Side Stitch (Exercise-Related Transient Abdominal Pain)

Discover the causes behind Side Stitches, their treatment and prevention.

by Brad Walker | Updated July 14, 2024

What Causes a Side Stitch?

Pain from a side stitch is usually caused by vigorous exercise and activity. Side stitches occur more frequently in sports that require a lot of up and down movement, like running, jumping and horse riding. They also occur more frequently in novice or amateur athletes.

The pain is caused by a spasm of the diaphragm muscle. The diaphragm is a dome shaped muscle that separates the thoracic (lung) cavity from the abdominal cavity and moves up and down when you inhale and exhale.

Anatomy of a Side Stitch

To understand why the diaphragm muscle spasms, we need to understand what is happening during exercise: Let’s use the sport of running as an example.

It is interesting to note that more than 70% of humans exhale when their left foot strikes the ground, while less than 30% exhale when their right foot hits the ground.

When you inhale, your lungs fill with air and force your diaphragm downward. Conversely, when you exhale, your lungs contract and your diaphragm rises. This pattern of rising and falling occurs quite rapidly when you’re running and as most side stitches occur on the right-hand side, consider what happens to your diaphragm when your right foot strikes the ground.

As your right foot strikes the ground, gravity forces your internal organs downward. Some of these organs are attached to the diaphragm, which in turn pulls the diaphragm downward. Now, if you’re also exhaling at the same time as your right foot hits the ground, your diaphragm is being pulled upward as your lungs contract. This creates a stretching of the diaphragm muscle and the ligaments attached to your internal organs, which in turn causes the pain.

Treatment

Like any other muscle spasm, when a side stitch occurs it is important to stop the activity that brought the stitch on in the first place, or at the very least reduce the intensity of the activity.

Also, try gently stretching the effected side by leaning away from the stitch.

Another effective treatment for a side stitch is to alter your breathing pattern. First concentrate on taking full, deep breathes and avoid shallow breathing. Then, if you are one of those people who exhale when your right foot hits the ground, try instead to exhale when your left foot hits the ground.

Prevention

There are a number of measures that help to prevent side stitch, the main ones being:

Rising Stomach Stretch (0:57) Lie face down and bring your hands close to your shoulders. Keep your hips on the ground, look forward and rise up by straightening your arms. Hold the stretch position for a minimum of 20 seconds.

Rotating Stomach Stretch (1:24) Lie face down and bring your hands close to your shoulders. Keep your hips on the ground, look forward and rise up by straightening your arms. Then slowly bend one arm and rotate that shoulder towards the ground. Hold the stretch position for a minimum of 20 seconds and then repeat on the opposite side.