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Side Stitches and Exercise Related Abdominal Pain

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

by Brad Walker | First Published September 19, 2004 | Updated September 28, 2018

A side stitch, also known as exercise related transient abdominal pain (ETAP), is one of the most annoying and painful conditions suffered by participants of sport and exercise. Although not considered a true sports injury, it has been estimated that 70% of regular runners suffered from a side stitch in the last 12 months.

A side stitch causes an intense, stabbing pain under the lower edge of the rib-cage and although it can occur on both sides of the abdomen, research has found that it occurs more frequently on the right side.

The pain is usually brought on 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.

What Causes a Side Stitch?

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. 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 that are attached to your internal organs, which in turn causes the pain.

Treating a Side Stitch

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.

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.

Preventing a Side Stitch

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

  • Improve your cardiovascular fitness;
  • Concentrate on breathing deeply during exercise;
  • Warm up properly before exercising;
  • Gradually increase exercise intensity;
  • Avoid eating before exercising;
  • Drink more fluids;
  • Strengthen your core muscles (lower back, abdominal and oblique muscles); and
  • Stretch more, especially your lower back and abdominal muscles.

Standing Lateral Side Stretch (1:21) Stand with your feet about shoulder width apart and look forward. Keep your body upright and slowly bend to the left or right. Reach down your leg with your hand and do not bend forward. Don’t lean forward or backward, concentrate on keeping your upper body straight. Hold the stretch position for a minimum of 20 seconds and then repeat on the opposite side.

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.


Brad Walker - AKA The Stretch CoachAbout the Author: Brad Walker is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon (author page) has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 1,000's of verified customer reviews. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.

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