Have you ever suddenly felt a sharp pain around your abdomen during a run? If so, you’ve experienced a side stitch.
Side stitches can occur as a result of dehydration or overexerting yourself.
While not dangerous, they are painful and can cut your run short. Here’s what causes side stitches and five tips to prevent them from occurring.
What are side stitches?
Side stitches — also known as exercise-related transient abdominal pain (ETAP) — are acute cramping or pain in the abdominal area that often occurs during physical activity, such as running or swimming. In 2014, 70% of runners experienced side stitches.
There are various reasons side stitches may occur. “It is thought to be related to improper training, dehydration, incorrect breathing, weak core or pelvic floor muscles, or eating too much before activity,” says Sara Mikulsky, MD, a physical therapist and owner of Wellness Physical Therapy, PLLC in New York City. “More often side stitches will occur in a novice runner or athlete, but experienced athletes can also get this cramping.”
What causes side stitches?
While the exact cause of side stitches is unknown, the type of exercise a person does can affect their chances of developing them.
“Athletes that engage in activities that involve having their torso upright, such as horseback riding, swimming, and usually running, may be more affected,” says Samantha DuFlo, MD, a physical therapist and founder of Indigo Physiotherapy in Baltimore, Maryland.
In a 2000 study of people across six sports, athletes participating in swimming (75%), running (69%), and horseback riding (62%) were most likely to report having experienced a side stitch in the past year. Researchers attributed the prevalence of side stitches in these sports to the repetitive torso movement.
Other reasons you may experience side stitches include:
Poor posture and weak core muscles. “If the muscles in the core or pelvic floor area are weak, they cannot stabilize against the increased movement of the body,” says Mikulsky. This can potentially affect the body’s ability to use oxygen and expel carbon dioxide efficiently. It may also cause internal organs to move around a bit more than usual.
Eating a big meal or being dehydrated. Eating a heavy meal within a couple of hours before working out can lead to additional cramps and side stitches, says Jaclyn Fulop, a physical therapist and the founder of Exchange Physical Therapy Group in northern New Jersey.
In a 2005 study, runners who ate a large amount of food within one to two hours before exercising had a higher frequency of side stitches. Not drinking enough water before engaging in physical activity may also lead to muscle cramping, says Mikulsky.
Overexertion. Pushing yourself too hard without warming up or strengthening your muscles can also lead to side stitches.
“Just as in strength training, it takes time for the body to adjust to new demands on its organs and systems,” says Mikulsky. “When we increase aerobic activity such as running, the body will need to learn to allocate oxygen and blood flow to different areas. If increases in activity occur too quickly, the body may not be able to handle the demand.”
5 tips to prevent side stitches
While not dangerous, side stitches can be painful and cumbersome. Before beginning any physical activity, there are various steps you can take to prevent side stitches.
1. Warm-up before working out
Instead of immediately beginning your workout, allow your body to adjust to exercise.
“Warming up with pre-run activation drills and stretching benefits your body by increasing blood flow to the areas your body will want it,” says DuFlo. It will also prepare your muscles and nervous system to engage in exercise.
2. Slowly increase your activity
Instead of going from zero to 100, slowly increase your level of exertion. Mikulsky says to follow the commonly used 10% rule: Don’t increase your activity level by more than 10% a week. This pace can give your body time to adjust and lower your risk of pain.
3. Practice breathing exercises
Deep breathing both before and during exercise can help prevent side stitches. “Learning how to breathe properly through the belly and not relying on accessory breathing muscles [like the spinal and neck muscles] is important,” says Fulop.
A 2009 report found deep breathing to be one of the most effective ways to relieve side cramps. Forty percent of athletes who experience side stitches use deep breathing to treat them.
4. Strengthen your core and pelvic floor
Focus on strength training, especially your core muscles. Building your core improves posture and stability during a workout, decreasing the chance of side stitches, says Mikulsky. On top of that, “keeping a strong core will allow for more efficient expansion of the chest allowing more oxygen to flow into the lungs.”
5. Eat a light meal and stay hydrated
“Avoiding large, heavy meals that are full of fatty or fried food before physical activity can help decrease the chance of side stitches,” says Mikulsky. “Eating a meal such as this is more difficult for the body to digest and requires more blood flow and organ functioning.”
Opting instead for a lighter, healthier meal, like oatmeal and berries, can make it easier for the body to digest and fuel your workout. Also, remember to drink water during and after your workout.