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how to prevent a side stitch

Ten years ago, Matt Matava, MD, was running the New York City Marathon when, at mile 18, he stopped to remove a piece of gum from the bottom of one of his running shoes. Suddenly, he felt his hamstrings coil into a knot.

Matava, an orthopedic surgeon for the St. Louis Rams, was able to stretch out his cramping muscles and finish the race. But these painful, involuntary contractions have been known to break strides and impede events — and they can temporarily take all the fun out of an otherwise satisfying workout.

Fortunately, there are a variety of ways you can prevent cramping. Douglas Casa, PhD, ATC, recommends starting with a simple warm-up. “By getting more blood flow to the muscles,” he explains, “you’re getting nutrients and oxygen in faster and waste out faster.” Here are some other expert-approved strategies for prevention and treatment.

Prevention Strategies

Stay hydrated.

When you start sweating because of heat or exertion, you lose salt (sodium) and other electrolytes, and the fluid in the space between your muscles, or interstitial space, shrinks. “When that space shrinks, the nerve-to-muscle connection becomes hyper-sensitive,” explains Michael Bergeron, PhD, FACSM, director of the Environmental Physiology Laboratory at the Medical College of Georgia. “You begin to get little twitches that can eventually evolve into full-blown muscle cramps.” This type of cramping can spread throughout your body because the interstitial space is compromised all over. To prevent it, take steps to avoid dehydration.

To be sure you’re consuming the right amount of fluids, measure your personal sweat rate, suggests Monique Ryan, MS, RD, author of Sports Nutrition for Endurance Athletes). Simply weigh yourself immediately before and after a one-hour workout. The amount of weight you lost is known as your sweat rate.

Ryan recommends consuming 20 to 24 ounces of fluid for every pound of weight lost to replace both sweat and urine losses. Take a drink break every 15 minutes, and if your workout lasts longer than an hour, she suggests drinking a sports drink. The salt helps replace electrolytes, and the carbs keep your muscles fueled. (For more, see “How to Hydrate”.)

Also be mindful of the weather’s effect, advises Bergeron. “In the cold, especially when you put on a lot of layers, you don’t realize you’re sweating,” he says. “Plus, if the air is dry, sweat is evaporated very quickly; you may be losing fluid and not recognizing it.”

Avoid acid-forming foods.

Some nutritional experts believe that acid-promoting foods deprive the body of minerals and can lead to muscle cramps. “Foods high in phosphorous, such as red meats, will deplete calcium and magnesium,” says Zoltan Rona, MD, a complementary-medicine physician in Toronto. “So will anything containing caffeine, like coffee, soft drinks and chocolates.” Other top acidity promoters are processed sugars, refined flour and dairy products. (For more on alkalinizing foods, see “Fix-It Foods.”)

For foods that alkalize the body and provide additional cramp-minimizing effects, look to sweet potatoes, bananas and carrots (for potassium); nuts, beans and oat bran (for magnesium); and dark, leafy greens (for calcium).

Train your muscles properly.

Whether you’re in the middle of a 10K ski race or at the end of a tough weightlifting workout, asking too much of your muscles can cause them to cramp. “Fatigue sends signals that tell the muscle to contract more than necessary for the action, while simultaneously decreasing signals that tell the muscle to relax,” says Carol Torgan, PhD, FACSM, a Washington, D.C.–based kinesiologist. “Hence the intense contraction.”

If you feel a cramp in a particular area, such as the calf or quadriceps, it could be from overexertion, says Torgan — or, put another way, it could be from inadequate training. Her advice for preventing fatigue-related cramps is simple: “Practice, practice, practice.” If your muscles are prepared for what you plan to ask of them, they won’t become as fatigued. Follow a training plan that corresponds to your athletic level and goals in the months before a competition, and eat enough carbohydrates during activity to continually fuel the muscles with glycogen.

Monitor your medications.

“Certain medications can dehydrate you or cause problems with neuromuscular firing,” says Bergeron. So read the fine print on potential side effects. Cramp-causing drugs include diuretics and prescription medications for asthma, high cholesterol, high blood pressure, Parkinson’s disease, Alzheimer’s disease and osteoporosis. Ask your doctor about any medications you’re on — prescription or over-the-counter — before undertaking exercise.

Treatment Options

OK, so you weren’t able to prevent the cramp. Now what?

First, slow down or stop. The symptoms of a cramp are similar to those of a muscle tear or pull, and if you do have a serious injury, continuing on could worsen it. If it is a cramp, though, these tips should help.


For heat- or dehydration-related cramps, drinking a salt solution can be effective, especially if you catch the symptoms (twitching skin and shifting cramps) within the first 10 minutes, says Bergeron. He recommends 16 to 20 ounces of fluids with a half-teaspoon of salt when the cramp hits.

Stretch it out.

Stretching and massage both help relax the nerve sensors causing the contractions. “Fire the antagonist [opposing] muscle at the same time that you stretch and massage the cramping muscle,” advises Matava. “By stimulating the antagonist muscle, you activate the golgi tendon [an organ filled with sensory receptors] in the cramping muscle, which then stops the cramp.”

If your calf muscle is cramped, for example, flex your toes upward to stretch and relax your calf as you massage it, says Matava. You can also try pulling back on the ball of your foot with a rolled up towel or standing on a stair and letting your heel drop down.

Stamping Out Cramps for Good

To really get to the root of muscle cramps, consult with a trainer to make sure your fitness regimen works your body evenly, says Gregory Florez, CEO of, a health-coaching-services company based in Salt Lake City, Utah. “You may have some muscular imbalances, which are common,” he explains. This causes one group of muscles to become overactive and thus more prone to cramping.

But plenty of well-balanced athletes get cramps, too. “Even a slight change in activity — something as simple as wearing a new type of running shoe or adjusting the seat height on your bike — can cause your muscles to be used in a different pattern,” says Torgan. And that can spell trouble. Keeping a detailed training journal of such adjustments, she says, can help athletes pinpoint the source of likely problems and steer themselves back onto a cramp-free course as quickly as possible.

How to Alleviate a Side Stitch

how to prevent a side stitch

You know the feeling: that nagging pinch in your side that feels like a spike-wielding gremlin has taken up residence in your ribcage.

Exercise-related transient abdominal pains, commonly known as side stitches, are all about breathing.

The ligaments between your diaphragm and liver can stretch uncomfortably when you take one breath for every two strides — a common pattern for athletes, says Gabe Mirkin, MD, the Maryland-based coauthor of Women and Exercise: Physiology and Sports Medicine.

For long-term relief, Mirkin suggests interval training, which can help condition these ligaments. But in the meantime, when a side stitch hits, try this odd but effective method: Stop, place your hands under the spot where your liver sits (find it just below your ribs on your right side), and push in and up while at the same time blowing out against pursed lips (an action that pushes the diaphragm down).

Mirkin asserts that, done right, this trick works surprisingly often: “Many people will tell me that when they stop and push up against their liver, the pain immediately disappears.”

This article originally appeared as “No More Muscle Cramps”.

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