Tips for Preventing and Relieving Side Stitches

Q: What causes those runner’s cramps, and how can you ease them?

A: Often occurring on the right side of the body, just under the rib cage, sideaches are a sharp, unpleasant phenomenon that — although fleeting — can really cramp a runner’s style. Several explanations have been offered as the potential cause of this discomfort: a mass of food in the wrong place in the intestines at the wrong time, irritation of the stomach lining, a lack of oxygen to the diaphragm, or exercising too soon after eating or drinking. The theory many experts lend credence to, however, is that side stitches are caused by stressing the ligaments that attach the liver, stomach and spleen to the diaphragm. “As we run, our internal organs bounce up and down. If you land on your right foot while the diaphragm is moving up — as it does when you’re exhaling — this places a lot of strain on the diaphragm because it’s being pulled in two different directions,” says Joe Friel, MS, endurance sports coach and author of Your First Triathlon. “This can cause a spasm in the right side, where the liver — a big, heavy organ — is located.”

Suggested Solutions

• Change the rhythm of your breath. “Some athletes have found if they exhale only when their left foot strikes the ground, tension on the diaphragm is reduced and the stitch goes away or doesn’t worsen,” says Friel.
• Change the shape of your breath. Do deep belly breathing, moving your stomach rather than your ribcage. This engages your diaphragm more and can help work out a kink.
• Press into the pain with your left hand, and raise your right arm. This can ease pressure on the ligaments that connect your diaphragm to other organs.
• Lie down with your hips elevated. The pain tends to dissipate quickly in a horizontal resting position.
• Grunt loudly. Never mind the “why” behind this one — anecdotally, it works. (Do you want your stitch to go away or not?)

Prevention Is the Best Cure

• Ramp up your activity level slowly — too fast a pace right out of the gate can create cramping.
• Avoid eating a heavy meal or gulping large amounts of water in the two to four hours leading up to a workout.
• Strengthen your abdominal muscles — a stronger core can prevent cramping.