Suffering from a side stitch?

If you’ve ever run a long distance before, you probably would have experienced a side stitch (exercise related transient abdominal pain (ETAP)) at some point.
It is usually experienced just below the ribs, often affecting the right side. It usually results in ceasing to run further.

Here are a few possible causes:

  • Some biomechanists suggest that it is caused by reduced blood supply to the diaphragm(the primary muscle required for breathing). This theory has been largely disregarded as a possible reason for pain
  • Other medical scientists have proposed that pain was due to the downward pulling of visceral ligaments (ligaments that connect your abdominal organs such as the spleen, liver and stomach). However this mechanism couldn’t explain why swimmers could experience stitches
  • A more plausible and recent theory is that of parietal peritoneum irritation. The parietal peritoneum is one of two membranes that lines the abdomen. This membrane has a good nerve supply. The other membrane is called the visceral peritoneum. Between these two layers, is a naturally occurring fluid, which helps to allow the two membranes to slide against each other
  • Friction between the two membranes can occur when the stomach is full or the amount of fluid lying between the two membranes is reduced
  • Eating or drinking just before running causes the stomach to distend, thereby exerting pressure against the membrane. Dehydration may also result in the reduction of fluid between the membranes. Other factors include poor fitness, insufficient warm up and abdominal or core muscle weakness

Top Tips to avoid a stitch:

  • Eat 1.5 to 2 hours before exercising, preferably carbohydrate richer and protein poorer meal.
  • Pre-hydrate slowly well before your run
  • Plan the progression of your running regime- by consulting your Physio, Personal trainer or Running coach
  • Don’t neglect your core stability exercises as part of your routine.

Top Tips if you have a stitch:

  • Lower the intensity of your run by slowing down
  • Breathe deeply
  • Apply a firm and gentle pressure to the painful area for a few seconds until the pain dissipates.
  • Raise your arm above your head and side bend away from the pain.


Characteristics and Etiology of Exercise-Related Transient Abdominal Pain,’ Medicine and Science in Sports and Exercise, Volume 32 (2), pp. 432-438, 2000

The Lore of Running, Tim Noakes, Publisher: Human Kinetics Publishers Date Published: 1991

Johnson. “Side Stitches : Cause and Cure”. Retrieved 9 September 2011.

Quinn, Elizabeth. “The Side Stitch”. Retrieved 4 November 2012

Sports Medicine 32(6): 2002. 261-269 The human spleen during physiological stress, Stewart & McKenzie