Side stitch

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For other uses, see Stitch.

Side stitch (also called a side ache, a side cramp, a side crampie, a side sticker or simply a stitch) is an intense stabbing pain under the lower edge of the ribcage that occurs while exercising. It is also referred to as exercise related transient abdominal pain (ETAP).[1] Some people think that this abdominal pain may be caused by the internal organs (like the liver and stomach) pulling downwards on the diaphragm,[2] but that theory is inconsistent with its frequent occurrence during swimming,[3] which involves almost no downward force on these organs. If the pain is present only when exercising and is completely absent at rest, in an otherwise healthy person, it is benign and does not require investigation. There are a variety of published ways of alleviating the symptoms including adjusting at what point in a runner's stride they inhale.[4]


There are other theories regarding side stitches than simple stretching of the visceral ligaments due to repeated vertical translation and jolting. Such theories include:

  1. The pain may be caused by an increase in blood flow the liver or spleen. Increased heart rate will force extra red blood cells into the liver which can cause temporary hepatomegaly and portal hypertension.[5] Temporary hepatomegaly and portal hypertension can restrict blood flow through the portal vein of the liver thus slowing blood flow to the rest of the body; this is why most runner's cramps are felt on the right side near the liver.[5][6] A plausible mechanism for the pain is that high internal pressure in the liver or spleen restricts blood flow, causing hypoxia.
  2. Diaphragmatic Ischemia[1][7]
  3. Imbalances of the thoracic spine[8]
  4. Irritation of the parietal peritoneum[1]
  5. Strain on visceral ligaments by a fluid-engorged gut[1][7][9]
  6. Shallow breathing[10]

The reasons for the variety of theories include, in particular, the prevalence of ETAP during swimming.

Most of the time, side stitches occur on the right side of the body.[citation needed] This may be because the largest organ in the abdominal cavity, the liver, is on that side. Certain athletes also report a pain in the tip of their shoulder blade. This is believed to be because this is a referred site of pain for the diaphragm via the phrenic nerve[1][better source needed]. When the side stitch is on the right side, published advice is to try to exhale when the left foot lands.[4]

There is also a belief that an imbalance of electrolytes (such as calcium, potassium, and sodium) in the blood could also contribute to the side stitch.[10]


  • Drink water or fluids beforehand. Dehydration is a common cause of side stitches.[11]
  • Start off slowly and gradually get faster during aerobic activity.
  • Improve fitness
  • Strengthen the diaphragm by using exercises such as those that aid respiratory rehabilitation[12][not in citation given]
  • Strengthen core muscles (abdominals, lower back, obliques)
  • Limit consumption of food and drink, two to three hours before exercising (in particular, drinks of high carbohydrate content and osmolarity (reconstituted fruit juices))
  • Warm up properly.
  • Gradually increase exercise intensity when running
  • Run on soft surfaces.
  • Breathe with full exhalation.
  • Reduce the pace of the exercise if breathing becomes rapid or short (short breaths).
  • Change inhalation to last 3 paces or steps.
  • Change exhalation to last 2 paces or steps.


Pain induced by the stretching of the visceral ligaments is relieved by removing or minimizing the applied force, by slowing or stopping the exercise and lying down until the pain subsides.

  • Stretching may relieve the pain of a stitch.
  • Reduce pace until pain lessens.
  • Massage or press on the area with pain. Bend forward to stretch the diaphragm and ease the pain.[13]
  • Raise both hands above the head and inhale fully, expanding the abdominal and thoracic cavities, then exhale fully, tightening core muscles to do so until pain subsides.

See also[edit]


  1. ^ a b c d e Morton, DP; Callister, R (February 2000). "Characteristics and etiology of exercise-related transient abdominal pain.". Medicine and science in sports and exercise 32 (2): 432–8. doi:10.1097/00005768-200002000-00026. PMID 10694128. 
  2. ^ Collins, Andrew (2009). On Running on Lessons from 40 Years of Running. Bloomington, IN: Authorhouse. p. 148. ISBN 9781438936246. Retrieved 12 October 2015. 
  3. ^ "965 athletes in six different sports (running, swimming, cycling, aerobics, basketball, and horse riding). Over the course of a year of training and competition, 75% of swimmers had trouble with stitches, 69% of runners were afflicted, 62% of horse riders had ETAP, 52% of aerobics participants suffered, 47% of basketball players did so, and 32% of cyclists were affected " Characteristics and Etiology of Exercise-Related Transient Abdominal Pain,' Medicine and Science in Sports and Exercise, Volume 32 (2), pp. 432-438, 2000
  4. ^ a b p 391 The Lore of Running, Tim Noakes, Publisher: Human Kinetics Publishers Date Published: 1991 ISBN 978-0-88011-438-7 ISBN 0-88011-438-X
  5. ^ a b Moore, Keith (1999). Clinically Oriented Anatomy. Lippincott Williams & Wilkins. 
  6. ^ Muir, Brad (2009-12-01). "Exercise related transient abdominal pain: a case report and review of the literature". The Journal of the Canadian Chiropractic Association 53 (4): 251–260. ISSN 0008-3194. PMC 2796944. PMID 20037690. 
  7. ^ a b "Having a stitch explained". BBC. Retrieved 7 August 2013. 
  8. ^ Morton, DP; Callister, R (September 2010). "Influence of posture and body type on the experience of exercise-related transient abdominal pain.". Journal of science and medicine in sport / Sports Medicine Australia 13 (5): 485–8. doi:10.1016/j.jsams.2009.10.487. PMID 20022301. 
  9. ^ Plunkett, BT; Hopkins, WG (August 1999). "Investigation of the side pain "stitch" induced by running after fluid ingestion.". Medicine and science in sports and exercise 31 (8): 1169–75. doi:10.1097/00005768-199908000-00014. PMID 10449020. Retrieved 7 August 2013. 
  10. ^ a b "How to Stop Runners' Cramps". WebMD. Retrieved 7 August 2013. 
  11. ^ Johnson. "Side Stitches : Cause and Cure". Retrieved 9 September 2011. 
  12. ^ "Diaphragm Strengthening". Retrieved May 2007. 
  13. ^ Quinn, Elizabeth. "The Side Stitch". Retrieved 4 November 2012. 

Additional sources[edit]

  1. Sports Medicine 32(6): 2002. 261-269. The human spleen during physiological stress, Stewart & McKenzie
  2. Clin Nucl Med. 2010 Oct;20(10):884-7. The effect of exercise on normal splenic volume measured with SPECT. Otto et al.
  3. J Appl Physiol 74: 1024-1026,1993; Spleen emptying and venous hematocrit in humans during exercise. Laub et al.

External links[edit]