Whether you're out running or doing any form of exercise, an all-too-familiar sharp pain in your side can stop you in your tracks. If you've ever experienced a side stitch—also known as a muscle stitch or exercise-related transient abdominal pain (ETAP)—you know just how distracting and uncomfortable it can be.
Side stitches are common during many forms of exercise, particularly running. In fact, a 2015 study estimated that as many as 70% of runners had experienced a stitch in the previous year. Additionally, about one in five race participants are likely to get a stitch.
Fortunately, ETAP is not a medical emergency—or even a reason to see a doctor. The causes of side stitches are not yet fully understood, but most people can deal with one if it happens. Learn how to get rid of a side stitch so you can keep moving without the discomfort.
You may have experienced a side stitch (also called a side cramp, side sticker, or side ache) at one time or another during exercise. The main symptom of a stitch is localized pain on one side of the abdomen. This sudden sharp or stabbing pain is usually felt on the right lower abdominals just below the ribs. It is especially common among runners and swimmers. In older runners, stitches usually occur on the right side twice as often as on the left. The opposite is true of younger runners.
While age appears to play a role in ETAP—with older adults less prone to side stitches than children, adolescents, or younger adults—a person's sex or body mass index does not. Just about anyone of any shape, size, or ability can get a side stitch from many different types of physical activity.
Research shows that people describe ETAP in different ways, depending on the level of pain: sharp or stabbing if severe, or like a muscle cramp or pulling sensation when less intense. While the exact causes may not be well understood, there are a handful of known risk factors associated with ETAP.
Although side stitches have been well-studied, researchers still aren't entirely sure why they happen. While there are many possibilities, most of them are based on anecdotal evidence. Reasons you might get a side stitch may include:
Stitches also are often attributed to muscle cramps, but at least one study has shown no significant difference in electrical activity in the muscles when a subject was experiencing ETAP.
While there is no definitive explanation as to the cause of a side stitch, researchers have proposed two possible theories to explain the phenomenon: dietary-related causes and physiology-related causes.
Whether you're an exerciser or runner, what you eat and drink during and prior to a work out matters. Research has shown that the foods eaten before exercise are the predominant causes of ETAP. Interestingly, the volume of food eaten seems to have less of an effect than either the timing of a meal or the types of food eaten, however.
A study published in 2015 in Sports Medicine found that the consumption of juices or beverages high in carbohydrates (11% concentration or greater) just before or during exercise increased the risk of a side stitch. Additionally, some studies have suggested that drinking fruit juice or high-carbohydrate sports drinks before and during exercise can lead to ETAP. By contrast, people who consumed water or low-carb sports drinks experienced fewer side stitches, according to the research.
Exercise itself is not necessarily a risk factor for side stitches. ETAP is usually caused by repetitive movements in which the torso is repeatedly extended, which occurs during certain types of physical activity. This could explain why side stitches can affect horse riders or off-track racers whose upper bodies are placed in upright positions under rapid, repetitive stress. The structures of the body affected by this stress include:
It is possible that the friction between tissue layers and the stretching of ligaments and muscles could trigger spasms and inflame the sensitive nerve endings of the spine and parietal peritoneum in the abdomen.
As for runners, some anecdotal theories posit that exhaling on the right foot exerts greater pressure on the liver (which is also situated on the right just under the ribs). According to the theory, this may cause the diaphragm to lift at the same time that the liver drops, potentially triggering ETAP—though there is insufficient evidence to support this claim.
There's no shortage of tips for stopping a side stitch. While they might not work for everyone, none of them are harmful—and at least one of them might do the trick for you. The next time a stitch threatens to thwart your exercise, here is a sequence of steps to try before you throw in the towel:
If you develop a side stitch while you're exercising you should stop the activity immediately and take steps to alleviate the discomfort. If you continue to experience pain, call your doctor.
There are known risk factors for getting a stitch while you're running and exercising. Fortunately, by taking a few precautions, you might find that preventing a stitch can be easier than making one go away. While some risk factors cannot be controlled such as age or the weather, there are some helpful dos and don'ts you can keep in mind.
Do'sDrink only water before a workout
Always warm-up
Regulate breathing
Try yoga
Eating within one hour of a workout
Run hunched over
Skip cold-weather gear
Do too much, too fast
Skip the high-carb sugary beverages, including sports drinks, and just drink plain water for pre-hydration. Be sure to eat appropriately, too. Avoid heavy meals just before exercise, especially foods high in protein that can take longer to digest. While you're training, sip rather than chug fluids and avoid drinks with high concentrations of acid, added sugar (carbohydrate), or sodium.
What and When to Eat Before ExercisingGet oxygen flowing through your body before you ramp up your exercise. Regulating your breathing is one of the most effective ways to avoid a stitch. Simply inhale through your nose and exhale through your mouth, breathing deeply from your belly and not your chest to take in more air.
If you're running, change your stride-breathing pattern. Most runners follow a two-to-one breathing pattern, taking one full breath for every two full strides. Consciously changing that pattern every now and then may reduce the stress placed on the abdomen and torso.
Using Deep Belly Breathing When RunningIncorporate yoga into your fitness routine. The practice will help you to learn how to breathe correctly. Breathing techniques in yoga focus on deep belly breathing. Learn to breathe with your diaphragm by extending your belly during inhalations and pulling in your belly during exhalation.
Certain yoga postures can strengthen your abdominal muscles. Incorporate core strengthening into your training, including planks, side planks, and V-sits.
Always warm up first: Start with some dynamic stretches and a 5- to 10-minute walk or jog to get the blood pumping to your muscles before you run. Make sure you avoid hunching over, which will also allow you to breathe more deeply. Focus on maintaining good posture and proper running form.
If it's very cold outside and you're not dressed for it, you will likely find that it's hard to take in deep lungfuls of frigid air. Before going for a cold-weather walk or run, put on a neck warmer, snood, or wrap a scarf around your neck and lightly over your mouth and nose and breathe in and out through that.
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