Endurance exercisers are tough. We run, swim, and ride miles at a time. Nothing can stop us-except perhaps the dreaded side stitch. That sharp pain in the side has the potential to bring any workout to a screeching halt.
A side stitch, officially called "exercise-related transient abdominal pain" (ETAP) refers to the often workout-ruining (but temporary) cramp in the side that many endurance athletes know all too well. While it can hit any kind of exerciser, people who run are especially prone to it: According to a 2015 study in Sports Medicine, 70% of runners reported experiencing a side stitch in the year prior. One reason it's so common in runners is that it tends to hit when you perform repetitive movements with your torso held upright-the position you'd use when you're pounding the pavement rather than, say, swimming or cycling.
While side stitches are prevalent, there's unfortunately not a ton of good information out there on how to definitively stop them. Experts do have, however, some theories on how to prevent side stitches from occurring and how to deal with them when they do strike. Here's everything you need to know about the dreaded runners' stitch.
The side stitch, or ETAP, is a pain in your abdomen, usually on a side, that occurs while you're exercising.
"ETAP is typically a sharp or stabbing pain that can be pinpointed to a particular area within the abdomen," Darren Morton, Ph.D. an associate professor at Australia's Avondale University who has extensively researched the side stitch, tells SELF. "It is most common in the upper abdomen, just below the rib cage." In adult exercisers, it's usually much more likely to hit on the right side, and it may also be associated with pain in the shoulder tip region.
In some cases, this pain can be a mild cramping, but in others, it can be more bothersome: In a 2015 study by Dr. Morton published in Sports Medicine, the average pain rating score among 600 athletes was a 5.6 out of 10. So it's not exactly surprising that the athletes studied reported a decrease in their performance caused by the pain-the majority of them had to ease up on the intensity until the pain diminished.
As for how long it lasts? This can vary for each exerciser, so there's no real expected duration. Regardless of how long the pain lasts, though, a side stitch while running typically dissipates shortly after you stop exercising, says Dr. Morton.
There have been a few differing schools of thought on the "why" behind side stitches. Up until about 15 years ago, side stitches didn't receive a whole lot of research attention, Dr. Morton says. That meant that although the characteristics of the side stitch were pretty well understood, the mechanism responsible for the pain had remained unclear.
There have been a few theories, though. Previously, experts believed an increase in physical activity led to a lack of blood flow to the diaphragm, the muscle that helps us breathe in and out. Then they believed it had more to do with the stress placed on the ligaments that support our abdominal internal organs during exercise. But this didn't explain the "sharp" or "stabbing" feeling, nor why it occasionally happens in the lower abdomen.
Now, thanks to a comprehensive review of 14 ETAP studies published in 2015 in Sports Medicine, most experts believe a simple bout of friction is responsible. Let's backtrack a minute for a quick anatomy refresher: Your abdominal lining, called the peritoneum, has two layers. The outer layer lies against the abdominal wall and wraps around the diaphragm; the inner layer covers the internal organs. There's supposed to be a bit of space between those two layers, which allows everything to function smoothly. But when there's friction between those two layers and that bit of space decreases, the membranes rub together. And that's when we experience the gasping pain of that darn side stitch.
OK, but what causes the friction to occur-meaning, why can you sometimes run five miles feeling completely fine, while the next time, you're hunched over with that pain a half mile in? The answer basically comes down to pressure, namely from the stomach, which shrinks that space between the membranes. This can happen after you've just eaten a decent-sized meal or if you drink a lot of sugary beverages.
It's also possible that poor posture can play a role, too. An earlier study by Dr. Morton published in the Journal of Science and Medicine in Sport in 2010 found that people with a rounding of the upper back are more likely to get side stitches-and experience them more severely.
"Poor posture might impact the sensitive nerves that supply the membrane, making them more prone to irritation," Dr. Morton says.
Side stitches suck. So your best course of action is to do what you can to avoid getting one in the first place, Theresa Marko, P.T., D.P.T., M.S., a board-certified orthopedic clinical specialist in physical therapy and owner of Marko Physical Therapy in New York City, tells SELF. And there are a few ways to do so.
Diet can play an important role in avoiding the dreaded stitch-namely, you don't want to eat too large a meal in the hour or so before your workout. That's because a high-volume meal can take up space in your gut, leading to pressure and subsequent friction in your abdominal wall. Sugary drinks and fatty foods may irritate that abdominal lining, which can also cause a side stitch. To play it safe, Dr. Morton recommends limiting consumption of these foods for three to four hours before exercise.
How you hydrate during your workout is also important to avoiding a side stitch. While staying hydrated is paramount to performance, pacing yourself is vital.
"Don't chug," says Dr. Marko. "Take small sips to maintain hydration without filling up your stomach."
Working on diaphragmatic breathing (breathing that fully engages the stomach, abdominal muscles, and diaphragm) can also help. According to Dr. Morton, using this type of deep breathing while exercising can help prevent the abdominal muscles from tightening or spasming, which can contribute to a side stitch.
Another potential way to ward off the stitch? Work on your strength training, especially in your core region. One study of 50 runners published in the Journal of Science and Medicine in Sport found that stronger transverse abdominis muscles-the deep core muscles that wrap around your spine and act as stabilizers-were linked to a decrease in ETAP. To build up strength there, you can start working in moves like dead bugs, bird-dogs, glute bridges, and plank variations into your strength training routine.
While popular belief once held that dehydration caused side stitches, there's just not a whole lot of research out there to back that up, says Dr. Morton-it's mainly anecdotal. That doesn't mean that hydration doesn't matter at all, though. Like we mentioned before, avoiding chugging water during your runs can make a side stitch less likely to come on. And staying hydrated in general throughout the 12 hours before your activity is important for your body's overall function, Dr. Morton says.
Sometimes, despite your best attempts at preventing a side stitch, the pain still comes on and you just have to deal with it.
"When it comes to relieving ETAP, there is no one thing that seems to work for everyone-apart from stopping exercise, which isn't always possible or ideal," says Dr. Morton. Still, there are some side stitch treatment ideas that can help you feel better.
If you'd rather not stop-and the pain is not so bad that you can't continue-Dr. Morton says the first step is to slow down. Remind yourself that the pain will pass, usually quickly, but give yourself time to catch your breath and reduce any jolting to your abdomen.
Sports physical therapist and track specialist Wesley Spargo, M.S.P.T., of PhysioElite in Salt Lake City, tells SELF there are some quick tricks to tame the pain so you can make it through your workout.
"Take deep breaths and press on the area," he says. Try to breathe by filling your entire abdominal area with air and match your exhale with the length of your inhale. Focusing on the breath will help your nervous system chill out, which can help ease the pain as well.
If that isn't enough, create space in the diaphragm area through movement, which you can do through a variation of a stretch you're probably already familiar with: the forward fold.
"Bend forward and then lean toward the unaffected side to stretch the affected side," says Spargo. To complete this stretch, stand with your feet shoulder-width apart. Hinge forward at your waist and release your body into a forward fold. Bend your knees as much as you need-you want to feel the stretch in your mid-body, torso, and back-not your hamstrings. Your hands should be reaching toward your feet or the ground. Walk them out slightly so that your spine is extended. Next, walk both hands toward the unaffected side. You should feel the stretch in the side of your abdomen.
If you are still in pain, Dr. Marko says to slowly walk with your hands over your head to stretch out your abdomen. You can also lie on your back with your hips elevated, she says.
Side stitches are annoying, inconvenient, frustrating, and uncomfortable, but they are not usually anything serious or something to worry about.
"It could be detrimental to performance," says Spargo. "But the pain is benign."
Side stitches themselves are not usually cause for concern, but there are more serious conditions that mimic ETAP. So, when should you see a doctor?
"If the pain is sharp and stabbing while working out and does not resolve after stopping activity, then it is a good idea to get checked out," says Dr. Marko. Additionally, side stitches should not be happening in every exercise session. And if the pain comes on without exercising, then it's likely not a side stitch you're dealing with. Schedule an appointment with your physician to rule out a hiatal hernia, constipation, or other GI issues. In other words, a side stitch for days unrelated to activity is likely something above and beyond the typical runners' stitch.
Also, appendicitis can at first feel like a side stitch. If the pain is in your lower abdomen and you experience a high fever, vomiting, and/or diarrhea, then you should head to your local emergency room. Similarly, if you have chest tightness or pain accompanied by a side stitch, seek emergency care to rule out a cardiac event.
Unfortunately, the majority of us will encounter a side stitch in our lifetimes. Just remember, it's usually nothing serious, the pain will pass, and it's totally fine to slow down and breathe.
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