Running: Causes of Side Stitches and How To Prevent Them

February 25, 2020

Have you ever gone for a run and then suddenly felt a sharp pain piercing your side? The kind that makes you sit, grab your rib cage, and breathe funny as to not aggravate the pain? Yes, we’ve all been there. And no, it’s not just you. What a relief! (Until the cramp is gone). This phenomenon is called getting a stitch in your side. Although a side stitch is essentially harmless, it can be pretty painful. And oftentimes we are forced to drop out of a race in the middle because of it.

Why do we get side stitches

Diaphragm spams

According to Jordan Metzl, M.D., a sports medicine physician at the Hospital for Special Surgery in New York City and creator of Runner's World IronStrength workout, “…the most likely cause is a diaphragm spasm. The diaphragm, a sheet of muscle that extends across the bottom of the rib cage, plays an important role in breathing. Just like your leg muscles, your diaphragm can fatigue and cramp when put under too much stress. That’s why side stitches tend to strike beginner runners or those stepping up pace or distance.”

Essentially, a side stitch is a cramp that affects your diaphragm, hence the inability to breathe properly or deeply when it happens.

Weak core muscles

Another possible culprit to side stitches is having weak core muscles. You need core strength to stabilize your launch and land with each stride. If your muscles aren’t properly developed or if you’re running at a speed faster than what you’re conditioned for, you may encounter this problem. Runners experience side stitches because of the demand on their respiratory system. Running makes you breathe deeper and faster to sustain your working muscles with adequate amounts of oxygen.

Eating a heavy meal

Eating a large meal before going on a run can also provoke a side stitch. Eating a large amount of food right before going on a run can lead to side stitches and digestive issues. Aside from that, it also makes you feel sluggish during your run. Generally, it would help if you waited three to four hours after having a large meal before running. But if you ate a snack, wait at least half an hour or preferably one to two hours before going on your run. Always remember that everyone is different. Some people have more energy eating a snack before going on a run, and others have no trouble eating a meal before a workout. Find out what works best for you and stick to it.

Preventing side stitches

Side stitches aren’t a hundred percent preventable but there are some things you can do to reduce the probability of a cramped diaphragm.

Strengthen your core muscles

Doing strength and core exercises will help your running and prevent injuries. Many runners know this, but they're not sure when to do these workouts or what to do—until today. Understand that your core isn't just your abs. It also includes your hamstrings, glutes, hips, lower back, and oblique muscles. Core routines for runners should target these areas to prevent running injuries and maintain health. General strength includes all of these muscles. And, while not mainly focused, a well-rounded core program can improve your athleticism, reduce injuries, and make you a more efficient runner.

Core exercises for runners

Planks

While crunches are the most common core exercise, they're not an effective way to build muscle and strengthen your abdominal area. So, what's a better alternative to doing crunches? Try doing planks! They're much better at building core strength. Planks help improve core strength and stability. Planks activate more muscles than crunches or sit-ups do. Planks require the use of your arms, legs, and entire abdomen, making them an all-encompassing workout and a more efficient way to exercise. And they're much easier on your back than crunches.  Pushing your spine against the floor over and over again can cause lower back pain the day after your workout.

• High Plank — You can either start from the top or from the pushup position. Keep your palms of your hands and toes planted firmly on the ground, your back straight, and your core tight. A sagging back or bottom during a plank will result in lower back pain later on. Always think about technique and do not compromise your form for a longer plank time. When your body starts to shake, stop doing the high plank, rest for a few seconds, and try again. Also, don't let your head sag.
• Low Plank — The more common type of plank is called the low plank. You've probably done this at the gym or in yoga a thousand times. Lower down to your forearms, maintaining the same positioning and form as the high plank. Keep your elbows under your shoulder for maximum stability and your chest as close to the floor as possible without letting it touch the mat.
• Side Plank — For targeting your side abdominals are strengthening your spine, do side planks. Lie on your right or left side and hoist yourself up onto your forearm, which should be firmly planted on the ground. Your elbow should be directly under your shoulder to follow the body’s natural position. Raise your hips until it is parallel to the ground, your body should form a triangular shape from here. Brace both feet on the ground for stability. To develop your balance, try lifting one arm up and stacking one foot over the other. Remember to switch sides!
• Shoulder taps — This variation of the plank increases balance and mobility. From the high plank pose, take your right hand off the ground and tap your left elbow, repeat the movement with the other arm. Use your left arm and toes to balance. Return your right hand to the ground, and repeat the action on your opposite side. Do 10 taps each side to start off, but increase your number as your balance improves.
• Knee touches — This may seem like a simple maneuver but it will leave you feeling sore the next day. Drop to a low plank pose and alternate lightly touching your knees on the ground. Keep your back straight and don’t compromise your form. The knee movement gives your hamstrings and quads double the workout.

Control your breathing

The faster you run, the more oxygen your body needs. One efficient way of breathing sounds a little like this “hee hee, hoo hoo” which can be translated to “inhale inhale, exhale exhale.” Time it with your steps, so in that one breathing sequence with four parts you should have taken four steps. Hee [step], Hee [step], Hoo [step], Hoo [step] and so on and so forth. It’s all about proper timing. The faster you run, the faster you breath. Just don’t forget that rhythm and you’re good. Plus, this breathing technique helps boost your endurance.

Stay hydrated but let the water settle

Anyone who’s exercising needs to stay hydrated before, during, and after a workout. But, don’t bolt off at 10 mph after you drank a gallon of water. The volume of water swishing around your stomach will cause you to have a side stitch. If you wish to hydrate in the middle of your workout do it during your break time and give yourself a few minutes to rest before you start running again.

Eat mindfully pre-run

Foods high in fat and fiber take more time to digest. That doesn't necessarily mean that they're bad foods, but you need to be mindful of eating them before a run. If you want food rich in fat and/or fiber have them at least three hours before going for a run. Consuming these foods within one to two hours before can cause havoc — in the form of a side stitch among numerous other problems. Experiment with a variation of foods pre-run, eat lightly, and give yourself ample time to digest. One person's perfect pre-run fuel is another's disaster, so find what works best for you in your training.

As a runner, your diet and nutrition are of utmost importance for maintaining good health and promoting peak performance during training sessions and races. Proper nutrition and hydration can make or break a workout or race, and also affect how you feel, work, and think. One of the most popular questions that new runners have is what they should eat before, during, and after running. It's common for runners to worry about what they eat before a run to avoid any cramping or gastrointestinal issues. But they're also concerned that not fueling up before a run will leave them feeling weak, lethargic, and hungry.

Find the in-between of starved and stuffed; you should be energized but not full. Don't eat immediately before running because it could lead to cramping or annoying side stitches. But on the flipside running on an empty stomach will cause you to run out of energy and leave you feeling fatigued during your runs.

Invest in a solid warm-up

People often overlook warming up because they're more interested in getting to the explosive parts of the workout. But, warming up is essential to avoiding side stitches and injuries while running. Invest in at least two to three minutes of brisk walking or dynamic stretching, then gradually work your way into a comfortable running pace. Go slow and steady until your body is warm enough to run at a fast pace. Warming up will increase the quality of your workout and decrease the risk of stitches that arise from shallow, rapid, and irregular breathing.

Stop for a moment and stretch

What do you do when you get a leg cramp? You stretch! The same thing applies to when you’ve got a stitch in your side. Stretch your upper body to relax the diaphragm and abdominal cavity. Put your arms over your head, inhale and lean your upper body forward while exhaling and letting your arms dangle in front of you. Keep doing this stretch until you feel your stitch loosen. The heat from the palms of your hands also help relieve the pain of the stitch. Press them against your sides until the residual pain dissipates.

You know what they say, no pain no gain! And stitches are part of the game.