You’ve completed your warm up, the weather is perfect for running, you feel good, and then you get a side stitch.
A side stitch when running can be very unpleasant.
The stabbing pain beneath your ribs is probably not unfamiliar to you.
Although a side stitch is harmless, it can be enough to slow you down or stop you in your tracks entirely.
Many runners experience a side stitch no matter their running experience.
It’s not just something that only beginner runners have to deal with.
As with any pain felt within your body, it’s a sign that you need to take notice and change the way you are currently approaching your runs.
A side stitch is normally a sign that your body is overwhelmed.
In this guide we’ll explore:
- What is a side stitch?
- What are the symptoms of a side stitch when running?
- What causes a side stitch when running?
- Who is at risk of developing a side stitch when running?
- Other potential causes of pain under your rib cage
- How to treat a side stitch when running
- How to prevent a side stitch when running
What is a side stitch?
A side stitch (also known as exercise‐related transient abdominal pain (ETAP)) is pain felt on either side of your abdomen just below the rib cage.
The pain and discomfort associated with a side stitch is more commonly felt on the right side of your abdomen.
According to a 2014 study, 70% of runners reported a side stitch in the last year and that in a single running event approximately one in five participants can be expected to suffer the condition.
In addition, according to a 2007 study, a side stitch was reported in a large range of sports including:
- Swimming (75%)
- Running (69%)
- Horse riding (62%)
- Aerobics (52%)
- Basketball (47%)
- Cycling (32%)
The study adds that a side stitch appears to be most prevalent in activities involving repetitive torso movement.
Studies have also shown that older adults are less likely to develop a side stitch compared with children and younger adults.
What are the symptoms of a side stitch when running?
Symptoms of a side stitch vary from person to person.
It sometimes presents itself as pain on the right side under your ribs. It can also appear on your left side underneath your rib cage.
Other signs and symptoms of a side stitch include:
- A dull ache
- A pulling sensation
- A sharp, stabbing pain
- Shoulder tip pain
What causes a side stitch when running?
From poor blood supply to improper breathing, there are many different theories that could explain why a side stitch develops.
The main theories out there are to do with poor blood circulation in the diaphragm and decreased oxygen intake.
It’s important to note that the exact cause of a side stitch is unknown.
Here are the main causes of a side stitch when running:
- Improper breathing
- Poor blood circulation in the diaphragm
- Irritation of the abdominal and pelvic cavity
- Eating too soon before a run
- Drinking sugary beverages before exercise
- Poor form and posture
- Running too quickly
- Not warming up before a run
The diaphragm plays an important role when breathing.
Many runners forget to breathe deeply and so don’t always use their diaphragm as effectively as they should do.
Instead, short and shallow breaths – those that you feel mainly in your upper chest – are used which then causes tension and cramps.
Poor blood circulation in the diaphragm
The movement of blood in the diaphragm and muscles during exercise can lead to a side stitch.
Irritation of the abdominal and pelvic cavity
Research shows that irritation of the abdominal and pelvic cavity may be the cause of a side stitch.
When the abdominal cavity is irritated, it can result in pain in other localised areas, which may explain why some people experience shoulder tip pain when they have a side stitch.
Eating too soon before a run
Eating too soon before a run or eating too much has been attributed to a side stitch.
Runners have reported that they are more likely to get a stitch if they are full from a pre-run meal or snack.
Drinking sugary drinks before a run
Some research has shown a link between consuming sugary drinks before a run and the increased likelihood of a side stitch developing.
Poor form and posture
Improper running form and posture has been linked to a side stitch.
If you have weak abdominal muscles, your body is more likely to compensate in other areas, therefore creating muscle imbalances which could cause a side stitch to develop.
Running too quickly
Running too quickly so you become out of breath is a common cause of a side stitch when running.
Not warming up before a run
Some runners have reported that they experienced a side stitch when running if they neglected a pre-run warm up.
Dehydration, or drinking too little before a run, is thought to be a cause of a side stitch.
You can also get a side stitch by drinking too much water before a run.
Who is at risk of developing a side stitch?
Anyone can get a side stitch no matter their age, gender, size and running ability.
You are more at risk of developing a side stitch if you:
- Don’t warm up before a run
- Take sudden leaps in your training (e.g. increased duration or intensity)
- Don’t breathe properly on your run or can’t control your breathing on a run
- Eat too soon before a run
- Are dehydrated
- Have weak core muscles
Related: 9 core exercises for runners
Other potential causes of pain under your rib cage
If you experience pain under your rib cage, then it’s important to speak to your doctor to understand other potential causes.
Oftentimes when you feel pain, it’s an underlying sign that something is wrong in your body.
Pain under your rib cage can change from being mild to severe, so it’s important you get it checked out.
Here are other potential causes of pain under your ribs:
- An injury to your ribs
- Kidney stones
- Irritable bowel syndrome (IBS)
- Acid reflux
- Stomach ulcer
How to treat a side stitch when running
If you’re out for a run and the pain strikes, try these simple tips to help reduce your pain and resolve the side stitch:
- Take a break or slow down to a walk.
- Breathe deeply and exhale slowly.
- Stretch your abdominal muscles by reaching one hand overhead.
- Try bending gently into the side where you feel the stitch.
- Try pressing your fingers gently into the affected area while you bend your torso slightly forward.
- Stay hydrated while exercising, but avoid sugary sports drinks if they irritate your stomach.
How to prevent a side stitch when running
There are many ways to prevent a side stitch.
If you’ve suffered from a side stitch in the past, then trying to prevent it is very much a process of trial and error.
Try these tips on your next few runs and see what works for you.
#1 Eat a light breakfast
Eat a light breakfast before your run that is low in fibre and fat.
It takes your digestive system a long time to break down fibrous foods.
If you’re running while your body is in the middle of breaking down these foods, you’re likely to experience a side stitch, cramps and an upset stomach.
Instead, eat carb-rich foods that are not too heavy on your stomach.
If you’re going for a long run, try and eat a meal two to four hours before the start of the run.
For shorter runs, a light snack eaten 30-60 minutes before your run will suffice.
If you struggle to eat very early in the morning, make sure you have a carb-rich meal like pasta the night before.
#2 Don’t forget to warm up
A warm up is essential to get your body and mind ready for the run.
Opt for a light jog in your warm up so you can fully optimise your breathing before your run. You can also follow this with some dynamic stretches.
Believe it or not, your body takes roughly a mile to get into the swing of a run.
Before this point, your breathing and movement may feel laboured, hence why a warm up is advised to make this process a little bit easier.
#3 Run slow and steady
Don’t be tempted to head out too quickly.
Your breathing may feel laboured which may in turn end up being a catalyst for your side stitch.
Start slowly and increase your speed over time.
#4 Strengthen your core
Your core muscles, such as your abdominals, are important in running as they help you to hold a strong and stable position for longer.
Sports like running and swimming call heavily on your upper body muscles, and as a result, you are more likely to experience a side stitch when doing these types of sports.
Your running technique and form is not only important to help you run more efficiently, but it also helps you prevent common running injuries and niggles like a side stitch.
Try some core exercises for runners next time you hit the gym or do a workout at home.
If you do these regularly, they will go a long way in helping you improve your core.
#5 Control your breathing
If you struggle to catch your breath while running, this is a sign that you are running too fast.
If you cannot hold a conversation while you run, slow down to a pace where you can speak to a friend without gasping for breath.
Your diaphragm – the area of the body where a side stitch is commonly felt – plays an important role in breathing.
Irregular and shallow breathing can cause a side stitch to develop.
Find your breathing rhythm by running slow and steady. Remember to breathe deeply, from your diaphragm, but try not to focus on it too much.
#6 Stay hydrated
Dehydration has been found to play a role in the forming of a side stitch.
Although drinking water during your run may invoke a side stitch if you’re not used to doing it, studies have shown that if you practice fluid intake during a run, the pain will slowly go away.
Avoid drinks high in sugar as these have been found to cause a side stitch compared to water.
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