Side Stitches: 6 Causes and How to Manage
You know this feeling. Brooke Bjorge, MS, RDN and owner of Grit Sports Nutrition out of Bozeman, MT, shares the 6 main causes of side stitches and what you can do to manage and prevent them.
Side stitches, aka exercise-related transient abdominal pain (ETAP), are a common issue for endurance athletes. I’ve talked to multiple clients lately who have been impacted by this aggravation, both in training and racing situations. Once they arrive on the scene, they can be pesky to get rid of! Let’s learn a little more about the causes as well as prevention:
#1: DIAPHRAGMATIC ISCHEMIA
Cause: During intense exercise, the diaphragm (a muscle used in breathing) might not get enough blood flow, leading to cramping or pain.
Detail: The diaphragm requires a steady blood supply to function properly. During intense exercise, blood is diverted to the working muscles. This can potentially lead to reduced blood flow to the diaphragm, which causes ischemia (lack of blood flow) and cramping.
Prevention/Management:
• Warm up well before intense exercise.
• Gradually increase the intensity of workouts.
• Practice deep, diaphragmatic breathing techniques.
#2: LIGAMENT STRAIN
Cause: The repeated movement of organs (like the stomach and liver) against the diaphragm can strain the ligaments that connect these organs, causing pain.
Detail: The repetitive movement of organs can stretch the ligaments connecting the stomach, liver, and diaphragm, leading to pain.
Prevention/Management:
• Avoid eating large meals or consuming large amounts of liquids immediately before exercising. Snack/meal timing is important here!
• Maintain good posture during exercise to reduce ligament strain.
• Strengthen core muscles to provide better support for organs.
#3: GASTROINTESTINAL DISTRESS
Cause: Eating or drinking too much before exercise (or too close to exercise) can lead to side stitches. High-fat, high-fiber foods and carbonated drinks are major offenders.
Detail: Eating or drinking too much, especially certain types of foods or beverages, can cause side stitches. High-fat, high-fiber foods, and carbonated drinks are known culprits.
Prevention/Management:
• Eat smaller, easily digestible meals at least 2-3 hours before exercising.
• Avoid high-fat and high-fiber foods before workouts.
• Limit or avoid carbonated beverages before exercise.
#4: IMPROPER BREATHING
Cause: Shallow or irregular breathing can contribute to the development of side stitches. Deep, rhythmic breathing helps maintain diaphragm function and reduce the risk of pain.
Detail: Shallow or irregular breathing patterns can put extra strain on the diaphragm, leading to side stitches.
Prevention/Management:
• Practice deep, rhythmic breathing techniques.
• Focus on breathing deeply from your diaphragm rather than shallow chest breathing.
• Sync your breathing with your movements, especially during running or other repetitive activities.
#5: WEAK CORE MUSCLES
Cause: Weak abdominal and core muscles may not support the torso adequately during exercise, leading to improper posture and increased strain on the diaphragm and ligaments.
Detail: Weak abdominal and core muscles can result in poor posture and extra strain on the diaphragm and associated ligaments.
Prevention/Management:
• Incorporate core-strengthening exercises into your routine (e.g., planks, sit-ups, and leg raises).
• Maintain good posture during exercise.
• Engage your core muscles while working out to provide better support for your torso.
#6: DEHYDRATION
Cause: Lack of adequate hydration can lead to muscle cramps, including in the diaphragm.
Detail: Dehydration can lead to muscle cramps, including those in the diaphragm.
Prevention/Management:
• Stay well-hydrated throughout the day, not just before and during exercise.
• Drink small amounts of water frequently rather than large amounts at once.
• Monitor your hydration status by checking the color of your urine (light yellow indicates good hydration).
General Tips for Prevention/Management:
• Warm-Up: Always start with a legit warm-up to prepare your muscles and diaphragm for the exercise.
• Pacing: Avoid sudden increases in exercise intensity. Gradually build up the intensity and duration of your workouts.
• Breathing Exercises: Practice breathing exercises to enhance your respiratory efficiency and diaphragm function.
• Posture: Maintain good posture during exercise to reduce the strain on your diaphragm and ligaments.
• Stretching: Stretch your side muscles and diaphragm before and after exercise to keep them flexible.
In Summary
If you experience a side stitch during exercise, here are a few suggestions to nip it in the bud:
Slow down your pace or temporarily stop to walk.
Breathe deeply and evenly.
Press gently on the area where you feel the stitch while bending forward slightly.
About the Author
Brooke Bjorge, MS, RDN
Brooke is a Registered Dietitian Nutritionist and the owner of Grit Sports Nutrition. She opened her doors in 2012 and has been an integral part of the endurance sport community ever since, particularly in the running, cycling and triathlon arenas. Brooke is passionate about working collaboratively with athletes to develop simple, effective fuel plans for ultimate performance, as well as offering Precision Hydration sweat testing. She has physical offices in Scottsdale, AZ and Bozeman, MT and works with clients remotely throughout the country.
Brooke is an avid endurance athlete herself, with 17 years of racing experience under her belt. This year she raced the Boston Marathon, Coeur D'Alene 70.3 and City to Sky 50K.
