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Side Stitches and How to Handle (And Possibly Avoid) Them by John Mora

July 10, 2013

There is nothing quite as upsetting as having to slow to a crawl on the first mile of a 10k simply because your side feels like it’s about to give birth to an alien, ala Sigourney Weaver. At least if it is your legs giving you the problem, you can take solace in the fact that they are simply poor, tired victims of overtraining or (God forbid) undertraining.

Although side stitches are a common difficulty, research in this area is uncommon, and most advice is largely anecdotal.  Still, a little common sense combined with physiology 101 suggests a few theories:

The Shake-n-Break Theory:  The jarring effect of running may cause the liver to pull against the diaphragm.  The diaphragm is a tough muscular sheet above the liver that forces your lungs to contract and expand.  The liver, the largest single organ in the body is situated on the right upper section of the abdomen

When you run and your right foot strikes the ground, your internal organs on the right side are jostled.  As a result, ligaments surrounding the liver may pull on the diaphragm and cause pressure.

The Frying Pan Theory:  If you run in hot weather and you haven’t been hydrating properly, high body temperature can cause side stitch pain.  Although it is commonly believed that stitches can be avoided by not drinking fluids, proper hydration is key.

Dehydration and high body temperature can cause several reactions that can combine to create a side stitch.  The abdomen is a very important area for temperature control.  Dehydration could cause a lack of blood flow to the area and an electrolyte imbalance, thus a stitch

The I-Can’t-Believe-I-Ate-the-Whole-Thing Theory:  If you experience pain on your left side, Anderson suggests it may be your stomach irritating the diaphragm, especially if full before a hard running effort.  Also, the presence of fatty foods that park for long periods of time in your stomach can cause distress.

The Couch Potato Theory:  Some suggest it may simply be a lack of proper training:  Many runners experience less or an elimination of side stitch problems as they go from a poor fitness level to a better one.  This would indicate stitches to be a function of fatigue.

These are the most prevalent theories; Other theories include the shunting of blood away from the diaphragm or liver, a lack of oxygen to internal organs, or an accumulation of gas in the colon.  Some say it may be a physiological reaction to anxiety and nervousness.

The truth: Like many simple bodily function (such as a yawn) nobody knows for sure.

Avoid the Stitch

Though the exact cause of these little pests is not known (and may never be) here are a few simple precautions:

  • Don’t take in excessive amounts of food or fluids prior to hard running, and avoid fatty foods.  Everybody digests at a different rate, but time your meals so that you don’t feel like a water balloon with legs.
  • Stay loose and relaxed.  If you’re nervous on the starting line of that PR-busting 5k, the added tension could hamper your breathing, or cause you to go out too fast.
  • Sit-ups will strengthen your abdominal muscles, which may help stabilize your internal organs.
  • Don’t race or train infinitely beyond your fitness level.  Unrealistic speeds may bring on stitches.

If you get a side stitch, here are a few ways to cope:

  • Slow down or walk it off.  You may be pushing yourself too hard.
  • Breathe deeply.  Concentrate on forceful exhalations.  Try changing your breath pattern.  Most people exhale and inhale as their right foot strikes the ground, so try breathing as your left foot strikes.  Grunting, coughing or other obnoxious noises may help.
  • Massage the area that hurts.  If your internal organs are not getting enough blood, or if your diaphragm is being irritated, this may help relieve the tension.
  • Stop, lie down and put your feet up in the air.  Though this may be the last thing you want to do in a race, sidestitches sometimes mimic the symptoms of a heart attack.  If the pain doesn’t go away, seek medical attention immediately.


John M. Mora is a freelance writer and advertising copywriter living in Plainfield, Illinois.  He is author of Triathlon 101 and  co-author of Paula Newby-Fraser’s Peak Fitness for Women, available at


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