As many of you know, I’ve been running a ton lately because I’m training for the NYC Marathon. Many days, I’m trying to beat the heat or I want to get my run out of the way, so I hit the pavement or the gym in the morning. Since I started running in the morning, something annoying has been happening–I get a side stitch every time I run! It’s driving me insane! Just when I started feeling helpless, I remembered something…I’m a Dietitian with an education in Sports Nutrition and Exercise Physiology. I can hit the books to research the cause and cure of my side stitch. And that’s exactly what I did.
What is a side stitch?
As it turns out, a side stitch has a scientific name: exercise-related transient abdominal pain (ETAP). It’s often described as a cramping, aching, or pulling feeling at first, and then it progresses to a sharp or stabbing severe pain in the lower abdomen. Interestingly, side stitches occur most often among two types of athletes: runners and horse back riders. The reason for this is that activities that involve repetitive torso movement cause side stitches more often than activities that don’t include torso movement (like cycling). Certain demographics also affect your chances of experiencing the dreaded stitch, including:
Age. Side stitches are much more likely to affect the young athlete. One study reported that 77% of active individuals under the age of 20 experienced ETAP, compared with only 40% of individuals over the age of 40. Not only does the prevalence of side stitches decrease with age, but the severity of the stitch decreases as well.
Gender. One study reported that females experience side stitches four times more often than males.
Fitness Level. Well conditioned individuals are less likely to report experiencing ETAP, as compared to people that are physically unfit.
What causes a side stitch?
Unfortunately, the reason for abdominal pain is not entirely clear, but here are some common theories.
Bad Posture. Studies have shown that people with poor posture are more susceptible to side stitches, and the worse the posture, the worse the stitch.
Eating or drinking right before exercise. Consuming food or drink closely before exercise has consistently been reported to evoke ETAP. The good news is that you can teach your body to tolerate fluid consumption with practice.
Irritation of the lining of the abdomen (aka the parietal peritoneum). This is the most widely accepted reason for the side stitch. Some scientists believe that the irritation occurs from friction between the lining of the abdomen and the abdominal wall. This friction happens when the stomach swells during exercise, due to an increase in the quantity or thickness of the lubricating fluids in the stomach.
Have you started to wonder why I keep calling it a “side stitch” rather than a cramp? Well, research has shown that the painful feeling in your side is actually not a muscular cramp. This is news to me!
How to prevent side stitches
Because scientists have not been able to figure out the primary cause of side stitches, it’s difficult to determine a way to prevent the stitch from occurring. However, some strategies seem to work for many people.
Avoid large volumes of food and drink before exercise. To prevent ETAP, large volumes of food and drink should be avoided at least 2 hours before exercise. During exercise, small but regular volumes of fluid may be better tolerated than large gulps of water or sports drink.
Improve posture. One study reported that improving posture reduced symptoms of ETAP in children. Two other studies have reported improvement in symptoms of ETAP through a treatment regimen that aimed to improve spinal alignment and function. A great way to improve posture is to strengthen your back and core muscles. Yoga and pilates are excellent types of exercises to target those muscles.
Unproven strategies. The most common techniques for getting rid of a side stitch are deep breathing, pushing on the affected area, stretching the affected site and bending over forward. Research has not confirmed that these strategies work, and some believe that bending over and stretching the affected site would work against the problem and cause the stitch to continue.
I think my main problem has been, ironically (since I’m a Sports Dietitian), the timing of my meals. Sometimes I wake up at 7am, have coffee and toast and am running by 8:15am. I thought I could handle a small meal of simple carbs before a run, but it seems that my meal timing may be the cause of my stitch! I also always thought the stitch had to do with breathing, but there has been no research to confirm this thought. Lastly, I often skimp on my strength training exercises, but I will have to make sure I’m working my back and core at least twice per week.