impact the occurrence of side stitches. Once or twice a week go for a shorter workout and add three or four short speed drills.

Strong abdominals may help with ETAP

When The Stitch Strikes

When you’re out on a run and the side stitch strikes you may need to slow down or stop until it subsides.  A couple of methods to relieve the pain are:

1.  Deep Massage – Press your fingers deeply into the area that hurts and massage it firmly while breathing deeply.

2.  Poke and Blow – Push your fingers deeply into the aching side.  At the same time, purse your lips and exhale as hard as you can.

3.  Stretch – Raise your arms over your head and reach to the left.  Hold for 30 seconds.  Release, then stretch to the over side.

It’s Not One Size Fits All 

Keeping track of when the ETAP occurs may also help you determine what it is that’s causing your pain. Writing down what you ate before you ran, at what point in the workout the pain began, and what pace you were at the time may provide clues as to cause and prevention.

Since there are so many variables and conditions that may or may not be present in your situation, you may need to use the trial and error method to find out what your triggers are. Research certainly suggests it’s not the the same for everyone.

Finding what is sending your diaphragm into a tizzy might be tricky, but certainly would be worthwhile if it keeps you from doubling over during a race or run.

(*I am not a doctor. If you have persistent, unexplained abdominal pain, you should consult your physician for advice.) 

Do you suffer from ETAP?  Have you found a solution that works for you?