How to Treat a Side Stitch

Athlete in motion competing in a blur of sport.
There are a lot of runners out there and most of them have experienced a side stitch.

Call it a pain, a cramp, a poke in the gut or, simply, a side stitch -- however you describe it, most runners will know what you're referring to because they've experienced it themselves. While it's unpleasant, a side stitch is not an injury. A side stitch is simply a feeling of discomfort on the left or right side of your abdomen, slightly below the rib cage. Think of it as an internal cramp. The cramp or spasm is actually occurring in your diaphragm -- the muscle that separates your upper torso from your lower torso and assists in breathing.

It's the up and down movement of your diaphragm and internal organs that creates the spasm. Any activity that involves consistent jumping and jostling can lead to side stitches. But because running, by its very nature, produces constant jouncing, it is the sport most often associated with the temporary side pain.


Because of its sudden onset and intensity, a side stitch can be alarming. But there's no need to be concerned if you understand what's happening and how to fix it. It is quite common and treatable [source: The Stretching Institute]. With adjustments in your running stride, breathing pattern, and even choice of terrain, you can make the stitch go away quicker. Additionally, if you make modifications in your pre-run eating patterns and warm-up routine while steadily improving your cardiovascular fitness, you'll get side stitches less frequently. Bottom line? Whether you're a novice jogger or an elite runner, we can help ensure that this unwelcome guest doesn't visit often and never stays for long.

Cause of a Side Stitch

runner man beach
Breathe deeply and it will pass.

Running causes your body to move up and down with each stride. Breathing also involves an up and down motion of your diaphragm. But what happens when your breathing and running stride are not in sync? You guessed it -- you get a side stitch.

When you inhale, your lungs fill with air and your diaphragm is pushed downward. When you exhale, your diaphragm moves up. But if your footstrike occurs during exhalation, the diaphragm gets pulled in two different directions. If this happens repeatedly, the muscle responds by going into a spasm [source:].


Side stitches are particularly common among beginners. This is due in part to the fact that beginners tend to breathe more rapidly, which never allows the diaphragm to fully relax on the downward cycle. With the continuous upward tension and downward tug brought on by the pounding of your feet on the pavement, a side stitch is more likely to occur [source:].

It's more common for side stitches to occur on the left side of the body than the right. That's because the biggest internal organ in your abdomen -- the liver -- is located on the right and is connected to the diaphragm by two ligatures [source: Johnson]. Pockets of air and gas or a belly full of food can also create an imbalance and additional stress on the diaphragm.

While runners come in all shapes, sizes and abilities, they tend to have one thing in common: They breathe out when their left foot hits the ground and breathe in when the right foot lands. This is true -- by some estimates -- in 70 percent of all runners [source: The Stretching Institute]. This is how it should be; however, if your breathing is out of whack during a particular run, you are more likely to create a tugging of the diaphragm and internal organs, which can result in the dreaded side stitch.

So, how do you treat the problem? Breathe deeply and turn to the next page.


Side Stitch Treatments

female runner stitch
Sometimes you may just need to stop, catch your breath and wait for the spasm to go away.

As cardiovascular fitness improves, side stitches become less common. You tend to breathe deeper, which allows the diaphragm to move through a greater range of motion, instead of being held upward in a small tight pattern. But side stitches can still happen to the best of runners so it's wise to have a plan in place for when they occur. Here are some treatments to try:

  • Stop being shallow -- If you notice that you're breathing in and out in short breaths, focus on altering your inhalation and exhalation.
  • Hold it -- While continuing to run, breathe in deeply and hold your breath for a moment before exhaling rapidly.
  • Alter your cadence -- By speeding up or slowing down, you may be able to throw off the uneven rhythm between your footstrikes and breathing, which likely caused the problem.
  • Give it a rest -- If all else fails, a period of walking will give you a chance to catch your breath and enable your diaphragm to finish its twitchy dance.

Make mental notes of when you tend to get side stitches. Is it when you run after a meal? When you launch into an intense workout without a warm-up? When you're running downhill? All of these scenarios increase the chances of suffering from a side stitch. So avoid a big meal before running, give your body a chance to adjust to the pace of your training for the day, and recognize that -- especially with beginning runners -- your diaphragm may not be used to the jostling it gets while running downhill and breathing heavily.


Otherwise, recognize that side stitches come and go. They may be momentarily unpleasant, but you'll be back in full stride in no time.


Lots More Information

Related Articles

  • "Side Stitches: causes, cure, prevention" (Sept. 1, 2010).
  • Higdon, Hal. "Hal Higdon's Smart Running." Rodale. 1998. (Sept. 1, 2010).
  • Johnson, J. "Side Stitches : Cause and Cure" 1996. (Sept. 1, 2010).
  • Walker, Brad. "Side Stitches and Exercise Related Abdominal Pain" The Stretching Institute. ( Sept. 1, 2010).