How to get rid of a side stitch when running (and why it happens)

How to get rid of a side stitch when running: slow down or walk, breathe deeply and slowly, and press firmly on the painful spot. Some runners also bend forward slightly or change their breathing rhythm. None of these are proven, because nobody has fully worked out what a stitch actually is. They're just what most runners try first, and for most runners the stitch fades once they ease off.

The better question is how to get fewer of them, and there the research has a few useful leads, mostly about what you eat and drink before running. Below: what a stitch is, the current best guess at why it happens, how to get rid of side stitch when running in the moment, and what to change so it happens less. If you'd rather the plan handled pacing and progression for you, that's what a running app that adapts to your lifting does.

One rule first: a stitch is a common, harmless-feeling cramp-like pain that eases when you stop. Pain that's severe, doesn't ease when you stop, spreads, or comes with chest pain, shortness of breath, dizziness or nausea is not a stitch problem. Stop and get medical help.

What is a side stitch?

The research name is exercise-related transient abdominal pain, or ETAP. A review by the researchers who have studied it most describes it as a localized pain, most often on the side of the mid abdomen along the bottom edge of the ribs, though it can occur anywhere in the abdomen (Morton and Callister, 2015). When it's severe it tends to be sharp or stabbing; when it's milder, cramping, aching or pulling. Some people also get pain at the tip of the shoulder.

It's common. The same review reports that about 70% of runners say they've had one in the past year, and in a single running event about one in five participants can expect to get one (Morton and Callister, 2015). It's especially common in sports with repetitive torso movement in an upright position, which is why runners and horse riders know it well.

It's also most common in younger people, and it isn't related to sex or body type. Well-trained athletes still get stitches, though they may get them less often.

If you're a beginner on a beginner workout split, stitches are one of the most common reasons an early run turns into a walk. That's fine. Walk it off, then carry on.

Why do you get a side stitch? Nobody fully knows

There's no settled cause. The review lists several theories that have been put forward: reduced blood flow to the diaphragm, stress on the ligaments that attach the abdominal organs to the diaphragm, gut distension, cramping of the abdominal muscles, compression of an artery, aggravation of spinal nerves, and irritation of the parietal peritoneum, the lining of the abdominal cavity (Morton and Callister, 2015).

Of these, the authors concluded irritation of the parietal peritoneum best explains the features of a stitch, but that more research is needed.

A couple of popular explanations look weaker than they sound:

• ›"It's a muscle cramp." In a study of 14 people measured while they had a stitch, there was no increase in muscle electrical activity at the site of the pain, which the authors said suggests it isn't caused by muscle cramping (Morton and Callister, 2008).
• ›"It's your diaphragm." A study measuring lung function during a stitch found no meaningful drop in breathing-in performance, and the authors concluded the diaphragm does not appear to be directly involved (Morton and Callister, 2006).

Practical takeaway: the cause isn't settled, so be skeptical of anyone selling a single guaranteed fix.

How to get rid of a side stitch when running

Here's the honest bit. The review says strategies for relieving a stitch during an episode are equivocal, and management advice is largely anecdotal (Morton and Callister, 2015). So these are what runners commonly try, in rough order of how much they disrupt your run:

1. ›Slow down. Drop to an easy jog or a walk. This is the one that works for most people most of the time.
2. ›Breathe deeply and slowly. Long exhales, full breaths. There's more on how to breathe when running in general, but during a stitch, slower and deeper is the usual move.
3. ›Press on the spot. Push your fingers firmly into the painful area and hold while you keep moving slowly.
4. ›Bend forward or stretch. Some runners lean forward slightly, or raise the arm on the painful side and lean away from it.
5. ›Change your breathing rhythm. If you always exhale on the same foot, switch it up.
6. ›Stop. If none of that works, walk until it fades. It usually does.

If you're racing, slowing down for a minute costs less than limping through ten. If it happens in every race at the same point, that's a pacing or fueling clue, not bad luck.

How to get rid of side stitch when running for good: what may help

You can't guarantee you'll never get one. You can stack the odds.

Watch what you eat and drink before running

This is the best-supported lead. The review notes stitches are made worse by eating beforehand, with hypertonic drinks (concentrated, sugary ones) particularly provocative (Morton and Callister, 2015).

Two specific findings:

• ›At a 14 km community run, a survey of 848 participants found 27% reported a stitch during the event, and runners who ate a large amount of food relative to body weight one to two hours before were more likely to get one (Morton, Richards and Callister, 2005). What the meal contained didn't seem to matter; how much did.
• ›In a treadmill study of 40 people prone to stitches, reconstituted fruit juice brought on more stitches and bloating than flavored water, a sports drink or no fluid (Morton, Aragón-Vargas and Callister, 2004). The authors advised susceptible people to avoid fruit juice and similarly concentrated drinks shortly before and during exercise.

Commonly suggested prevention, per the review: avoid large volumes of food and drink for at least two hours before exercise, especially concentrated drinks (Morton and Callister, 2015). In practice: a smaller pre-run snack, sips rather than gulps, and plain water or a regular sports drink rather than juice.

Posture

The same research group found that people with a more rounded upper back (kyphosis) were more likely to be susceptible to stitches, in a study of 159 active young adults (Morton and Callister, 2010). The review lists improving posture, especially in the upper back, among commonly suggested prevention strategies, along with improving core strength or wearing a supportive broad belt. Suggested, not proven.

Pacing and progression

Stitches seem to show up more when you're doing something harder or newer than usual. That's coaching observation, not research. But it lines up with what most runners notice:

• ›Start slower. The first ten minutes are the warm-up. A proper warmup for running before hard sessions gets you to pace gradually instead of all at once.
• ›Build gradually. Fast, steep work like a running hill session is a common trigger for people who aren't used to it. Ease in.
• ›Run hot days slower. If you're chasing running in the heat benefits, slower is the price of admission anyway, and hot days tempt you to gulp a lot of fluid at once, which the research above suggests is worth avoiding if you get stitches.
• ›Practice drinking on the run. Small, regular sips in training make race day less of a shock to your gut.

Some runners also find that running sprint drills and strides before a hard session make the jump to pace feel smoother. Whether that affects stitches specifically hasn't been studied. It just makes for a better warm-up.

When a side stitch isn't a side stitch

A stitch eases when you slow down or stop, and goes away within minutes. See a doctor if:

• ›The pain is severe, or doesn't ease when you stop
• ›It comes with chest pain, shortness of breath, dizziness, nausea or vomiting
• ›It keeps coming back in the same place, or happens when you're not exercising
• ›You're not sure it's a stitch

When in doubt, get it checked. Coaching advice can't tell you what's going on in your abdomen.

How exrsz handles stitches

exrsz builds a periodized plan from your goal, schedule, level and equipment, with running and lifting balanced in one plan, so progression is gradual and hard sessions aren't stacked. It adapts each week to how you actually trained and reshuffles missed sessions. The pre-run snack size is still your call.

FAQ

How do I get rid of a side stitch while running?

Slow down or walk, breathe deeply and slowly, and press firmly on the painful spot. A review of the research describes relief techniques as equivocal and largely anecdotal, so try them in that order and stop if it doesn't fade (Morton and Callister, 2015).

What causes a side stitch when running?

Nobody fully knows. Among the theories, irritation of the lining of the abdominal cavity best explains the features of a stitch, according to one review, but more research is needed (Morton and Callister, 2015).

Does eating before running cause side stitches?

It seems to make them more likely. In one survey of 848 participants at a 14 km run, runners who ate a large amount of food one to two hours before the event were more likely to report a stitch (Morton, Richards and Callister, 2005).

How common are side stitches in runners?

Very. About 70% of runners report having one in the past year, according to a review of the research (Morton and Callister, 2015).

When should I worry about a side stitch?

If the pain is severe, doesn't ease when you stop, keeps coming back, or comes with chest pain, shortness of breath, dizziness or nausea, stop and see a doctor.