A Real Pain in the Side Stitch – Dealing With a Side Stitch

By Rick Morris

Talk about a pain in the side, a side stitch or side ache, while not technically an injury, can be more disabling than many real injuries. Once, during an important cross-country competition in my high school years, I suffered a side stitch so severe that I had to run nearly doubled over. My coach appeared and reminded me that no one has ever died from a side stitch and told me to straighten up. After shooting him my most poisonous glare, I gamely continued on. Needless to say, his unappreciated advice did little to make me feel better. However, he was right. A side stitch is a painful condition, but is not usually considered medically dangerous.

Side stitches, which are also known as exercise related transient abdominal pain (ETAP),  have been a bit of a mystery. Researchers have not been able to pin down the exact cause of the cramps. At one time the most popular theory was related to blood flow in the trunk of your body. When you run, blood is diverted from the diaphragm to the working muscles of the legs. This results in the diaphragm being starved for oxygen, causing the cramp. Another more recent theory suggests that the cause of ETAP is centered around the ligaments that attach your stomach to your diaphragm. The movements of running causes a bouncing movement of your stomach which pulls on these ligaments. This causes a pain in your diaphragm. This would explain why stitches are more common when you run after eating or drinking a large amount.

A 1999 study published in Medicine & Science in Sports and Medicine[1], investigated both of these theories. The study showed that the most likely cause is the ligament theory. With this in mind, the following tips should help you avoid future side stitches.


  • Do not run until 3 hours after a large meal. You will want your stomach to be mostly emptied before you start to run.
  • Drink small amounts of fluid frequently, rather than a large amount more infrequently.
  • Perform core strengthening exercises. The tighter and stronger abdominal muscles will help support the stomach and diaphragm.
  • If you get a stitch, contract your abdominal muscles to support your stomach. Breath with your belly. You should feel your belly move in and out as you breath, this will also help stabilize your stomach. Place pressure directly on the point of the pain with your fingers or the heel of your palm.
  • Improve your fitness. ETAP tends to disappear or at least lessen in frequency and severity as your increase your endurance and conditioning.

[1]              Medicine & Science in Sports & Exercise, 31(8):1169-1175 August 1999