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Side Stitches

Running can be a pain in the side, literally. If you've ever been running or jogging, chances are at some point in time you've experienced a sharp pain that strikes directly under the ribs where the abdomen meets the chest. That pain is typically called a side stitch.

Although side stitches are a fairly common occurrence, there's still a bit of a mystery around what actually causes them. Here are three theories.

When you bend your knees to run, you contract the muscles in your belly, which increases the pressure in your belly. As you start to run, you take in more oxygen and your lungs expand more than when you're resting. The combination of a compressed belly and expanded lungs shuts off some of the blood flow to the diaphragm. The diaphragm then goes into a spasm (the side stitch) when it can't get the oxygen it needs.


If you take shallow breaths when running, the diaphragm stays in an elevated position and doesn't lower enough to allow the connective ligaments of the liver to relax. The diaphragm becomes stressed, and a stitch may result.


As you inhale, your diaphragm moves down. When you exhale, your diaphragm moves back up. When you run, your organs bounce, pulling the diaphragm down and straining it as it moves up while exhaling. In this scenario, the liver adds to the pain because it's the largest organ in the abdominal cavity, it's situated in the upper right abdomen, and it's attached to the diaphragm by two ligaments. As you run, the extra weight of the liver pulling down, along with the jostling of the diaphragm, causes a stitch on the right side just below the ribs.

No matter what explanation proves to be correct, doctors agree on one thing; Side stitches are not dangerous, just painful. The ache should go away in a few minutes.

Here are some things you can do to avoid side stitches and what to do if you get one.

  1. Before you exercise, experiment with your fluid intake. Sometimes drinking a lot before a workout session can accentuate the problem, so experiment with how much you drink before a workout. Just don't cut back so much you get dehydrated.

  2. If you get stitches regularly, don't eat an hour before running. It's thought that the food in your stomach during a workout may contribute to cramping by putting more stress on the ligaments.

  3. Work on your abdominal strength, especially the obliques and transverse abdominis.

  4. Walk or jog slowly to warm up, breathing deeply from the belly. (To see if you're really breathing from the belly, lie down on the floor with your hand on your stomach. Take a deep breath. If your hand rises slightly, you're breathing properly. If your chest moves, you're not breathing deep enough.)

  5. Periodically "purse" your lips when you exhale while running. It looks like you're about to blow out a candle and helps you concentrate on breathing.

  6. Running outside in cold temperatures can trigger side stitches because it's uncomfortable taking deep breaths of frigid air until you've warmed up. Warm-up indoors before you head outside.

  7. Once you have a side stitch, slow down or stop. You need to relax the muscle that's cramping.

  8. Massage the area to reduce the pain. Run your fingers into your abdomen, under the ribcage and into the cramping muscle to stretch it.

  9. Stretch doing side bends, with one arm reaching over your head.

  10. Alter your breathing. People who take shallow breaths are more likely to experience stitches, so take deep breaths and exhale completely.

  11. If you continue running, exhale with force on each stride. If the stitch is on the LEFT side, you should forcefully exhale when the RIGHT foot strikes the ground. Do the reverse if the stitch is on your RIGHT side.

If the pain doesn't subside within a few minutes, see your doctor and make sure it's not something more serious.

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